A man reads the labels on two bottles.
“Same active ingredients, but one has a much lower price,” he notes. He tosses the pricier one aside, holds up the other and says, “I’d buy this one.” Then he adds: “Well, the same goes for generic vs. brand-name prescription drugs. I know what I’d choose.”
Over a light, cheery tune, he invites the viewer to “learn more” at HealthyMoves.org. Small type at the bottom shows the ad is sponsored by Blue Cross & Blue Shield of Rhode Island. The insurer is airing six such ads as part of this campaign, which will run at least through April, according to Christopher Medici, chief communications officer.
Each of the ads focuses on personal choices that can make a difference – calling your doctor before visiting the emergency room, walking regularly, eating healthy foods, having regular medical checkups, and making sure you understand what your doctor tells you.
The Healthy Moves Web site develops each of those concepts in detail. It explains, for example, that while generic drugs “may look a little different or have a different name … the main difference is that they cost a lot less,” adding that according to the Congressional Budget Office, Americans save an estimated $8 billion to $10 billion a year at retail pharmacies with generic drugs.”
More details follow, as well as links to the Food and Drug Administration’s generic drugs Web site and to Blue Cross tools that allow members to look for generic alternatives to their medications.
The goal, Medici said, is to “raise awareness” of crucial issues in the community, so individuals can better understand their role both in maintaining their own health and in making health care more affordable for all Rhode Islanders.
“Our mission is to promote health and wellness and to help our members in the greater Rhode Island community lead a healthier lifestyle,” Medici said. Healthier lifestyles will reduce the need for expensive health care services, he noted, plus “if you lead a healthy lifestyle, you will be a better person, a happier person.”
That message isn’t new; in fact, it’s at the heart of the “consumerism” movement that is transforming the health insurance industry nationwide, with enthusiastic backing from the Bush administration.
Advocates of “consumer-driven” health care, however, tend to combine the gospel of healthy lifestyles and smarter use of health care resources with financial incentives.
Joel Cooper, Rhode Island president of USI New England, said financial incentives are key, because only a fraction of the population will make healthy choices and avoid expensive drugs and services just because it’s the right thing to do.
If a person can pay substantially lower health care premiums or avoid big out-of-pocket costs by quitting smoking, getting an annual physical or working to lower his cholesterol level, however, he’s a lot more likely to do so, Cooper said. USI is working with employers to implement health plans that provide such incentives.
State Health Insurance Commissioner Christopher F. Koller offered a similar view. The Healthy Moves messages are good, he said, but “the way to change behavior is in people’s wallets.”
“What’s missing here, or what’s sort of the next step is to link these behaviors to benefit designs,” Koller said. The workers’ compensation industry, for example, has successfully linked premiums and benefits to risk-management behaviors, he added, and health plans can do it as well. His office is now working with insurers “wellness” health plans for small businesses that would do that, he noted, and large businesses are taking similar approaches.
But is that really the best way to educate patients? In another era, it was taken for granted that the family doctor would impart this wisdom – at least the healthy choices part of it. And even with resources such as WebMD.com and health plans’ own sites, surveys have shown Americans still trust their doctors most when it comes to health care issues.
Craig O’Connor, lead organizer at Ocean State Action, an advocacy group that is heavily involved in health policy matters, said Blue Cross “should be commended” for its efforts, but doctors are still the best source of health care information.
“People don’t have at their fingertips the information they need to make decisions that are better for themselves personally but also better for the health care system as a whole,” he said. “The person that patients should be learning these things from is their doctor … and too often, patients have five minutes, 10 minutes with their primary-care physician.”
“Until we have a health care financing system that encourages primary and preventive care and reimburses institutions and physicians for that type of care,” O’Connor added, “we’re going to continue to see under-educated patients.”
Dr. Francis X. Basile, a primary-care doctor at University Medicine Foundation in Providence and a Blue Cross board member, sees it that way, too. Some patients are willing and able to educate themselves, he said, but many aren’t, and “there’s so much information out there right now, and not necessarily from people with a good scientific background … that most people need someone to help guide them through the minefields.”
His practice, which includes eight doctors, has been adding resources – including visiting specialists, plus case workers provided by Blue Cross – to provide more support to patients, and it wants to go further, adding nutritionists, for example, to create a “medical home” where the majority of patients’ needs can be met.
But all those efforts cost money, and insurers don’t pay for extra minutes spent advising a patient, or for offering nutritional advice.
“We’re not going broke,” Basile said, “but we’re killing ourselves, and what ends up happening is it sort of becomes demeaning; it’s a morale problem.”
The system doesn’t value primary-care doctors as it used to, Basile added, and it needs to recognize them again as a primary health resource, “and that that’s valuable, and that’s what you should do rather than let me go online and find out what’s available and go though this disjointed process.”
Even as it promotes individual initiative through Healthy Moves, Blue Cross is making “a valiant effort” to reward primary-care doctors who do more for their patients, Basile said. But for Blue Cross, too, there’s a cost.
“They hear us; we talk. [UnitedHealthcare of New England] does not,” Basile said. “What makes it tough for Blue Cross is United is coming in low on fees and is able to offer a better price when it comes to insurance rates, so Blue Cross is sort of stuck to a certain degree.”
