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So Why Does Your Health Plan Offer Incentives?

By Kyle Marshall | August 5, 2015 | Healthy Lifestyle, Insurance Education

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There are two kinds of health care patients: Those who sit back and take doctors’ orders without asking questions, and those who are actively engaged in understanding and managing their own health.

A big goal in health care these days is to develop more of the second. Getting consumers more involved in health care decisions may lead to better health outcomes, and some research suggests it might even save money.

Physicians play a role in patient engagement by spending time getting to know their patients, coaching them and encouraging them — not just diagnosing problems and prescribing drugs. And patients do their part by maintaining an active voice in the care they receive and in living a healthy lifestyle.

But what about others with a stake in helping people get and stay healthy? Do they have a role?

Brian Caveney, MD, vice president and medical director at BCBSNC, says that health plans, employers and hospitals all are involved in promoting patient engagement. Writing in the July/August issue of the North Carolina Medical Journal, Caveney says patients are influenced by incentives that health plans often put in place.

“In the absence of a perfect physician-patient relationship, other external influences can be structured to change the financial incentives and social norms that drive consumer decision making and patient behaviors,” Caveney writes.

What Does It Mean to Be Engaged?

Patient engagement can mean a lot of things to a lot of people. Doctor-patient collaboration, health and wellness programs, and even health IT and social media all fit into common definitions of patient engagement.

Most of it boils down to a simple question: Are patients actively involved in the process?

For consumers who want to take an active role in their health, insurers can offer more support than you think. Caveney outlines these incentives that make a difference for health plan members:

Wellness: BCBSNC uses online challenges and virtual coaching to help customers engage in physical activity, eat healthy and stop tobacco use.

Health management: Care managers who are licensed nurses reach out to members to help them manage conditions such as diabetes and asthma. With some plans, members can benefit from incentives such as dropping copayments for certain maintenance medications.

Incentives through employers: Many employers offer financial incentives for such behaviors as participating in a wellness program, maintaining a healthy body-mass index or remaining tobacco-free.

Incentives through hospitals: Most insurer-hospital contracts now include quality measures — for example, reducing unnecessary readmissions. To help them meet these goals, hospitals are improving their ability to follow up with patients and engage them in healthy behaviors.


The Payoff: Better Outcomes

When patients are engaged in their own health, they tend to see better outcomes with their medical encounters. A study in the journal Health Affairs, for example, found a link between higher patient engagement and better health outcomes on nine of 13 measures. The authors, from George Washington University and the University of Oregon, also found lower costs after a two-year period.

As health care transitions to a value-based system, health plans expect to step up their incentives for patient engagement and healthy behaviors. More than ever, those incentives will be through collaborating with doctors, hospitals and employer groups.

“Health insurance is often the common denominator in the health care system, and it is uniquely positioned to improve the health care ecosystem,” Caveney says in the North Carolina Medical Journal, which focused its July/August issue on patient engagement.