A new payer will be launching its value-based benefit plans to small employer groups in Fresno, Calif., during the first quarter of 2010.
While traditional payers are incorporating aspects of value-based benefit design into their products, SeeChange Health is the first to completely align its benefits with prevention and wellness, said Cyndy Nayer, president and executive director of the Center for Health Value Innovation.
“We’re going to see more of these precision-focused benefits,” she said. “The concept is to track people using IT and incentivize or de-incentivize them to drive compliance.”
SeeChange’s benefit design rewards members with richer benefits when they comply with certain criteria, such as completing screenings and health questionnaires and following age, gender and condition-specific guidelines.
Waiving or reducing co-pays, deductibles and/or co-insurance increases compliance, said Janice Rahm, executive vice president of product and marking for SeeChange Health. “We need to bring down financial barriers to access for needed care,” she said.
SeeChange plans to expand to Los Angeles and the San Francisco Bay area later in 2010.
Many traditional payers offer prevention and wellness plans that include incentives, according to America’s Health Insurance Plans (AHIP). Few, however, directly tie co-pay and co-insurance reimbursement to participation and compliance in specific programs.
All payers are innovative in how they design benefit packages, said Robert Zirkelbach, AHIP’s senior manager.
“The goal is to get the right treatment at the right time for members,” he said.
Payers do many things to accomplish this goal, such as designing the right formulary and offering discounts for completing health risk assessments and other incentives, Zirkelbach said.
“Innovation happens at the farthest edges and trickles down to the masses,” Nayer insists. “We need people to be willing to take risks with value-based actuarial models.”
Focusing on small employer groups is a smart move, she said. While more than 50 percent of large employers have some elements of value-based design in their prevention and wellness platforms, only 38 percent of all small businesses were able to provide health insurance to their employees in 2008 – down from 61 percent in 1993, according to the National Small Business Association.
What SeeChange is doing, said Nayer, “is absolutely the right path to take.”