Managed Care - February 2008 - (Page 36) Health recently. Like other notable com“Over the last two years, there’s been a panies on the short list, Hannaford has negative spending trend in medical, You can save $3 a huge workforce — 12,000 people — which is pretty unheard of,” says the wellfor every $1 spent and much to gain from improving the ness director. “We’re pretty sure a lot of on wellness. health of its employees. the wellness initiatives are contributing.” There are no exact figures on what Designating Aetna to coordinate the the wellness program pays back for the lion’s share of the wellness programs — more than $11 million in insurance distwo other health plans shoulder the accounts that it hands out in a year, says Udeh, but tivity in some of Hannaford’s northeastern stores there is one very healthy trend line to boast about. — offers some advantages. NCQA prepares to evaluate vendors of wellness programs NCQA, the quality-assessment organization that health plans know only too well, has set out to become the primary arbiter of how well health plans, disease management companies, managed behavioral health organizations, and other vendors of wellness programs are actually performing. NCQA plans to roll out a new evaluation program for wellness programs this year that it hopes will set standards for transparent performance measures that can be used to size up the players. To get started, the organization is devoting the next few months to researching the field and discussing its approach with some of the experts as it determines how to go about grading wellness vendors — most of whom don’t have many rules to live by at the moment. It all starts with defining some baselines for what constitutes success, says Ann Carson, NCQA’s assistant vice president for product development. And in a field where most of the available statistics are a blended mix of assumptions and broad indicators, that’s no easy task. “There is limited evidence about what is effective in wellness,” says Carson. “We want standardized performance measures as part of this program.” So NCQA has formed an advisory council to help fill in the blanks and offer up a consensus view of what works and what doesn’t. “These are experts from academia, from purchasers, representatives from consumer organizations, and also people who work in the field, health plans, and vendors to help us understand what is important for purchasers and consumers and the public sector in wellness, what is the state of the art,” says Carson. When it is done gathering evidence, NCQA wants to have a clear understanding of how evaluators can start to assess the wellness programs already in place in a company. If there are company wellness policies in place, asks Carson, how do you find out how much real leadership support they have in the top ranks of the company? That’s one of several keys to success. “What percentage of members is the organization able to get to complete the health appraisal?” is another question that NCQA is posing. When you have appraisals in hand, are you effective at identifying people who are at risk? What kind of communication and education programs are there, and how do they measure results? Adds Carson: “For core risk areas, we’re hoping to identify comparable questions — for smoking, obesity, or depression, and other areas — so you can accurately determine what percentage of members are smokers and so on.” For health plans such as Cigna, Aetna, WellPoint, and a slew of Blues that Carson has seen entering the marketplace, some of the lessons to be learned from the corporate leaders in the wellness movement could call for a new approach to health. “Some of the employers are thinking longer term than health plans,” says Carson. “We spoke with one employer who talked about its role as the big employer in a small town. “If it doesn’t improve the health of employees, helping to change their behavior related to obesity and smoking and healthy eating and physical activity,” those children will wind up as that company’s unhealthy employee base in 20 years. For now, though, NCQA’s evaluation process — like much of the wellness business — is still a work in progress. 36 MANAGED CARE / FEBRUARY 2008
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