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Employers focus on health insurance plans providing better care and lower costs

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Employers focus on health insurance plans providing better care and lower costs

WASHINGTON — Employers and health insurers are pursuing fresh benefit plan designs and communication strategies aimed at reducing medical costs and improving overall health conditions among employees and their families.

In 2016, Philadelphia-based Comcast Corp. plans to address the persistent issue of unnecessary and/or misinformed medical care and other types of systemic waste within its $1.25 billion health plan by implementing a “process-based plan design,” said Shawn Leavitt, Comcast's senior vice president of global benefits.

“What we're saying is that it's our money, and we have a right and a responsibility to our employees to ensure that it's spent wisely,” Mr. Leavitt said earlier this month during a presentation at the 19th annual National Business Coalition on Health Conference in Washington.

Consumerism by itself — at least as it is contemplated under many current high-deductible health plan designs — is unlikely to cut medical care costs or improve health outcomes, Mr. Leavitt said. Comcast is preparing a benefit plan design that couples value-based health care purchasing with independent third-party “personal shoppers” contracted to help employees and their families “receive the right care, in the right setting and at the right price from the right provider and at the right time,” he said

“The concept is that rather than in-network or out-of-network, you're either in-process or out-of-process,” Mr. Leavitt said. “You're considered in-process if you're using the concierge services to make appointments for high-tech imaging, which ensures that you're being driven into high-quality, freestanding, lower-cost providers; or out-of-process if you're selecting it yourself and being reimbursed at a lower rate.”

Mr. Leavitt said other examples of in-process utilization would likely include requests for additional medical opinions and cancer treatment plans that have been reviewed by top-rated specialist medical centers.

“We're kind of giving up on the concept that narrowing the network is going to help, or that direct contracting is the big ticket. Potentially, it will involve reference pricing,” Mr. Leavitt said. “We can take one of these big, broad networks that everyone has and, through effective consumerism and the support and concierge services, we'll only use the parts of the network that actually work and are necessary.”

Health insurers have also been investing time and resources to develop new programs and tools designed to improve the quality of both the medical care and health management communications employees and their families receive through their health benefit plans.

Two years after rolling out its Member Centric Decision Management analytics and automated communications software platform in 2012, Chattanooga-based BlueCross BlueShield Tennessee Inc. estimates that the 36 clinical outreach campaigns it has launched using the platform have resulted in more than $1.5 million in averted medical costs by closing gaps in patient care and treatment regimens.

The key to the platform's success is its capacity to work through a complex matrix of patients' previous claims, health risks, demographic and lifestyle information and communicate delivery preferences, said Lesia Stuart, director of predictive and accreditation analytics at BlueCross BlueShield Tennessee, during a panel discussion at the NBCH conference.

“When you marry all of those pieces of information together, you get a 360-degree view of the member,” Ms. Stuart said.

Insurers also are developing programs that can help employers address their single biggest benefits communication challenge, according to survey data published earlier this month by the NBCH and San Francisco-based Benz Communications Inc.: driving higher levels of benefits engagement among employees and their families, particularly when it comes to health management and preventive care services.

One such program is Indianapolis-based WellPoint Inc.'s Habit Heroes, a multimedia collaboration between WellPoint, Marvel Worldwide Inc. and its parent company, The Walt Disney Co., designed to inspire healthier nutrition and exercise habits in children.

“We worked with Disney and Marvel Comics to take a few basic psychological principals to develop within kids an internal sense of control over their behavior and choices,” said Davis Klaila, behavioral sciences director at WellPoint.

The program, which consists of online and mobile-enabled videos, games and challenges, as well as a special edition comic book featuring popular Marvel characters, is free for all health insurance enrollees covered by WellPoint or one of its subsidiaries.

“This is a primary intervention that can be done to help change behaviors, and it's something that every parent can do to help control health care costs,” Mr. Klaila said.