Direct-to-consumer Wellness Programs

I attended a managed-care business forum in Washington a couple of weeks ago to find out what initiatives payers have been working on recently. There were insurance companies from across the country presenting on topics ranging from clinical programs to new Web-based technologies.

While the focus on wellness and prevention programs was no surprise, by day two I couldn’t help but wonder where are the physicians? The payers were giving presentations on how they were engaging their members (i.e. your patients) to take better care of their health, how they were working with employers to incentivize employees to participate in payer-created programs, and the effectiveness of insurer-designed disease management programs. Ominously, not once did I hear any of them discuss how they were engaging with the physician community to deliver those services.

The reasons for this are varied, but arise primarily from employer pressure on payers to deliver inexpensive results. While it may seem to make sense to simply engage (and incentivize) network physicians to better develop these services, “it is more cost effective to build our own programs through third-parties” than with physicians, stated one healthcare executive at the event.

What are these member-centered programs about anyway? In many instances, payers are simply building tools on their member Web sites that provide online forums and general advice much the same way as, say, WebMD.com. A good example of this would be the Blue365® Program. In fact, Horizon BCBS’ consumer program “My Health Manager” is actually powered by WebMD.

In other instances, payers are getting much more involved, such as AmeriHealth’s ConnectionsSM Health Management Programs, which provides a “health coach” for those of its members suffering from select conditions. While this isn’t necessarily bad news for physicians (you weren’t getting paid for additional patient management), many of you would prefer to take care of your own patients and manage their care directly.

So what can you do to prevent any potential disconnects between you and your patients who utilize “payer healthcare”?

• First, find out what programs are available for the plans in which you participate. You can find them by simply going to the “member” section of most insurers’ Web sites. Knowing what is available can potentially help you maximize your time by extending those resources to your patients. For example, Horizon BCBS offers Health and Wellness Education Programs. To participate, you just enroll your patient in the program (by submitting an online referral), and Horizon keeps you informed of the patient’s progress.

• Second, ask your patients what, if any, programs they might be participating in through their plan or employer. This allows you an opportunity to engage your patient on a treatment plan, and to redirect the source of their care back to you.

• Third, encourage patients to take advantage of payer-sponsored discounts such as reduced cost gym memberships. Your relationship with a payer may be strained but patients who perceive their physicians to be working in conjunction with their benefit plan will be far more compliant.

• Finally, engage insurance plans to find out how you can participate in shaping these programs for the future. Many payers now have physician advisory boards that they consult before rolling out new initiatives, such as Aetna’s Physician Advisory Board.

Given the right facilitation, payers’ consumer wellness programs may even help you deliver better care to your patients - just make sure you remain in the equation!

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.