Consumer Wellness From the Payer and Employer Perspectives

On Tuesday, a panel of executives from a large employer and 2 insurance companies discussed their strategies around keeping employees healthy through wellness and disease management initiatives.

On Tuesday, a panel of executives from a large employer and 2 insurance companies discussed their strategies around keeping employees healthy through wellness and disease management initiatives. The panel, called “Consumer Engagement 2.0,” was part of the World Health Care Congress, held April 30-May 3 in Washington, DC.

Marleece Barber, MD, director and chief medical officer of Enterprise Business Services at Lockheed Martin, called herself a “physician who’s passionate about helping people live their best lives” and joined the panel to share how large employers view healthcare. Brian McGarry, market president of Aetna’s Mid-Atlantic region, represented the viewpoint of the insurers helping companies like Lockheed keep their workers healthy, as he said his main job is to talk with large employers about insurance strategies like plan design and network development. Representing the more clinical side of insurance was Mary Picerno, RN, chief nursing officer of consumer health engagement at Cigna.

Moderator Tom Spring, director of wellness and community outreach for the Health Alliance Plan, first asked the panelists about the importance of, and challenges with, leveraging vast amounts of data. Barber said that her use of data was focused on 3 priorities: keeping the workforce available, managing risk, and managing cost, which are all “tied together by the well-being of employees.”

McGarry considered data from a different angle, as he said payers use data to identify individuals and outline member-specific clinical steps to optimize each patient’s care. Data are used to evaluate the quality of care, increase patient and physician engagement, and drive change in the provider community. “The data are there,” said McGarry, but what’s important is “how we move the needle on getting providers to engage and make change.”

Picerno then outlined steps that insurers follow when they use data to mitigate health risk. First, she said, is identifying the target population and whether they need wellness and prevention or disease management initiatives. The payer must synthesize all the information from rich data sources by applying clinical algorithms. Interventions must be designed according to the principles of behavioral economics to provide insights into human behavior and show how to emotionally engage the consumer. Once the target population has been stratified by risk, a timely and effective outreach campaign can begin, and it must be practical for employees. “The goal of risk mitigation is improved health outcomes, but also sustained behavior change over time,” she said.

Barber agreed with Picerno about the importance of behavioral insights. “It really is crucial to understand and know more about the individual and population social environment and psychology” and the “intimate factors affecting them,” she said. Though gathering this information is difficult, it lets employers “think more broadly about who we’re designing interventions for.”

The panelists then discussed the different roles of health plans and employers in employee wellness and disease management, and whether there were common approaches to driving consumer engagement. From McGarry’s perspective, both entities would see an uptick in engagement if they “bring the provider, who today has zero incentive, into the loop,” as patients are more likely to listen to their doctor than their health plan.

Employers also take cues from their workplace and job culture, said Barber, which is why Lockheed has tried to “create opportunities for good decisions” by creating on-site wellness centers to provide preventive care, offering healthy menu choices, and encouraging wellness initiatives. She said that companies want to maximize physical activity, for instance by having meetings while walking, but “in order to do that, you have to create a culture that says you won’t be out of place” in moving around while you work.

Barber emphasized the importance of synergistic partnerships between employers and health plans, and Picerno agreed. “It’s the job of a health plan to be consultative and to really listen and understand what the culture of health and mindset is for the large employer,” she said. For example, some workplaces might want to focus on the high-cost, high-risk employees, some might want total population wellness, and many are somewhere in between.

Finally, the conversation moved to policy and reimbursement in response to a question from an audience member. McGarry described the current landscape as a “completely untenable, completely disparate health system where no one can connect providers.” He suggested alternatives like narrow networks and accountable care organizations that integrate delivery and reimburse for keeping patients well. Plans need to create incentives for employers and their workers to turn to vertically integrated providers, he said, because “the more quickly we move that, the more quickly the weeds are pulled,” leaving only the best quality providers to remain.