Gatekeeping, cost shifting, and disease managing have all been tried with various degrees of success, at various times, to control spending. In the wings: information technology and consumer-directed health care. Plans are starting to experiment with paying people to make lifestyle changes.
Blue Shield of California has launched a project it calls Healthy Lifestyle Rewards for about 25,000 members who can receive up to $200 for participating.
Members sign on to an Internet site and fill out a questionnaire that pinpoints health risks that could result in chronic disease.
The four areas for possible improvement are diet, exercise, stress, and smoking. While members don't have to show improvement, they do have to log on regularly over the course of the 10-month program and record their activities. About 1,000 employees of San Mateo County are eligible for the free program.
"Healthy Lifestyle Rewards is a bold step that will help us be more effective in managing health, preventing chronic disease, and improving employee productivity," says Paul Hackleman, the county's benefits manager.
Meanwhile, PacifiCare has launched its own version of an online lifestyle improvement program in which participants accumulate credits in order to enter quarterly drawings in which they can win such prizes as treadmills or mountain bikes. Credits can also be used for discounts on various health-related items.
Employers, for their part, have the option of offering additional incentives, such as lower health insurance premiums or copayments.
"It's similar to auto insurance," says Brad Bowlus, PacifiCare's president and CEO. "Consumers who maintain an excellent driving record receive lower auto insurance premiums. We are translating that same concept into the health care environment and are actively encouraging our members to maintain better health.
"HealthCredits can serve as a motivational tool for employees who have the opportunity to see their health insurance ... premiums decrease through more active participation in their own health," Bowlus suggests.
In the heartland, Minneapolis/Saint Paul residents who are members of HealthPartners can have part of their health club monthly dues paid by the insurer if they work out at least eight times a month. Also, those who participate in the Weight Watchers online program are eligible for a reduced Weight Watchers fee.
Meanwhile, in Pennsylvania, people enrolled in one of Highmark's Medicare products are also getting incentives to improve their lifestyles.
Those in FreedomBlue, Security 65, or Security Blue can obtain membership in free fitness and exercise classes under a program called SilverSneakers.
"The SilverSneakers program helps members maintain and improve their balance, strength, and flexibility — all of which help with everyday activities," says Judith Black, MD, Highmark's medical director for senior products.
"Our members will have access to classes designed for older adults at a variety of locations, such as fitness centers and senior centers."