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Are your patients feeling strapped for cash? If they live in California andhave the right insurer, they may be able to make some money by quittingsmoking or shedding a fewpounds.
In 2004, a Blue Shield of California pilot program sent checks totaling$200,000 to 1,100 members who participated in online programs that providetips on quitting smoking, losing weight, reducing stress, and eatingbetter.
"It is well known that lifestyle and behavior choices have a hugeimpact on health outcomes," says Deborah Schwab, RN, MS, the plan'sdirector of new product development.
Blue Shield researched specific financial correlations between risk factorsand health costs and concluded that even a small change could add up tosignificant value for the health plan and the individual who is functioning athigher levels, with less illness and disease. The literature shows thatspecific, modifiable health risks are associated with elevated medicalclaims—accounting for >25% of annualcosts.1,2
The Healthy Lifestyle Rewards pilot program invited 25,000 members toparticipate. Of the 3,800 people who accepted, 30% earned a cash reward.Participants registered online and filled out a health risk assessment toreceive interactive coaching with elements such as walking trackers, mealplanners, and stress-management and tobacco-quitting tools. The weight-lossprogram was the most popular—18% of participating members lost acombined total of almost 5,000 lb.
A Blue Shield medical advisory board—four physicians, one pharmacist,three nurses, and one health educator—reviewed the program to ensure itis evidence-based, Schwab says.
Project manager Dana Davies, MPH, a health educator, says the program canbe viewed as an extension of the physician office visit by offering supportand recommendations tailored to give the patient a better chance forsuccess.
"A physician can't make weekly check-ins with each patient that needsto make lifestyle changes," Davies says. "[This] is a potent toolthat is very much aligned with the goals of the physicians."
The program rewards members for participation, not just results: Twentyweeks' participation earns $75, 28 weeks earns $150, and 35 weeks earns $200.A person who follows the program for 35 weeks and loses 2 lb gets the samecash amount as someone who loses 25 lb.
The program is "broad enough so well members could engage and remainwell, and those with chronic illness could use it to reach a better state ofwell-being," Schwab says.
Researchers at Stanford University will analyze the pilot to see if claimschange as a result of improvement in participants' general health. Results ofthe Stanford study should be available later this year. 
References
2. Anderson DR, Whitmer RW, Goetzel RZ, et al. for the HealthEnhancement Research Organization (HERO) Research Committee: The relationshipbetween modifiable health risks and group-level health care expenditures.Am J Health Promot 15:45–52, 2000.[Medline]
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