Plans offer prizes to push patients to healthy living

Gifts provide incentives to participate in wellness programs.

By Robert Kazel, amednews staff. Oct. 20, 2003.

Some health plans are offering rewards ranging from CD-ROMs and exercise equipment to movie tickets and hotel discounts in exchange for their members' willingness to shape up, slim down or engage in other health-conscious activities.

PacifiCare Health Systems, the Cypress, Calif.-based managed care plan with more than 3 million members, this month is rolling out a points-based rewards program intended to boost enrollment in such activities as smoking cessation or weight-loss programs. The rewards program is free and open to all HMO, PPO and POS members. Physicians are not asked to put their patients in programs, nor do they get paid if their patients join up.

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"For so long we've been successful at developing educational programs and incentives for physicians to practice evidence-based medicine, and now we have what I like to call a reciprocal program for consumers," said Sam Ho, MD, PacifiCare's chief medical officer.

Members who participate in the program, called HealthCredits, can choose among 16 programs to earn varying degrees of points that can be redeemed for prizes or discounts on wellness-related merchandise or services. Additionally, random drawings award other prizes such as treadmills and mountain bikes.

PacifiCare members can earn credits by going on the Internet and completing an on-line health risk assessment; using another Internet site called a "virtual health club" to monitor meals, weight, and exercise; attending a Weight Watchers meeting at least three times a month; or joining a smoking cessation program.

Other activities that are rewarded include participation in PacifiCare's disease management programs for patients with asthma, diabetes or cancer and enrolling in an education program on menopause.

"We wanted to develop a suite of programs relevant to any members," Dr. Ho said. "All of these programs have had proven results."

Members don't need to demonstrate results, such as actual weight loss, Dr. Ho said. But he said later versions of the program might reward achievements.

Employers will be encouraged to take part voluntarily in the new program by offering their own rewards for PacifiCare members who amass points, such as extra days off, a greater cash contribution to offset insurance premiums or lower out-of-pocket costs for coverage, Dr. Ho said.

Another health plan, Oak Brook, Ill.-based Destiny Health, has a rewards program called "Vitality" that also seeks to encourage its members to live healthier lives, said Ken Linde, chief executive officer. Destiny, a subsidiary of Discovery Health of South Africa that has 25,000 members in Illinois, offers airline frequent flyer points and hotel discounts for members who have earned incentive points. All Destiny members are automatically part of the program.

"It basically says to people, 'Have some fun, enjoy your health care, and if you live your life right, we have some tangible rewards for you,' " Linde said. "Our members love it, they really do."

For instance, Destiny members are given 2,000 points for getting a flu shot, 5,000 for being a nonsmoker for at least a year, 5,000 for maintaining weight within certain guidelines, 2,000 for earning CPR certification, 500 for donating blood and 25 for each exercise workout as reported to Destiny on an honor system.

Other rewards enhance Destiny's cost savings and efficiency rather than wellness: Points are offered for filing a high proportion of in-network medical claims, using a high percentage of generic drugs, getting explanation-of-benefits statements electronically, and receiving claims payments via electronic funds transfer.

John La Puma, MD, an internist and weight loss specialist in Santa Barbara, Calif., said tapping patients' desires to get merchandise and participate in contests as a way to make wellness programs attractive makes sense.

"It may seem too much like Publishers Clearing House, but those people do have a terrific track record of attracting participants," he said. "I think it's a strategy whose time has come and will produce benefits for both [the plan and members]. Americans love games, they love the idea of winning prizes and they love competing. Thinking outside the box, even if it reminds one of a game show, is necessary because traditional thinking has failed for so long."