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ABQ Journal

By Winthrop Quigley/Journal Staff Writer

At the same time payers are using incentives to encourage better medical care, employers and insurance companies are trying to use other incentives to get people to reduce demand for services by taking better care of themselves.

It's easier said than done, according to John Iacuone, Lovelace Health Plan chief medical officer.

"Data upon data have shown that to get (health plan) members to engage in health and wellness programs, well, nobody's figured out how to do that. It seems simple, but the hardest problem is to get a society to take accountability for its own health and wellness," he said.

"We probably just haven't figured out the correct triggers, the correct support systems, the correct intervention to make people passionate about changing their lifestyle."

People don't understand their health risks, said Christina Za, the health plan's former director of product and business development. They get improper care in the wrong setting at the wrong time.
Patients with chronic diseases -- conditions such as diabetes, hypertension and coronary artery disease -- either don't know how to manage their condition or don't bother to do it, she said.

That costs meaningful money. According to Lovelace, a poorly managed patient with diabetes requires medical care that costs three times what a well managed patient costs.

Lovelace has teamed with several employers on approaches to get employees to become more responsible for their own health. About 400 Isleta Resort & Casino employees, for example, are rewarded when they do things that the medical evidence shows is good for them.

"This is a carrot approach," Za said. "We're providing incentives for things people know they should do. You should get a flu shot, you should get an annual exam, you should stop smoking. For some people, the carrot will work."

Wellness programs have been around for a long time, but Lovelace tries to tailor a program to the individual's needs and offer carrots that the employee will respond to.

"You can give me a pedometer to encourage me to walk, but what if I don't like walking?" Za said. "What if I have no place to walk? The pedometer doesn't meet my needs."

To design programs for victims of chronic diseases, Lovelace evaluated claims data and other health statistics for two years to determine "what is ailing our community," Za said. "What do people need the most help with? Where are the gaps in care?"

Lovelace experts worked with Isleta "to understand their culture and the environment of the group," she said. They learned what approaches to communication would have the best results.

Lovelace operates a clinic at Isleta, so the company installed biometric testing equipment and provided incentives to Isleta employees to get tested. Employees win rewards when they participate in diet, exercise and clinical care activities.

Lovelace will collect data about participants' health status over time and have them evaluated by a Stanford University team to see if the effort improves health.

"That's another problem," Iacuone said. "There has been a lack of evidence-based interventions that have meaningful data that show what works and what doesn't work. My guess is that parts of this will be wildly successful and there will be parts we'll wish had gone better."

To see this story in print, click here.

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