Plan rewards members for healthy behavior

On-line program encourages changes in lifestyles

Blue Shield of California is taking a different approach to cutting health care costs — rewarding members for engaging in activities aimed at improving their health.

Members who are participating in the two-year pilot project log onto the Blue Shield web site and complete activities at least once a week for a minimum of 20 weeks to earn a reward of $75. Members who participate for 28 weeks earn $150. At 35 weeks, the cash reward goes up to $200.

"It’s a comprehensive, on-line program to help motivate, support, and reward individuals to work on their modifiable risk factors," says Deborah Schwab, RN, MS, director of new product development at Blue Shield.

At the end of the first year of its Healthy Lifestyles Rewards program in December, the San Francisco health plan mailed almost $200,000 to more than 1,100 members for adopting healthy behaviors.

Participants in the program can choose from more than 10 lifestyle modification modules designed to help them increase their exercise, develop healthful eating habits, reduce stress, and stop smoking.

Data from a comparison of the health risk assessments participants took before beginning the program and after a year of participation show:

  • The participants in the program lost a total of almost 5,000 pounds.
  • The obese members who chose weight loss as a goal lost an average of 12 pounds.
  • There was a 20% increase in exercising 30 minutes a day, three days a week.
  • There was a 21% increase in participants who eat at least three servings of fruits and vegetables a day.
  • There was a 12% increase in members who rated their ability to deal with stress more confidently.
  • 92% of participants reported that they were successful in reaching their goals.

"Health care costs are escalating at a rapid rate, resulting in increases in premiums. When we conducted an analysis to look into the root causes of more expensive health care, lifestyle is by far the biggest contributor to the disease burden," Schwab says.

A multidisciplinary team at the not-for-profit health plan came up with the four focus areas for health improvement after studying the literature to determine which lifestyle changes would be most beneficial to its members.

"We knew that if we could encourage people to adopt healthier habits, it could make a difference in health care cost and claims," Schwab says.

The health plan looked for cost-effective ways to reach its members all over the state and ultimately decided on an on-line program to save administrative costs and channel the savings into providing awards.

Positive reception

Focus groups responded positively to the idea of a health plan rewarding members for staying healthy.

"They rejected the kind of goods, like t-shirts, visors, and water bottles, that traditionally are used in preventive health programs. They said that a premium discount would be great, but their No. 1 choice was giving members a cash reward at the end of the year," Schwab says.

Blue Shield of California worked with Miavita, an on-line wellness promotion company, to produce a customized web site with interactive modules that focus on the four components of the program: exercise, nutrition, stress management, and smoking cessation.

The web site includes interactive tools such as journals and planners, diet tips, recipes, and articles based on the members’ interest.

Participants took a health risk assessment at the beginning of the program to help them identify what areas they should work on improving.

Following the program, the members take another health risk assessment to determine whether they have made lifestyle changes.

The company is working with researchers at Stanford University to conduct a claims study of participants in the program.

"The literature tells us that the members should show a modest improvement in claims the first year, and increasing improvements in years 2 and 3," she says.

The program relies on self-reported information about participation.

"We took the approach that we were going to trust people. We require people to participate and log in for 20 weeks. It’s hard to lie for over 20 weeks. I’m sure there is a person here or there who didn’t do what they reported. But the majority of people have reaped benefits from the program," she says.

The health plan offered the program to 25,000 subscribers, a randomly chosen cross-section of members from all of its products, for the pilot program. Blue Shield employees also are part of the pilot group.

Participation varied widely among the groups, from 2% of one group to more than 50% of another. The plan found that members were more likely to sign up if their employer had an active health promotion program and a health promotion officer or nurse who offered wellness programs.

"We had lower participation from members in sites where their employer prohibited them from accessing the Internet at work," she says.

"We were expecting that the majority of participants would get $150 and fewer would get the $75 and $200 rewards. When the results were in, we were surprised that the majority went the full way and got $200. Once they committed to the program, they kept going," she says.

The majority of people who joined up had goals of weight loss, healthy eating, and stress reduction.

The typical profile among participants was a woman who is overweight and stressed.

The Health Rewards program is loosely linked to the company’s other health improvement, case management, and disease management programs.

"We wanted a broad-based program that would appeal to people who were well, but the focus areas we included are fundamental issues for people in a disease management program. They have better results if they exercise, eat well, reduce stress, and stop smoking," she says.

Case managers have referred some of their members to the program.

The web site refers members who have a question or need to the company’s Lifepath Advisor nurse line.

More than 90% of the participants have reported on a survey that the program worked for them and they would do it again.

"We’ve gotten a lot of notes from people who say that the money reward jump started them to get motivated, but they also add that the real reward for them is better managing their health," Schwab says.