Lumenos

Situation

Our health care system is not producing significant improvements in health in a cost-efficient way. It is critical to find a way to improve health outcomes without raising costs, and without continuing to reduce health benefits or increase cost sharing by employees.

Solution

The solution is to address one of the primary obstacles to better health – poor heath behaviors – giving consumers the tools, services and incentives to make better choices and do more to maintain or improve their health.

Better Health and Lower Costs

Since more than 50% of health care costs are attributable to behaviors – such as smoking and being overweight -- Lumenos health plans offer an integrated health improvement strategy that provides tools, services and incentives to make it easier for consumers to do the right things for their health. The strategy targets appropriate services and tools to the different risk levels in the covered population. Basic steps include:

• Assessing the risk levels among the covered population, offering tools such as an online health risk profile (My e-Checkup).
  
• Providing tools to low-risk individuals to maintain their health, from full coverage of nationally recommended preventive care to offering online tools such as My e-Checkup, fitness trackers and a health library.
  
• Reducing risk factors among the high-risk group, such as our Personal Health Coach program for chronic conditions, as well as smoking and weight management programs.
  
• Using consumer incentives to encourage utilization of tools and services. Consumers receive additional dollars in their health accounts for completing the online risk profile, and enrolling in and graduating from the Personal Health Coach program. With incentives, for example, completion rates for the online risk profile increased from an average 4% to 40% of population.
  

This strategy has created positive changes in behavior among Lumenos consumers:

• 53% report increased knowledge in managing their health care
  
• 36% report that they are more actively involved in health-related behaviors
  
• 97% report that they understand how the plan works.
  
• Those with higher than average doctor visits or ongoing conditions are the most likely to report they are more knowledgeable about managing their health since joining the plan.
  

These healthier behaviors were accompanied at the same time by positive trends in cost control:

• 30-40% reduction in year-over-year cost trend
  
• Pharmacy costs – down 15%
  
• Outpatient visits – down18%