Successful Plan Design

One highly successful example of a plan that engages members in identifying and treating chronic disease is Southern Farm Bureau Life’s current benefit incentive program, managed by Vigilant. The program is based on a premium discount incentive, $35 per month for employees and their spouses, so the total possible incentive is $65 per month per insured. The incentive is earned through completing an annual preventive exam, completion of a health risk assessment (HRA), and applicable biometric benchmarks (BMI, BP, total cholesterol, fasting glucose, smoking status). Patients not meeting a benchmark can still qualify as long as they are in a plan of care to meet these goals. Thus, the entire process is targeted to identify significant metabolic disease and its risk factors and make sure that they are being addressed.

Though the above main features of this incentive program are fairly typical, the administration of them is significantly different. The entire program is administered by Vigilant through the nurse navigator NP and dedicated Vigilant software informed by the claims and clinically integrated registry. No administrative work for HR is involved, which simply receives the list of qualified members annually at the end of the process.

Vigilant manages the program out of the Clinic, but Clinic participation is not required to qualify. However, the process is designed to make voluntary participation in the Clinic and its disease management processes almost inevitable. Specific software tools and the EHR and claims-based registry enable the Vigilant NP navigator to manage the population through each benefit cycle in a highly organized fashion. At any moment in time, the exact status of each member with respect to all components of the benefit are available. Members are free to obtain their qualifying components through their own primary care provider exclusively, through the clinic exclusively, or through any mixture of the two. Because of the acquisitiveness of the Vigilant registry, which identifies for example through claims the execution of an external preventive exam and which also assimilates all biometric values from all available sources (EHR, external records, employer screening events), the member’s application is constantly being accreted as he moves through the healthcare system and the year, greatly minimizing the efforts the member has to put forth. Indeed the member is often pleasantly surprised by automated email communication from the Registry congratulating him on completing step x and y in his discount qualification, and reminding him that he has only z left to do, without there having been any intentional effort on the member’s part.

All components of qualification are reviewed and certified by the Vigilant navigator NP. Significantly, the qualifying biometrics are chosen by the navigator NP from the trended spectrum of all available values for the member, making certain that, contrary to almost all employer-based biometric screening programs, the true state of control of that parameter is identified and utilized (BP and fasting glucose are two notorious examples of almost categorical inaccuracy when based on a single value). This process is very important because the biometrics immediately stratify into the Vigilant disease management software and programs, so that the biometric screening incentive process for blood pressure, for instance, is one and the same with the Plan’s hypertension management program. Vigilant handles the communications and promotions campaigns to inform and engage the population, cooperates with HR on communications initiatives, and is responsible for engagement. Members are free to opt out, and that status and the reason for it is tracked by the system, allowing the Clinic to recognize and utilize any opportunities that arise to move the member toward participation.

The result of these design characteristics has been extremely high and meaningful engagement. Over three years, Vigilant has driven the percentage of eligible members earning the discount to 85%. Earning of the discount is very meaningful because it means that all qualifying members have been screened for metabolic disease by a provider and if disease is present, enrolled in a management plan for that condition, most often Vigilant’s own disease management programs. Based again on comprehensive claims data, this process has resulted in a 29% increase in the number of known members with Chronic Disease in this highly cared for, white collar Plan. Moreover, the process has driven engagement in the Clinic system from 39% to 68% of all known Chronic Disease in the Plan. This engagement has resulted in a progressive reduction in cost per Chronic Disease member of 64% over three years (↓$5,352 per member).

Though the City of Vicksburg does not have an incentive plan, we have implemented this process as a population health risk assessment program with the same purpose, to identify and engage members with Chronic Disease. The result was a 24% increase in the number of known individuals with Chronic Disease, yet a first-year savings of $3,768 per member with Chronic Disease, a pattern similar to SFBLI. This strategy for a Plan incentive seems to work well for engaging members to establish the presence of chronic or pre-chronic illness and meaningfully address it.