Start-up Health Plan Seeks Chronically Ill and Offers them Richer Benefits.

I wrote recently about an innovative suite of health plans being offered by UnitedHealthcare that feature unique services to enhance the health and well-being of Spanish-speaking individuals. PlanBien incorporates linguistically and culturally relevant health information and customer service programs into its plan designs at no extra charge, ensuring the coverage is tailored to meet the unique health care needs of Latinos.

At the time I wrote that post I noted that I thought that tailoring a health plan to a specific demographic was an interesting concept, and I wondered how this might be applied to other groups. An article written by Steve Davis, managing editor of Health Plan Week, may have provided an answer to this question.

In the October 9, edition of Health Plan Week, Mr. Davis writes about a startup health insurer that is aiming to incentivize behavior change for both healthy and chronically ill members.

According to Mr. Davis, SeeChange Health plans to begin marketing its products to small employers in Fresno, Calif., this fall. SeeChange Health uses a unique value-based benefit model that actually seeks out both the chronically ill and the “overlooked healthy (i.e., those at risk for developing a chronic condition) and offers them richer benefits in exchange for compliance in managing the condition.

Here’s how it works

Here is how it works. SeeChange’s six plan design options are built on a PPO platform and begin with relatively high deductibles. One plan, for example, has a $2,000 annual deductible for single coverage and covers 80% of eligible claims once the deductible is met.

Want to boost your level of coverage to say a $1,000 deductible and 90% coverage? Schedule an annual wellness visit with your doctor, submit to a blood test, and complete a health questionnaire.

Then if it turns out that you have (or at risk for developing) one of five chronic conditions, you will receive a treatment program. Comply with the program and you will not pay any out-of-pocket costs for eligible charges related to that condition.

The idea has to do with the fact that it is less expensive for the insurer to identify and treat health risks at the earliest possible stage. The example given in the article noted that annual claims costs for a person in the early stages of Type 2 diabetes tend to be less than $600, whereas claims at the next stage run $7,000 a year.

This plan design is being touted as “the next big thing” after consumer-driven health care. The idea is simple. Give people a program that helps them manage or improve their condition, and then reward them financially for following the program. In the meantime, costs are lowered and outcomes improved. This just might work.

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