At the World Economic Forum (WEF) in Davos, Switzerland, in January executives from Aetna, Cigna, Humana, Kaiser Permanente and UnitedHealth Group joined roughly 2,500 other corporate and government leaders from around the world to detail the concept of aligned incentives, called "resilient dynamism," which has emerged across industries.
In the fall of 2011, Cigna CEO David Cordani visited a dozen cities in the United Kingdom, Belgium, Turkey, South Korea, Taiwan and China, the Hartford Business Journal reported, as the firm transitioned to what it calls a global health services company.
"Insurance is necessary but no longer sufficient, because insurance is the financing of sickness or the financing of disability," Cordani said in an interview at Davos with Bloomberg Television. "We need to add the services that work to keep people healthy in the first place... Engage individuals, pay physicians based on quality of outcomes, not volume of services, align incentives for both individuals and physicians."
Cigna now has more than 50 accountable care arrangements, including many with Medicare Advantage members. "We want to pay the highest performing physicians more, and the lower performing physicians less, like every other industry would do," Cordani added.
In addition to aligning with providers, insurers and employers have increasingly been trying to bring health interventions into the workplace as part of the patient engagement movement. At Davos, Humana shared the results of a health risk assessment of its 40,000 employees conducted in the late 2000s.
By matching survey data with health and pharmacy claims data, Humana found "that unhealthy weight was not only a widespread issue internally, but also a major contributor to healthcare costs."
Humana's study found a lack of physical activity correlated with one or more chronic conditions, with employees not meeting standard exercise recommendations having average annual medical costs about $1,000 higher than employees who regularly exercised. Humana employees 60 or older who didn't regularly exercise consumed an average of $3,609 more per year.
Humana says it is trying to create a corporate community around nutrition and weight loss and also promote the ideas among members, primarily seniors with Medicare Advantage. Humana partners with Wal-Mart for pharmaceutical benefits in some markets, and it recently launched an online health coach and reward program called HumanaVitality, in partnership with the South African firm Discovery Health.
The results of Humana's employee health risk assessment dovetailed with another focus at Davos: the global problems relating to obesity and diabetes.
With an estimated 350 million people globally suffering from diabetes and 1.4 billion suffering from obesity, WEF economists estimate that over the next 20 years, $47 trillion of global economic output could be lost to chronic non-communicable diseases, with obesity contributing to nearly half of all diabetes costs and heart disease representing about 20 percent.
George Halvorson, CEO of Kaiser Permanente, told Reuters that getting people to change their diet to attack the problem can be difficult, but encouraging even a modicum of physical activity can go a long way. "There's almost nothing we can do for our own personal health that creates more personal benefit than walking," Halvorson said.