By Jim Baer
Dennis Matheis, president
of Anthem/Blue Cross-Blue Shield of Missouri, heads up the largest
healthcare provider service in the state.
Matheis knows all-to-well about up-close and personal about
healthcare options. Just a couple of months ago he underwent
emergency coronary bi-pass surgery. “Fortunately for me, my
wife was a former cardio-care nurse. She recognized potential
heart attack signs right away. I was a little overweight and
not in the best of shape.” Matheis, 47, got through the surgery
just fine; dropped some necessary weight and has rebounded into
robust health.
Others are not so fortunate. What Matheis found out, and so
too did all major healthcare providers was the fact that people
needed to change lifestyle behavior. “That is sometimes the
hardest thing we can ever do,” reveals the president. “We (Anthem/BCBS)
are about helping people avoid diseases and helping them manage
healthy lives.”
“We concentrate on attacking three areas. These are: in providing
good and useful information; providing insurance coverage that
is easy to use and comes with understandable tools, and providing
incentives to drive people to really make lifestyle changes—for
the better. We need to have people having ‘financial skin’ in
the game,” he says.
In August, 2006 Anthem/BCBS launched four Lumenos® Health Care
Programs covering:
• Health Reimbursement Accounts
• Health Savings Accounts
• Health Incentive Accounts
• Health Incentive Accounts plus
This new suite of Lumenos products empowers consumers as never
before with health information, support tools, incentives and
financial accounts to help members improve and maintain their
health and wellness, while better managing healthcare costs.
“We found that Lumenos products helped clients to better spend
their money wisely. We added $100 to $300 to their personal
accounts and health assessments jumped to 50 to 55 percent,”
says Matheis.
Matheis pointed to the key drivers of healthcare status. A 2005
survey found that 66 percent of policy holders were obese; 28
percent had inactive physical activities; 23 percent were smokers,
36 percent experienced high stress and 22 percent were among
the aging population, age 55 and older.
“We are dedicated to helping improve the health of our members.
Prevention and screening tools help our members maintain good
health and gain the best outcomes of care available,” says Matheis.
GHP—A Coventry Healthcare Plan
Roman Kulich, president and CEO of GHP moved from Michigan in
mid-September to run the local GHP Coventry operation.
Today, this giant provider covers some 300,000 lives in a seven-state
region. The GHP operation felt that being proactive and having
a presence in the offices of their clients was so important,
they hired Sarah Smith, a healthcare associate to be the lead
field operations trainer. Smith, graduate of Missouri State
with a degree in Recreation and Leisure Wellness and Marketing,
and a personal trainer and yoga instructor, goes to the clients
daily to present seminars and direct lifestyle programs.
Typically, Smith will be offering free to company member’s nutrition,
weight reduction and stress/sleep management awareness programs.
“Coventry is about well being and preventative care and we are
very proud of the programs we’ve added as benefits to improve
the healthcare status of our clients. We offer 24-hours-a-day
of continuous service,” says Kulich.
Coventry has a wide variety of clients and the list includes
the University of Missouri System, St. Louis Special School
District, and the Zoo/Museum District among its key accounts.
The heart of GHP wellness care is a unique ePHIT program. All
covered members have access to online personal health improvement
training programs and wellness resources. Members are encouraged
to take advantage of a health risk assessments every year. GetPHIT
provides personalized exercise designed to meet personal goals.
EatPHIT provides diet and nutrition planning. LivePHIT provides
resources specific to the interests and concerns of children
and teens. And the program provides online personal coaching
with a staff of 32 coaches specializing in exercise and nutrition.
GHP has linked itself to a host of vendors who provide the model
programs to the clients at their workplace. For instance, they
are contracted with a Smoking Cessation vendor who provides
“Free and Clear,” a program that offers clients eight-week nicotine
replacement therapy.
As Kulich pointed out, in Missouri one in four is a smoker and
their success rate for breaking that habit is 38 percent. “The
national average for going ‘cold turkey’ is just five percent,”
says Kulich.
“Coventry plays a committed role and a proactive role in good
healthcare management,” says Kulich.
Coventry has even taken it a step further. Today, they offer
incentive prizes to members who exhibit best healthcare practices.
These clients can earn points and redeem their points for valuable
items like gift cards, cash cards, digital cameras and access
to a variety of discounted fitness programs.
Frost Electric Co. of Maryland Heights is a satisfied GHP/Coventry
member. Michelle Akeman, human resources member explained. “A
healthy, happy workforce is a more productive one. Coventry
has established a well-being program with on-line rewards that
is popular with our 140 employees. We’ve utilized a number of
their programs, including Lunch and Learn and their benefits
work well for us,” says Akeman.
Saint Louis University is also a GHP member. “GHP launched ePHIT,
an interactive website which allows employees to monitor their
physical activity and nutritional intake, and awards redeemable
points for those using the program. We are impressed with the
online personal trainer, featured recipes, and prizes available.
