Insurers Responding To Market Demand For Products

Interview: Founder Of New Blues Plan Subsidiary

Sees Primary Prevention Moving To Mainstream

For years Michael Samuelson has been quietly arguing that the wellness ‘movement’ is actually a marketable product that employers will demand, and that will impact the treatment model in a way that will be supported. Next week he will get his biggest forum – the first Blues plan to form a wholly-owned subsidiary whose product is prevention and wellness services for corporations and insurers.

Samuelson has been featured on more than 200 television and radio programs, as well as in Newsweek, USA Today, and The Wall Street Journal, and is past president and CEO of the National Center for Health Promotion (NCHP). He has been instrumental in marketing and delivering health and wellness programs to thousands of corporations, medical centers, and individuals.

His ground-breaking research at the University of Michigan at first drew acclaim and then widespread recognition as very likely to succeed in an area where few have done so. When he got the call to come make it happen at a major insurers, it came as a shock but ended up being a calling – and ultimately a new company.

We should say something here as a pretext. As the health financing model migrates into out-of-pocket costs as a cost management strategy, with high deductible plans and defined contributions, there is a hidden market demand rising from employers in general and consumers in particular for below-the-deductible prevention coverage. United, Aetna, Humana and Wellpoint are all moving in this direction with varied success, but if you look at the web-based potential and advanced marketing metrics involved, it’s starting to look like a core product for many plans.

Q:  What’s the idea behind it.

A: The idea behind it is that insurance companies in general and this one in particular is recognizing that two primary reason, one being fidiciary responsibility to membership and to the region they serve, they need to do more than simply process claims. They need to be a health and wellness partner.

And the other part is that insurance companies like any business need to differentiate their services. So one of the ways we can do that is by moving to the left side of the spectrum that tradiitonally focuses on the treatment model, and recognizing the need and opportunity to be involved in the entire health spectrum.

SO this particular Blues is the the first BLue to go out and form their own wholly-owned subsidiary for prevention services. 

Q: How is this actualy offered to an employer in terms of benefit structures and is it part of the whole package.

A: It is and sometimes the insurance company will hold it in as a way of retaining and acquiring key emplyioer groups. SOmetimes it willl be positioned as a separate add-on,so they will use it as a profit silo and sell the programs separately to employer groups. In this case the institute will provide programs to insurers directly to their population. Provide programs to insurers who in turn will provide them to their members. So again, the strategy goes everywhere from parring new lines of business to maintaining existing ones.

Q: Is this sort of an expansion of the definition of prevention services, which before this generally were covered benefits for office visits and didn’t really get into details of specific programs.

A: Yes, this definition involves awareness, education, early detection, early intervention. So the idea is to work directly with the member, or work through the member’s employer group, to provide opportunity for the member to get engaged early in their overall quality of life programming, wellness programming, and disease avoidance programming.

Q: Does this add to thepremium at all?

A: In some cases it would. It would be sold as an add-on for the employer. In some cases it is folded in because the insurer recognizes the value in having a healthy client. It’s provided in a variety of ways.

Q:  This is a separate wholly-owned subsidiary of the Blues of RI.

HOw has this evolved into an actual marketable product rather than just an idea.

A: It’s evolved because the treatment model is broken. There is a recognition that the continuation of goinng from 1.9 trillion to 4.3 trillion by 2012 is no longer tenable. So the idea, the inherent value of keeping people healthy, is resonating not just because it’s the right thing to do, but because of the economic hemmoraging that’s occurring because of the existing treatment model. So it’s almost a passive marketing model because the demand is driving the creation of the product. It’s because the system is broken.

Q: Have you looked at the impact in terms of demographics? Is this something that is primarily for the chronically-ill in terms or return on investment?

A: Oh, absolutely not. If you look at this spectrum as going from optimal wellness all the way to chronically-ill and end-of-life issues, and then you overlay risk factors on top of that, this primary market goes for the moderate-to-low risk. And the idea here is that the economics, according to Eddington and a lot of the work that’s been done on the treatment model, is three-to-one in terms of dollars saved by keeping people low-risk as opposed to waiting until they are high risk and trying to move them back. So the business model here is you keep people aware and keep them healthy, the dollars in terms of productivity to the employer, and the health care cost savings to the plan and the individual, are all vested in keeping people healthy.

Q: I’ve heard people describe what you’re doing as, in a way, the birth of the wellness industry on a large scale because of the fact that it’s starting to be integrated into the payment structure, and employers are demanding the products that really work and are willing to pay for it. Do you kind of look at it that way, this is a sort of beginning.

A: I think of it in terms of the connective tissue. It runs through the whole system. And it’s integral to the whole system. Health and wellness runs the whole continuum. So there are opportunites at every level to improve quality of life right up to the last breath. So it goes preconception to grave. The big opportunity you are seeing is truly in the area of personal responsibility or organizational responsibility are in the prevention model. SO the economics and productivity and quality of life, all of those are driving this particulare “movement”   within inside the health and wellness area.

Q: Do you think it will explode and grow bigger?

A: Absolutely. Part of the issue is health and wellness is such a broad term. But if you begin to boil it down to awareness education, early detection and early prevention, then you can get your arms around it. Then it has meaning and you can operationalize it. So it’s separate from disease management. There’s always qualities of this you can find within DM and case management and end-of-life issues. But in terms of the primary economic return, you want to catch it on this side – left of center that goes from optimal wellness ending in chronic disease/end of life. That’s how you shift the treatment model..