Health Plan Case Studies

Mid-sized Blue Plan

Decreased Medical Costs: A Case Study

Overview:

  1. Study conducted by Johnson & Johnson Health and Wellness Solutions with a mid-sized Blue plan
  2. Analyzed data from more than 166,000 members over a four-year period (2002-2005)
  3. Found that participants (in a comprehensive health promotion and disease prevention program) consistently incurred lower health care costs.1

Pain Points

Concerned by the declining health of its members and the associated rising costs of treatment, the health plan turned to Johnson & Johnson Health and Wellness Solutions for help.

What We Did:

We worked with the plan to implement a tailored, comprehensive health promotion and disease prevention program for health plan members.

Results We Saw*:

As illustrated in the graph below, over four years results showed consistent savings per participant and positive ROI**.

Results We Saw

* Results are specific to this customer and do not reflect generally expected performance given the unique nature of each wellness program.

** Measurements were obtained through a health risk analysis provided by Staywell from 2002-2003, and by HealthMedia from 2004-2005. Digital Health Coaching programs were available to study participants from 2004-2005

Long Lasting Results*

The Blue plan outcomes also show long-term results in ROI over the course of the eight year study. While Return on Investment spiked the first year, it continued to show positive returns, as high as 2.63, throughout the entire eight years2.

HMSA Results

1Schwartz SM, Ireland C, Strecher V, Nakao D, Wang C, Juarez DT. The Economic Value of a Wellness and Disease Prevention Program. Population Health Management. 13(6):309-3167, 2010

2Schwartz SM, Mason S, Wang C, Pomana L, Hyde-Nolan ME, Carter E. The Sustained Economic Value of a Wellness and Disease Prevention Program. Population Health Management. 17(2):90-99, 2014

* Results are specific to this customer and do not reflect generally expected performance given the unique nature of each wellness program.

Large Blue Plan

The Power of Digital Health Coaching: A Case Study

The large Blue plan study provides a compelling and convincing analysis.

Pain Points

With the goal of improving the overall population health of its health plan members and reducing associated health costs, the health plan implemented the Johnson & Johnson Health and Wellness Solutions suite of Digital Health Coaching offerings*.

What We Did:

We applied the Digital Health Coaching methodology we were using within the plan’s chronic condition support programs to evaluate cost savings. We matched two groups by age, gender, morbidity risk and medical costs (in 2005). The study group participated in the Care For Your Health program in 2006, and the control group had access to the program but did not use it.

Results We Saw**:

The study looked at the effectiveness of using Digital health Coaching solutions as a part of their chronic condition support program for health plan members. The study showed the following results1:

  • $356 average decrease in medical costs per program participant
  • Rising medical costs among non-participants, accounting for a cost difference of over $900 per member between participants and non-participants
  • 20% decrease in hospital admissions for program participants

Decreasing Medical Costs: What Worked

When we looked at where the cost decreases were occurring from 2006-2007, we found the following:

  • $178 decrease in inpatient outpatient
  • $126 decrease in outpatient costs
  • $84 increase in pharmacy costs

The takeaway? Program participants were taking their medications, taking better care of their health and, as a result, staying out of the hospital and ER.

Read Blue Plan Study >>

1Schwartz et al., (2010). The Impact of an Online Disease Management Program on Medical Costs Among Health Plan Members. American Journal of Health Promotion, 25(2), 126-133.

* Intervention included Care for Your Health Digital Health Coaching program in conjunction with other features such as telephonic counseling, reminders, and educational tools.

** Results are specific to this customer and do not reflect generally expected performance given the unique nature of each wellness program.

Regional Health Plan

Participation Success Story: A Case Study

A nonprofit, regional health plan based in the mid-west that provides health coverage to individuals and companies. This plan is also a subsidiary of one of the nation’s leading health care systems. A leader in personalized customer service, disease management and wellness programs, the health plan partners with physicians, employers and community organizations to improve the health and well-being of the community.

Pain Points

The health plan wanted to build awareness of and increase participation in the health and wellness programs available to members, and in turn, help members to lead healthier lives and reduce their out-of-pocket healthcare costs.

What We Did:

To achieve their goals of increased member participation and engagement, we partnered with the plan to help them do the following:

  • Create a wellness program brand to build awareness of the Succeed health risk assessment & Digital Health Coaching (DHC) programs.
  • Motivate the health plan organization to increase member participation by competing for the most Health Risk Assessment (HRA) referrals.
  • Use Succeed HRA data to identify and recruit members into the plan’s disease management program.
  • Train nurses to weave Digital Health Coaching programs into their consultations using Counselor Assist.
  • Integrate the HRA & DHC into their Health Engagement program, which offers a two-tier design that rewards committed members with lower out-of-pocket costs.

In order to encourage new members to enroll in the HRA and DHC programs, new members automatically receive the Enhanced plan for the first 90 days and continue to receive the plan as long as they:

  • Complete the online Succeed program. 
  • Meet with their personal care physician to complete a Member Qualification Form.
  • Achieve specific wellness targets or commit to participating in health improvement programs including Skills for Life Digital Health Coaching programs.

Results We Saw*:

All of these engagement initiatives have led to impressive results for the plan’s member population**:

  • Membership participation increased from 5.7% to 11.9% bewteen 2007 and 2010.**
  • Approximately 70% of those eligible engaged in health and wellness related activities (as required by the program) during 2010.**
  • One organization saw their employees’ average Lifestyle Score increase from 76.15 in 2007 up to 81.72 in 2010. This 5.5 point increase translates into a population striving to live healthier lifestyles.**
  • Between 2007 and 2010 the number of employees in one organization who did not meet the minimum physical activity recommendations dropped from 60.4% down to 37.8%.**

By meaningfully integrating wellness offerings from a program, data and recruitment perspective, this regional health plan was able to dramatically increase their participation and engagement.

* Results are specific to this customer and do not reflect generally expected performance given the unique nature of each wellness program

** Data and results are based on customer and internal data analyses. All analyses utilized participation in health and wellness activities as defined by the customer.

 

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