Preventive health is focus of partnership 

Programs aim at preventing disease, exacerbation

Highmark Blue Cross Blue Shield is expanding its successful preventive health programs into the community, partnering with local organizations to offer health improvement programs to the public.

"It’s a natural fit with our mission of helping people live longer and better lives by giving them access to things that we know will promote health and prevent disease and disability. From a global perspective, when a lot of people improve their lifestyle practices, there is a change in the health of the community as well," says Anna Silberman, vice president of preventative health for the Pittsburgh-based health plan.

Starting in September, 16 community organizations and hospitals began offering Highmark’s preventive health programs and services. People do not need to be Highmark members to participate.

"In this era of managed care, everyone tries to hold down health care expenditures and utilization across the board. Our goal with this program is to increase utilization of these programs. We’re very happy to pay for prevention," Silberman says.

After one month, 372 people have enrolled in the program. The most popular programs are Eat Well for Life, a four-week program with instruction on balanced nutrition, and HOPE, an osteoporosis management program. (For a list of all programs, see the chart.)

Highmark aims to close the gap between what is known to be effective and what health care insurers pay for, Silberman reports.

"One thing that has troubled me over the years is the huge gap between what we know to be the truth and what is practiced and paid for. With this intervention, we hope to close that gap," she says.

For instance, if people maintain a body mass index (BMI) within a normal range, they are less likely to incur pain and suffering and unnecessary health care costs than people who are obese.

It’s the same with smoking cessation, physical activity, management of osteoporosis, heart disease, and diabetes.

"This platform gives us the opportunity to integrate health promotion and disease prevention formally into the health care system. It is a wonderful opportunity to walk the talk," says Silberman.

Highmark’s wellness staff of exercise physiologists, registered dietitians, and stress management experts trained the staff at the community organizations. The health plan developed the program content and provides a detailed instruction manual for their partners.

"It’s a turnkey program. We provide extensive training and materials for the instructors," says Silberman.

"As health care expenses increase, it’s important to focus on strategies we know will reduce the prevalence and cost of preventable diseases and disabilities. Many chronic conditions that account for so much of our morbidity and mortality are preventable. We want to spare people the pain and agony of chronic disease with simple solutions that help them live better," she says.

Highmark has been offering parts of the program to members within its network with good outcomes, Silberman says.

The health plan decided to expand the programs to make them more convenient for its own members and to allow people in the community to participate.

"It’s becoming increasingly difficult for many people to find time to adopt healthier lifestyles, and that’s why we’re partnering with community agencies and hospitals to provide access to programs that can be easily incorporated into a busy schedule," Silberman adds.

Highmark looked at population density among its membership and chose locations that easily could be accessed by their members.

"We went to places where people in the community were already congregated and we carefully checked to make sure the professional credentials of the instructors were in line with what we wanted," Silberman says.

The health plan is conducting a baseline risk assessment on its own members who participate and will follows up with an assessment after the program ends. If the member is participating in a nutritional program, the plan also takes lipid profiles before and after the sessions.

Before creating the preventive health programs, Silberman’s department studied the prevalent and preventable conditions in the company’s claims history.

"We looked at high-volume claims and what conditions could be prevented," she says.

For instance, heart disease is the No. 1 killer in the country, and it is preventable. One the other hand, some cancers and some forms of nerve disease cannot be prevented.

"We read every day about the increased rate of diabetes, based on the foods people eat and their sedentary lifestyle. These are issues that can be prevented," Silberman says.

The initiative targets people who are well today and want to stay well, those who have primary conditions and want to prevent symptoms, and those who have secondary or tertiary conditions and want to avoid further exacerbation.

"We’re offering something for all our members — not just people who are incurring claims," she says.

People who want to participate in the program call a toll-free number and register for the site closest to where they live or work.

If someone already has a chronic disease such as heart disease, arthritis, or diabetes, changing his or her personal health habits can prevent progression that leads to morbidity, early mortality, and hospitalization, Silberman says.

"We all know on some level what we should do, but it’s not always easy to initiate the practice of those things. People often encounter social and physical barriers that keep them from adapting new healthier practices. We try to recognize all those barriers and learning styles so we can reach as many people as possible," she says.

The program has been developed using the latest information about how adults like to be educated.

"Adults don’t like to watch PowerPoint presentations about what to eat all day. Instead, we offer hands-on training. We take people to the grocery story and teach them the lifestyle, not just the words," she says.

Highmark’s program addresses prevention of three different levels:

1. Primary prevention includes actions that prevent initial onset of a disease or disability, including wearing seatbelts, eating healthfully, and getting regular exercise. The goal is to have an impact on people before they incur claims.

2. Secondary prevention involves making sure that someone with a chronic disease that has not led to complications has access to information that can lead to a healthier lifestyle and prevent complications. For instance, someone with diabetes that is under control with no complications could get valuable advice from a registered dietician about diet.

3. Tertiary prevention helps people who have already had complications from their disease prevent it from happening again. For instance, someone with coronary artery disease who has had a heart attack would benefit from meeting with a dietitian or taking a course on eating well.