WELLNESS PROGRAMS remain at the forefront, but all health plans and programs are evolving to meet the demands and needs of employers and provide them with a broad spectrum of choices.
'It is very gratifying to see that wellness is finally begin recognized as a critical tool for helping stabilize health insurance costs,' says Sally Stephens, president and CEO of Indianapolis-based Spectrum Health Systems and a long-time advocate for wellness and prevention. 'The trend we are seeing consistently now is that employers are moving to the next level in wellness programs.'
For some companies that means a model that rewards employees and spouses. For others it means eliminating barriers to primary-care access.
Health hurdles. Smoking and weight management are two of the biggest health hurdles Indiana employers face. Every state's population increased in terms of incidence of overweight and obesity in the latest survey, and although Indiana improved its rank slightly, that isn't necessarily cause for celebration. 'It's not because we've gotten healthier, it's really because other states got unhealthier,' Stephens says. 'From my perspective as a registered nurse and diabetes educator, if you can impact stress, weight and smoking you are going to be able to affect every single other condition that's out there.
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According to Stephens, many Spectrum clients are emphasizing weight management from a cultural perspective--holding contests, health action campaigns, walking campaigns and other opportunities to engage employees. 'Those who do are more successful in slowly inching their risk downward,' she says.
Vicki Perry, president and CEO, Indianapolis-based ADVANTAGE Health Solutions, sees a demand for wellness programs and chronic disease management programs that can be integrated with the payer Side. 'Rather than fragmented wellness ... we are seeing interest in aggregating both of those so that claims data can be an early driver for those initiates with outreach to those identified populations.'
According to Chris Reef, CEO of Welborn Health Plans, the average rate increase on Welborn's entire book of business was 4.6 percent in 2007. He credits integrative prevention and wellness programs, at least in part, for those results and notes that the company's WellCare Department has nearly doubled in size in the last 18 months. 'I don't think it is a silver bullet,' he says, 'but prevention and wellness is going to go a long way toward helping.'
Another trend Stephens notes is an increased emphasis on coaching, one-on-one contact with individuals at the workplace. 'We take a hands-on approach with high visibility at the worksite,' she says. 'You want the 'signs and symptoms' of a wellness program. It has a bigger impact on the culture of an organization.' Spectrum also offers a 24-hour nurse line to provide support for client's employees after hours.
Welborn places nurses onsite to act as health care advocates at no charge to clients. 'Ultimately it's about educating people, working with them and providing them access,' Reef says. 'Being local gives us a big advantage because we employ a significant number of nurses and physicians directly here at Welborn. So we are onsite. We are at the hospitals. We are doing health fairs. We provide such comprehensive health and wellness with our employers that it is truly a partnership.'
Innovative plans and approaches.
'We are seeing a lot of interest in primary-care clinics, both at the employer's site level as well as the community-base level,' Perry says. 'This is to address access and inconvenience issues for their employees. Employers are also becoming interested in discovering a way to integrate occupational health with primary-care access that can address their absenteeism and that can also be a good site for aggressive wellness programs or disease management programs.'
Anthem Blue Cross and Blue Shield in Indiana launched its landmark program 360[degrees] Health this March. The program enables employers to customize health benefits to meet their specific needs. Components of the comprehensive program include Healthy Lifestyles, 24/7 NurseLine, My Health Coach, Worksite Wellness and others.
United HealthCare offers clients a health and wellness Web site filled with educational materials they can share with employees. Company representatives, including the medical director, meet with clients routinely 'We do a full clinical consultation with each employer group, because we all know every employer is not the same as the next,' says Dan Krajnovich, CEO of United HealthCare Indiana. 'It is very important that we look at the data for that employer and drill down to what is really impacting their population, and then implement a program that's going to be meaningful for them.'
United HealthCare recently introduced EDGE, a premium designation network that rates physicians based on quality and efficiency. EDGE offers lower co-pays to consumers who use two-star physicians. 'Through our own studies in evaluating these two-star positions over an episode of care, we've seen a reduction as much as 20- to 40-percent in the health-care costs over the episode of that treatment with that particular physician,' Krajnovich says.
