Nebraska Makes Wellness Integral Part of Health Insurance Plan
By Jennifer Ginn, CSG Associate Editor
Nebraska, like many states, has had a problem with trying to keep state workers covered by a reasonably priced insurance policy.
“Our costs were increasing in double-digit rates for the past several years,” said Roger Wilson, administrator of Nebraska Central Services, which includes the department of Wellness and Benefits. “At one point, we were as high as (a) 22 percent (increase in insurance rates) in one year. It really impacted our employees. …”
Wilson said he looked at the health insurance plans the state offered, half of which required no deductible. Just offering medical and prescription coverage wasn’t enough, he said. Thus wellnessoptions, one of this year’s Innovations winners for the Midwest, was born.
Wellness initiatives have long been a focus for state Chief Medical Officer Dr. Joann Schaefer, yet the state’s health insurance policies weren’t encouraging wellness, Wilson said.
“What we decided to do was to take a look at our entire benefits program and see how might we be able to structure them in such a way to integrate wellness into the overall health plan,” he said. “A lot of folks put it in a separate program. What we decided to do was create an integrated approach. Instead of looking at the health plan as medical and prescriptions, we now look at medical, prescriptions and wellness.”
Nebraska’s 18,000 state employees were given the option in 2009 of joining a wellness PPO. To qualify, members must complete an online health assessment, a blood screening and one of four wellness programs, which deal with everything from working with a coach to make lifestyle changes to a walking program. In return, the employees get lower premiums, better coverage for preventive care, lower co-pays, and a smoking cessation program and medications at no cost.
“It offers a lot of choices for folks to take advantage of preventive benefits rather than being reactive when something actually happens,” Wilson said. “We took away a lot of barriers for folks going to see a doctor for their yearly physical, colonoscopy and mammograms. … We’re finding an awful lot of folks are taking advantage of this.”
Wilson said about 30 percent of eligible state employees and their spouses have joined wellnessoptions. After one year, the number of members getting their recommended health screenings increased by 19 percent, resulting in the diagnosis of 257 new cases of early stage and 10 cases of late-stage cancer. High cholesterol was diagnosed in 288 people, high blood pressure in 218 people and 191 people were newly diagnosed with diabetes.
Wilson said at first, some employees resisted the idea of the health screenings and providing information about chronic diseases to their employer. He said the state hired an outside company to collect and manage the personal health data, which helped allay some fears. The company is certified and handles all HIPAA requirements.
“We, as a state, do not have access to any of the employees’ protected information,” Wilson said. “(The outside health management company) will aggregate it and give general summaries of what’s going on with the plan, … but we do not have the individual health records to look at of any one person.”
As some states have begun to look at more punitive pricing policies for their health insurance plans, such as charging higher premiums for smokers, Wilson said Nebraska officials believed it was important to use more of a carrot than a stick to help people make healthier lifestyle options.
“We thought from day one we had to get folks involved by them wanting to get involved,” Wilson said, “not by telling them they had to be involved. That’s why we use the carrot approach. … That will be our focus for some time into the future.”