HMO will tie rates to users' health
- 07/10/06
Beginning Oct. 1, many Blue Care Network HMO customers can pay less for their health insurance by adopting healthy lifestyles and giving up habits such as smoking and overeating.
Employers who commit to providing a health-minded workplace and enroll in Healthy Blue Living can expect to pay an average of 10% less than they otherwise would have. Workers at enrolled companies who agree to maintain or pursue specified healthy behaviors will pay lower co-pays and deductibles than their smoking or couch-potato coworkers.
The idea of tying a person's financial risk to his or her personal behavior has been growing in popularity as employers nationwide struggle to provide medical coverage without going out of business as insurance premiums continue to rise at double-digit rates.
Okemos-based employer Weyco Inc. drew some of the most high-profile attention to the topic in January 2005 when it fired workers who refused to quit smoking. Most employers have rejected that idea, but many large employers have adopted the idea of requiring employees who smoke to pay a larger portion of their health premiums. Those companies were working off the premise that in the long run, the policy could help them avoid health costs.
Blue Care Network believes it's the first to offer a medical plan that rewards companies and workers who commit to healthy behavior with lower insurance costs, said Dr. Douglas Woll, senior vice president and chief medical officer.
"This isn't for everybody," Woll said. "This is going to require a commitment from the employer ... and it will put the onus on the employee to adopt a healthier lifestyle."
Still, he said: "There's been a tremendous amount of interest in this."
Blue Care Network expects to enroll between 5,000 and 10,000 members in the plan in the first year, Woll said.
Employees at participating companies then can choose whether to commit to healthy lifestyles. Their choices will not be shared with the employer.
But those who choose not to participate will pay higher deductibles and co-pays.
Those who commit to maintain or pursue a healthy lifestyle will pay less.
To keep lower payments, workers and their spouses must complete health risk appraisals during the first 90 days of coverage and then meet with their primary-care physicians to determine their current health statuses and what they need to do to improve them.
Participating members will be scored on their alcohol use, blood pressure, blood sugar, cholesterol, smoking status and weight. All categories count for 15 points, except for not smoking, which counts for 25. If a person scores at least 80 points, he qualifies for the lower payment rate. Those with a lower score have to commit to follow a doctor-prescribed individualized care plan, such as joining a free smoking-cessation or weight-loss program, to be eligible for the lower payments.
Members' commitment to their healthy lifestyle pledge will be monitored by their primary care doctors and the HMO.
Members who fail to follow a prescribed individual care plan will be moved to the higher payment level beginning the next month and won't become eligible for the healthy-behavior rates until the next enrollment year.
The costs to each individual member will differ depending on his or her employer and what that employer chose to include in its insurance plans.
Blue Care Network developed Healthy Blue Living in response to demand from small businesses and the Detroit Regional Chamber of Commerce.
The chamber outlined the concept during a health-policy session at its annual Leadership Policy Conference on Mackinac Island last month.
The goal was to develop an innovative program that would reduce insurance premiums by greater than 10% without simply cutting benefits or shifting costs to employees, said Roy Lamphier, the chamber vice president of insurance programs.
Contact KATIE MERX at 313-222-8762 or kmerx@freepress.com.
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