Our employees are more willing to check out the program as a
result of the extra incentives,” says Kate Goodman, senior administrative
assistant in the office of the vice president for Human Resources.
“We are proud to partner with GHP to offer our employees and
their dependents a free program to help them quit smoking, and
lastly GHP’s Health Education Associate designs presentations
about various wellness topics and holds discussions on campus,”
she says.
“The sky’s the limit when it comes to good healthcare and wellness
programs. Our goal is to send our people out there to create
the awareness and make sure employers have all the proper tools
to manage these wellness programs,” says Kulich.
Nationally, Coventry has more than four million members. “It
is our ability to drill down to the local members and provide
the best care that makes the difference,” says GHP/Coventry’s
president.
Mercer Consulting for Healthcare Management
Mercer Health is the largest healthcare consulting firm in the
world, and a part of the Marsh Mercer Kroll Consulting Network.
Emile Des Roches, managing partner runs the local Mercer operation.
“Typically, we provide health options to companies with employees
of 5,000 or less. That’s where the lions’ share of Mercer’s
business is today,” indicates Des Roches.
The emphasis for Mercer is on employer ‘branded’ programs, rather
than insurance ‘branded’ programs. There is a difference.
Their major client in the area is the Greater Missouri Educational
Trust, which covers the lives of teachers in 25 different school
districts, stretching from Cape Girardeau to Kansas City. “This
is similar to the healthcare program offered by the RCGA (Regional
Chamber and Growth Association) for its members,” says Des Roches.
Cooperating School District (CSD) represents 35 local districts
and some 20,000 members. Steve Keysor, CFO of CSD works closely
with Mercer. “Mercer has grown with the trust since it was started
in 1991. They handle the day-to-day operations, handle claims’
eligibility, and they are very knowledgeable of the market.
They are an invaluable asset to us,” says Keysor. “They provide
us financial updates, they do a lot of things with the program,
and they do them very well,” says Keysor.
Hancock Place School District is one of the 35 members. “They
are very competent, they pay our bills in a timely manner and
we are very happy with them (Mercer), says Paul Northington,
finance director for Hancock.
Mercer has teamed with Matria Healthcare to create a unique
health management solution approach.
The four core components are:
• Turnkey Wellness program,
including biometric screenings
•
Lifestyle Management Solutions
• Chronic Condition Management,
an online and telephonic disease management initiative
• Health Advocacy, a stand-alone
solution that can be offered with turnkey wellness solutions
Des Roches explains how the turnkey works so well. “Fifteen
years ago, General Electric (G.E.) was the poster child for
how this works. We spent $600,000 at that time to develop a
website, put together a nursing contract, and we branded it
all G.E. Healthcare. Today, G.E. has one of the best healthcare
plans in the world,” says Des Roches.
“Today, it is all a matter of new ways of thinking. We have
provided learning opportunities to get clients to use our products.
We have changed their lifestyles, and their employees are living
better lives. John Pizza, national consultant for Mercer in
Dallas says its all about lifestyle choices and changes. “Today,
we spend 75 percent of our efforts to get clients just to use
our health management tools,” says Pizza.
Like Des Roches pointed out. “‘Joe Six-pack’ who works on an
assembly line, has flowing white beard and a belly that hangs
over his belt doesn’t want to make lifestyle changes. We found
that providing health risk assessments and providing the right
tools will change behavior habits. Changes in culture and behavior
are all a concept of a good turnkey wellness program,” he says.
Different at Ascension Health
Ascension Health, headquartered in St. Louis is the nation’s
largest Catholic and non-profit health system. The corporation
covers 20 states and Washington D.C. and has 100,000 employees.
They have a network of gigantic Catholic hospitals, and these
far-flung hospitals have an independent subsidiary relationship
to the Bridgeton-based operation. Ascension Health does not
offer direct programs to the subsidiary members. Subsidiary
members design and maintain their own health management programs.
Bob Henkel, chief operating officer explains. “Our healthcare
assessment programs are for the 485 people who work at this
location (near the airport).
However, they are building a model community that in the future
may well serve the rest of the system. The jury is out on that.
Local Ascension employees are offered screenings at no cost
to determine, among other things body mass, cholesterol count,
blood sugar levels, etc.
“We want our employees following programs of good exercise and
diet. We offer cash bonuses ranging form $25 to $300. We are
creating wellness, stress and behavior management programs.
We offer ‘on line’ coaching and fitness center discounts,” says
the Ascension COO.
Managing behavior is very critical for any successful healthcare
program. Surveys and statements of the aforementioned healthcare
providers indicate that in this arena, St. Louis healthcare
providers are well ahead of the curve. And, as leaders have
found out, there is still plenty of room for more healthcare
improvement.
