Blue Cross & Blue Shield of Rhode Island is the only insurer serving the state’s individual market, and it’s under constant pressure to reduce costs. It offers subsidies and discounts for passing medical underwriting, and in recent years, it has added high-deductible plans.
Now Blue Cross is trying something different: Healthmate Coast-to-Coast Direct Plan 1000/2000, which is being offered for the first time during open enrollment, May 15 through June 15, has a $1,000 individual deductible ($2,000 for families), but it provides first-dollar coverage for a slew of preventive and maintenance care – even children’s vitamin supplements.
Jim Gallagher, assistant vice president of strategic marketing and product innovation, answered questions about the new plans.
PBN: What is the philosophy behind this new plan?
GALLAGHER: The philosophy is to offer a plan that functions as the member’s advocate, rewarding them for being proactive about their health and encouraging them to take full advantage of their plan’s benefits and features. The goal is to support members’ efforts to maintain their health in two ways: to reduce barriers (such as high copayments) that could discourage members from getting routine preventive care or maintenance treatment for chronic health conditions such as diabetes; and to provide incentives for members who do take the initiative to receive recommended preventive care.
Members enrolling in this plan will experience a new welcome process that will ensure they fully understand their plan’s benefits and services, so they can take advantage of all the resources and incentives available to help them live a healthier life.
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PBN: How different are the benefits from your standard HealthMate individual plans? Are there tradeoffs for the enhanced benefits?
GALLAGHER:This plan was not designed by “trading off” benefits at the member’s expense. This plan has very similar benefits to our other HealthMate Coast-to-Coast Direct plans. The major difference is in the plan deductible and maximum out-of-pocket cost for members. This plan offers additional coverage that is not available in our other plans, such as lower copays on prescription drugs and 100 percent coverage for nutritional counseling, smoking cessation counseling, asthma and diabetes management office visits, lab tests and X-rays. In addition, the standard premium for this new plan is about 10 percent lower than the standard premium of our HealthMate Coast-to-Coast Direct 500/1000 plan.
PBN: These benefits seem very targeted. How did you decide what, precisely, to cover at discounted rates? And who’s your target demographic?
GALLAGHER: We are trying to offer members benefits that not only pay for “sick” care, but also keep them focused on staying healthy. Sometimes it’s not easy to choose specific benefits, but we tried to offer enough support and tools to help our members achieve better health. The new plan offers an array of benefits to keep members healthy and support their health care goals. Some of these features include up-front coverage for routine physicals, a $50 incentive for completing a personal health assessment and signing a health pledge, and no copayment for certain over-the-counter preventive supplements such as children’s multivitamins. We also offer access to health coaches and care coordinators who will provide one-on-one assistance to help members create care plans and set goals to improve their health.
PBN: In the individual market in particular, there’s been a lot of emphasis in recent years on pared-down, “consumer-driven” health plans. How do plans like those influence utilization, compared with this new plan type?
GALLAGHER: The market needs various options that will meet the needs of all our customers. Some people purchase health insurance purely based on cost, while others want a more comprehensive plan that covers the majority of medical expenses at first dollar. This new plan provides another option to Rhode Islanders and offers incentives and support to help them take the right steps toward living a healthy life.
PBN: Why are you starting in the individual market, and do you plan to roll this out to small and large groups in the near future?
GALLAGHER: [Blue Cross] is the only health insurance carrier in the individual market in Rhode Island, and we wanted to make this exciting new plan available to all residents of the state. We are hoping our members and others looking to purchase individual coverage will see the value and importance of some of these innovative plan benefits and will take the first step in improving or maintaining their health. We will be rolling out similar plan designs to all markets in the near future.
Blue Cross is sponsoring two informational meetings about the new plans, May 18 at 6 p.m. at Davenport’s, 1925 Pawtucket Ave., East Providence, and June 3 at 6 p.m. at Ivy Garden, 272 Cowesett Ave., West Warwick. Plan information is also available online, at www.bcbsri.com.
Good Job Blue Cross, MEMBER ACCOUNTABILITY and results witll help the overhuaul of the current system . Root cause iniitiavies often help identify underlying issues ,i.e. Preventative isssues such as sleep disorders /Sleep apnea contribute to Mood ,producitivity, Hypertension ,diabeters etc, What we take for granted (sleeep ) has a lot to do with preventing other systemic issues /disesases .
Pete Fontaine RN
This is a significant step in the right direction. Patients, providers (especially PCPs) and health plans should collaborate and align their efforts towards obtaining better outcomes over the full cycle (prevention, diagnosis, treatment and follow-up) of each patient’s medical condition(s) .The goal is to get better health for lower cost, and the health plans like BCBSRI have the potential to be a major factor in achieivng it. It is great to see BCBSRI taking action to make this happen.
Charles Hewitt