CATALYST is another new program offered by United HealthCare. CATALYST offers employers the opportunity to purchase a catastrophic or baseline benefits plan for employees. Employees can then add a variety of features to enhance the plan to meet their individual needs.
Chad Decker, director of marketing for Evansville-based Health Resources, Inc., sees more employers shifting the cost of ancillary products (dental, vision and others) to employees on a voluntary basis. A leader in dental plans, Health Resources' comprehensive plan has included cosmetic treatments and preventative measures and day-one coverage with no preexisting condition clauses for a long time. An implant rider gives plan participants an allotment of $1,000 for implants over and beyond the $1,000 for standard care.
Health Resources recently began offering dental plans to businesses having only two participants. 'With the economy the way it is, it's easier to get two employees signed up than three,' Decker says. 'We also offer free orthodontia if 10 people sign up. This works very well for the voluntary market.'
The company is preparing to roll out a new self-funded dental plan that gives self-funded companies a plan design with limitations to control costs, plus a network of more than 1,100 dentists in Indiana that their employees can go to and not get balance-billed (which requires patients to pay the difference between the bill and the insurance payment). Another feature of this offering is that qualifying employers can participate in a quarterly profit-sharing scenario. 'It's a win-win for everyone,' Decker says.
Health Resources' Indianapolis market continues to be one of the fastest-growing dental network plans. The company anticipates adding vision plans to its offerings in 2009.
Health plans. Here are some of the major health plans, networks and third-party administrators serving Indiana. The cities listed indicate either company headquarters or Indiana offices.
ADVANTAGE Health Solutions, Indianapolis, is a provider-owned company offering a comprehensive array of health-care benefits, including HMO, HMO/ POS, self-funded and HSA plans to all employer groups and Medicare AdvantagePD for seniors. The company, which serves the upper two-thirds of the state of Indiana, impacts over 86,000 commercial lives in group sizes ranging from 2 to more than 1,000. It has more than 3,500 health-care providers. 877/901-2237--www. advantageplan.com
Aetna, Fort Wayne, is a POS, PPO and indemnity company for insured and self-insured clients. 260/496-5400--www. aetna.com
Anthem Blue Cross and Blue Shield, a subsidiary of WellPoint Inc., Indianapolis, offers HMO, PPO, POS and consumer-driven plans to its 2.5 million Indiana members. The plan includes 5,000 primary care physicians, 20,000-plus specialists and 120 hospitals. 317/488-6000 or 800/331-1476--www. anthem.com
Cardinal Health Alliance, Muncie, provides HMO and PPO products to East Central Indiana. The plan has 10 pharmacies, 47 ambulatory facilities, 8 urgent-care facilities and 11 hospitals. 765/286-2150-www.cardinalcare.com
CIGNA HealthCare of Indiana, Indianapolis, offers HMO, POS and PPO plans. 8001472-8348--www. CIGNA.com
CorVel Corp., Indianapolis, provides PPO services. 317/816-6996-www.CorVel.com
Deaconess Health Plans, Evansville, is a PPO network servicing more than 180,000 members with 1000-plus physicians, 250 ancillaries and 16 hospitals. 812/450-7265--www. deaconesshealthplans.com
Delta Dental Plan of Indiana offers dental HMO, PPO, POS and managed fee-for-services plans to its nearly 500,000 Indiana members. More than 1,470 Indiana dentists participate in the fee-for-service network; 780-plus participate in the PPO network. 800/292-0626--www.deltadentalin.com
Encore Health Network, Indianapolis, covers 629,191 Indiana members with access to 33,361 physicians and 176 hospitals. Employers with employees outside of Indiana can easily be covered through Encore's network partnerships. Its national, regional and travel networks offer a single point of contact for multi-state coverage needs. Encore is locally owned and managed by The HealthCare Group LLC and provides healthcare through more than 100 health insurance companies and third-party administrators. 317/705-3280 or 888/574-8180--www. encoreconnect.com
Health Resources, headquartered in Evansville with sales offices in Elkhart, Indianapolis and Bowling Green, Kentucky, is a dental PPO serving more than 87,000 subscribers and 175,000 members with dental care through prepaid group coverage. More than 1,500 dentists, 1,100 in Indiana alone, serve Indiana and Western Kentucky. 800/727-1444 or 812/424-1444--www. hri-dho.com
LutheranPreferred Network, Fort Wayne, is a wholly owned subsidiary of Lutheran Health Network and is managed by MedPartners. It is a PPO network of healthcare providers serving more than 16,900 locations, including 85 hospitals spanning Indiana, northwest Ohio, southern Michigan and the Chicago area.
