Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Tailoring a Solution using a Consultative Approach

Wellness and Care Management Solutions

DRC Best Practices Workshop October 20, 2009

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

LISTEN PROPOSE

Consultant interacts with customer to tailor solution

TAILOR

Consultant proposes solution templates

Flexible IT platform uses Business Process Management Workflow technology to deliver solution

DELIVER

Enhanced analytic capabilities enable measurement of activity and outcomes

Consult with customer to review solution and provide recommendations for renewal

MEASUREREPORT

Consultant interacts with customer to understand goals

BCBSM Consultative Tailoring Process

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• Creating a Culture of Wellness

• Wellness Initiative Trends

• Findings

Goals for Today

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The Wellness Council of America (WELCOA) has identified the seven best practices for employers to follow when creating a comprehensive, effective worksite health promotion program.

1. Capture senior-level support2. Create a health promotion team3. Collect data that will drive your health promotion initiatives4. Craft an annual health promotion operating plan5. Choose appropriate health promotion initiatives6. Create a supportive environment7. Consistently evaluate your health promotion outcomes

Creating a culture of wellness“The Seven C’s”

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WELLNESS

CARE MANAGEMENT

CULTURE

Population Identification & Opportunity Assessment

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Population Identification & Opportunity Assessment

WELLNESS

CULTURE

CARE MANAGEMENT

ASSESSMENT INTERVENTION

Health Assessment

Biometric Screening

Claims

Pharmacy

Environmental

Assessments

Wellness Coaching

Employer Campaigns

Chronic Condition Mgmt

Care Management

Elective Surgery Counseling

Employer Campaigns

BCBSM Consulting

Employer Policies

Employer Campaigns

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Wellness Initiative Trends

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Types of Incentives

• Gift Incentives

• Monetary Incentives

• Benefit Design Incentives

• Premium Surcharge Incentive

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0 20 40 60 80 100

Participation %

$0

$25

$50

$75

$100

$250

$500

Incentive Value

Incentives Impact HRA Participation

Results for completion of Health Risk Assessments show a correlation between incentive value and participation

Summary of market findings, Incentive, 2006.

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BCBSM Customer Compliance Examples

96%

87%

94%

88%

75%

90%

50%

80%

42%

63%

90%

50%

58%

83%

30%

13%

60%

85%

56%

0%

20%

40%

60%

80%

100%

Company A -copay/ded

Company B - none

Company C -premium

surcharge

Company D -copay/ded

Company E -copay/ded

Company F - none

Company G -premiumsurcharge

Co

mp

lia

nce

Pe

rce

nta

ge

s

HA Compliance W ellness Coaching Compliance Overall Program Compliance

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Non-compliant members pay a higher premium

share contribution starting 5/1/10

1/1/10 - 3/1/10

2) Onsite Biometric Screening

(2/9/10 & 2/16/10)

Or

Physician Attestation Process

Customer A

Members identified as high-risk are targeted for

Max Net Savings Telephonic Outreach

Telephonic Outreach

35% of Identified on Chronic Condition

23% of Identified on Elective Back Surgery

1/1/10 – 12/31/10

3/1/10 – 3/31/10

2) Online Health Assessment

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Member completes by 3/31/10

2) Physician Annual Exam obtaining biometric results

3) Online Health Assessment using biometrics

4) One Online Digital Coaching Intervention

Customer B

Members identified as high-risk are targeted for

Max Net Savings Telephonic Outreach

Telephonic Outreach

40% of Identified on Chronic Condition

15% of Identified on Elective Back Surgery

1/1/10 – 12/31/10

Non-compliant members

pay a higher premium share

contribution starting 5/1/10

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Step 1 Step 3Step 2 Step 4

Customer C

Members identified and targeted for

Max Net Savings

35% Chronic Condition and

23% Pain Management Telephonic Outreach to

Max Net Savings Target

Non-compliant employee Premium

Share Contribution Increase on

1/1/11

Employee completes Online Health

Assessment by 3/1/10

(Member uses biometric results from fall 2009

onsite screening)

Note: Wellness Only Option for non-blue members eligible for OHP and BS only.

All employees complete (1)

Online Digital Coaching

Intervention

1/1/10 -12/31/10

Employee participates in Onsite Biometric Screening

(9/1 – 9/15/10)

Wellness

Care Management

At risk employees must complete (2)

Telephonic Wellness

Coaching Calls

1/1/10 - 5/31/10

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Customer D

All members begin in enhanced benefit level.

Compliance Period

5/1/10 – 6/30/10

1/1/10

Member submits

Attestation Form to BCBSM.

Member schedules lab appointment & annual exam.

Enhanced Benefit Level

Employee stays in higher benefit level.

Standard Benefit Level

Employee is shifted into

lower benefit level.

Step 1

Member discusses

biometric results & action plan during annual

exam.

Step 25/1/10

Step 3

Member calls Wellness

Coaching Unit to discuss

action plan w/ health coach.

Compliance Period 1/1/10 – 3/31/10

7/1/10

Member completes HA using biometric

results from annual exam.

Enhanced Benefit Level

Employee stays in higher benefit level.

4/1/10

Standard Benefit Level

Employee is shifted into

lower benefit level.

Note: Members non-compliant in 2009 must comply with Steps 1& 2 to move to the enhanced plan 4/1/10.

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Findings

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Low-risk

No intervention

required

Lower benefit level

Employee is shifted into lower

benefit level

Paying higher co-pay and deductible

Higher benefit level

Employee stays in higher benefit

level

At-risk

Wellness or Disease

Management intervention

required

Noncompliant

Employee did not complete

HA

Employee compliant

Employee Noncompliant

Compliant

Employee completes

HA

Step 1 Step 3Step 2 Step 4 Step 5

All employees begin in

Enhanced Benefit Level

BlueHealthConnection

HA and Claims Data

Risk Assessment

Employee completes BCBSM

online HA (within first 60

days)

Solution Process Flow

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• Overall Compliance – 77%– Completion of HA – 81%– Completion of Wellness Coaching – 87%

• Stratification– Low risk – 58%– Wellness Coaching – 42%

Findings

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Wellness Coaching Stage of Change

More WillingReadiness to ChangeLess Willing

Members’ Readiness to Change Progression(Initial and Final Wellness Coaching Calls)

27%44%15%10%4%Final Readiness to Change (final call)

4%29%36%20%11%Initial Readiness to Change (first call)

MaintenanceActionPreparationContemplationPre-

contemplationStage of Change

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Chronic Condition Stage of Change

More WillingReadiness to ChangeLess Willing

Chronic Condition Members’ Readiness to Change

3%74%13%9%0%Final Readiness to Change (final call)

0%1%24%73%2%Initial Readiness to Change (first call)

MaintenanceActionPreparationContemplationPre-

contemplationStage of Change

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.

Michelle DeWyre, M.A.Senior Health Care Analyst, Wellness and Care Management Consulting