Industry Voices—Health plans, it's time to focus on well-being

After more than a year of living through the isolation of a global pandemic, most people are eager to return to (a new) normal. But, adapting to this new reality poses challenges for employers and health plan members.

The pandemic has changed the ways in which we work and how we access almost everything, including health and wellness services. The expansions of telemedicine, home-based fitness programs, remote mental health services, and virtual programs for chronic condition management were all meant to encourage social distancing and reduce the risk of COVID-19 exposure. Now they are a lasting part of the new normal.

This shift in access, coupled with the rise in remote work, reflects a growing need for programs that offer employers and health plan members the tools and resources to navigate towards a post-pandemic world. Simply focusing on physical health or workplace wellness is no longer enough. These well-being platforms must be holistic, encompassing physical, emotional and financial concerns, and they must be easily adaptable to address the unique needs of each person and organization.

Encouraging—and recommending—preventive care

One of the most pressing needs is encouraging health plan members to resume use of the preventive services that hospitals and health systems postponed in order to prioritize patient and staff safety in response to COVID-19.

According to a Health Care Cost Institute report, overall utilization of vaccinations and preventive screenings was down across the board in 2020 when compared to 2019.  Some procedures, such as prostate cancer screenings and mammograms, rebounded to 2019 levels—but many have not, including colonoscopies, TDAP vaccines, and childhood immunizations. 

Putting off these preventive care appointments can have a negative impact on clinical and financial outcomes. Health plan members may contract a preventable illness or miss the diagnosis of a chronic condition, leading to worsening symptoms and costly acute care. 

With their emphasis on prevention, well-being programs can play an important role in supporting health plan members to address those gaps in care. That’s why True Health New Mexico, a physician-led health plan with 32,000 members nationwide, makes its Better You well-being platform free for all members. Along with innovative condition management programs and activities that address non-clinical social determinants of health, Better You offers reminders to health plan members for upcoming screenings or vaccinations and helps members stay up to date with changing recommendations.

Supporting customized well-being journeys

Another key benefit of a platform is the potential to encourage a comprehensive approach to managing health and achieving well-being goals. That’s difficult to do using a series of standalone apps or services. As an example, let’s look at Meritain Health, a Buffalo, NY-based Third Party Administrator (TPA) with more than 1 million members nationwide. It revamped its Healthy Merits wellness program to address the bottom-line concerns of its clients while respecting the personal wellness goals of health plan members. 

Healthy Merits integrates health risk assessments, wellness program participation rates and claims data. This enables employers to calculate what’s driving rising healthcare costs and what steps could be taken to lower these costs at a personal and organizational level. Health plan members are able to personalize their health and well-being journey with more than 400 activities and challenges that are available in a central location, whether it’s online or in a mobile app. Fitness trackers and devices can also be paired with the platform. Wellness coaches are available to provide encouragement. Since the program was revised, participation rates have soared to more than 60 percent for groups offering qualifying incentives with over half of those achieving over 80 percent. 

The most common benefit associated with the ease of accessibility and variety of resources in these well-being platforms is long-term behavior change. This helps health plan members achieve their personal goals and the priorities selected by their health plan and employer. I know this from experience. At age 50, my doctor told me I had high blood pressure. I needed to either change my diet and start exercising or start taking medication. Like most people, I wasn’t looking to start taking a new prescription, so I chose to alter my diet and add some exercise to my weekly routine. Unfortunately, I really didn’t know much about how to put these changes into practice.

Thankfully, I had access to a program that I could use via my mobile phone and smartwatch that gave me a menu of options that fit my lifestyle and provided me with ongoing motivation. When I failed to increase my physical activity at first, a wellness coach contacted me and recommended a step challenge. When I had trouble altering my diet, I received recipe recommendations and reminders about what I should be trying to avoid. I also received daily text “nudges” to check in and update my progress, and affirmations around tracking even when I “missed the mark” on any given day. As a result, I ended up losing 30 pounds—and have managed to keep it off. This wouldn’t have been possible without a well-being platform that allows users to choose the activities and resources that make the most sense to them.  

Improving access to person-centered care 

Beyond the individual outcomes that members like me can achieve, health plans benefit at a larger level from investing in well-being platforms. Starting in 2021, the Centers for Medicare & Medicaid Services has doubled the weight of member experience measures used to calculate Star Ratings. This reflects an increased emphasis on the role of person-centered care and member experience. A personally interesting, easy to access and comprehensive well-being platform that addresses members’ physical, emotional and financial health can have a major impact in this area. This type of platform also allows for the delivery of the kind of sustained engagement that members appreciate and associate with their health plan.

As the world emerges from the physical and social isolation of the pandemic, we are all acutely aware of the importance of maintaining our health and well-being. The virtual-first options that offered a lifeline during the pandemic are here to stay. Employers and health plans across the country are recognizing the role well-being platforms can play in providing centralized access to these vital resources. Well-being platforms can also break down the barriers that members have all too often faced when trying to get the help they need.      

Dan Zimmerman is regional vice president of Health Channels at WellRight.