Three Rivers Preferred is a joint venture between Three Rivers Medical Associates, an Independent Physician Association of approximately 900 physicians, and Lutheran Health Network. LutheranPreferred and Three RiversPreferred have a combined membership of more than 90,000. 260/435-7768 or 800/258-0974--www.lutheranpreferred.com, www.threeriversmd.com
Parkview Signature Care PPO network serves Indiana and northwest Ohio through more than 9000 physicians, providers and hospitals. Signature Care is affiliated with Parkview Health, a not-for-profit health system based in Fort Wayne, Indiana. 260/373-9100 or 800/666/4449--www.signaturecareppo.com
Physicians Health Plan of Northern Indiana, Fort Wayne, is a physician-sponsored, not-for-profit health maintenance organization that provides members open access to over 3,800 network providers and 40,000 pharmacies nationwide. It offers fully insured HMO, POS and high-deductible health plans compatible with health savings accounts for businesses and for individuals looking for individual and family health insurance. Other services include wellness options, dental and vision products, life and disability, and third-party administration. PHP serves members in Northern Indiana, Southwest Michigan and Northwest Ohio. 800/982-6257--www.phpni.com
Sagamore[R] Health Network, Carmel, has been Indiana's largest rental Preferred Provider Organization (PPO) network for over 20 years. It offers over 200 hospitals and over 40,000 physician locations. Sagamore offers URAC-accredited Medical Management Services, an Ambassador Care gatekeeper PPO product and a reduced-access PPO network called Select. 317/573-2900--www. sagamorehn.com
SelectHealth Network, South Bend, is a PPO developed by St. Mary's Health System of America, Inc. Two-hundred primary-care physicians, more than 400 specialists and three hospitals serve its members. 574/283-5959--www. selecthealthnetwork.com
SIHO Insurance Services, Columbus, provides HMO, PPO and consumer-driven self-funded health plan coverage. SIHO's 9,000 participating physicians and 65 hospitals serve more than 80,000 participants. 812/378-7000--www.siho.org
Spectrum Health Systems, an independent health management company based in Indianapolis, partners with organizations to help them better control their health care costs. It offers comprehensive health improvement and wellness programs (assessments, education, monitoring and outcomes measurement) that have greater than 3:1 return on investment, and manages 45,000 individuals in Indiana. 888/573-1569-www.spectrumhs.com
Unified Group Services, Anderson, is a full-service third-party administrator for self-insured group health plans. It provides administrative services to more than 100 Indiana employer groups and more than 50,000 covered lives. 765/608-6680 or 800/291-5837--www. unifiedgrp.com
UnitedHeahh Group in Indianapolis provides a full spectrum of consumer-oriented health benefit plans and services through its business segments: UnitedHealthcare, Uniprise, Ovations, Arnett and Golden Rule. The company organizes access to quality, affordable health care services on behalf of more than 397,000 Indiana residents in commercial plans and 122,000 in Medicare plans in partnership with 128 hospitals and 9,835 physician/providers. 8001385-5445--www. unitedhealthgroup.com
Welborn Health Plans (WHP), Evansville, is a nationally and Indiana-ranked health care organization that provides access to high-quality health care coverage for nearly 35,000 members in the southwest Indiana and western Kentucky region. WHP offers an excellent array of HMO, POS/PPO-type plans, TPA services for self-funded clients, Medicare Advantage (MA) plans and Medicare Advantage with prescription drug coverage (MA-PD) options for Seniors. Members have access to a very comprehensive network--representing 950+ regional providers -and-over 525,000 providers nationally. 812/426-6600 or 800/521-0265, www. welbornhealthplans.com
