More on wellness from November's Disease Management

One of the ways that BlueCross BlueShield of Tennessee is showing its support of preventive services is through its recent purchase of Gordian, which provides lifestyle management, health maintenance, disease management, risk stratification, retrospective claims analysis and health risk assessments. Allen Naidoo, director of strategic business partnerships and human resources, says that the purchase fits into the health plan's philosophy of finding ways to best serve customers.

BlueCross Blue-Shield of Tennessee's wellness programs target the health plan's 4,200 employees. Fitness programs award free health club membership to all employees who use the facilities a minimum of six times a month-one-third of whom are enjoying this benefit-along with sponsoring Walking Works and FitStart/WellFit. Participants in FitStart, a personalized fitness program, showed positive results in 2004: 47% lost weight, 58% saw an improvement in systolic blood pressure and 76% in diastolic blood pressure, and 47% experienced improvements in cholesterol levels.

These exercise offerings are supplemented by membership in Weight Watchers, covered by a payroll deduction over five weeks; vaccinations; lifestyle and health counseling; Blue Perks (for members also); online discounts for many health-related services and alternative medicine therapies; and weekly motivational meetings to help employees adapt to new behavioral changes.

UnitedHealthcare also is paying close attention to health risk assessments, providing monetary rewards, premium discounts and significant changes in benefit design aligned to healthier behaviors for those filling out an health risk assessment. Dr. Gavras says that for every $1 spent on wellness, a company can recoup $5.

Susan Lee, health promotions manager for BCBS of Florida, says in the course of preventive screenings, she sees many employees with high blood pressure and diabetes who are unaware of their conditions. The screenings enable the health plan to contact members' physicians for immediate attention, avoiding visits to the emergency room.

"You have to partner with employers; you can't just lay programs on top of theirs because you have to understand corporate culture and values," Lee says.

The health plan also designed a program targeting school bus drivers in Marion County, contributing $250 to FSAs for drivers reaching weight loss goals. Out of 188 participants last year, 25 accomplished their goals.

For its own employees, BCBS of Florida has created a serenity room in its Miami locations, stocked healthy foods in the cafeteria and vending machines and conducted health fairs.

As obvious as it sounds, health plans want to keep their members healthy, "It's a win-win situation for payers and members," says Laura Bird Long, MD, chief medical officer and vice president of health services for BlueChoice HealthPlan, a subsidiary of Blue Cross and Blue Shield of South Carolina in Columbia. "You have to get ahead of the curve before members get sick. And to do that, it is critical to address lifestyles and get people to comply."

Preventive care

Prevention: what's in a name? There doesn't seem to be a nationally accepted definition, which unfortunately may cause some patients to miss out on important services. According to the Wall Street Journal, different insurers have different views of what constitutes "preventive care"'-complicated by physicians who often do not identify certain services as preventive when billing insurers. The ramifications can be quite harmful for patients in a consumer-driven plan, many of which pay for preventive services before the deductible is met.