Managed Care - March 2008 - (Page 55) PLAN WATCH Humana’s Multi-Year Pacts Could Be Attractive to Customers Health plan offers different cost guarantees in its No Worry and SmartResults consumer-directed programs By Frank Diamond umana is a forward-reaching company in the way a tree stretches toward the sun with roots firmly planted. The company has been getting some attention for programs that allow employers to sign up for multi-year contracts. Those programs — No Worry and SmartResults — spring from SmartSuite, Humana’s first effort to encourage consumers to take more responsibility for their care and its costs. The company launched SmartSuite in May 2001 for its own employees. It proved a hit and was extended to other employers the next year. What SmartSuite taught Humana is that when employers are offered a good deal, they’d like the opportunity to sign on for more than just one year. “One of the things that we tried as a company to really change is the buying cycle,” says Bill Tait, Humana’s vice president for sales and market operations. “The history of the industry has been that you bid everything every year. We’ve tried very hard to change that for many reasons.” H “We’re willing to put our fees at risk to demonstrate our confidence” in Humana’s consumerdirected offerings, says Bill Tait, Humana’s vice president for sales and market operations. Do the math There are about 25,000 members in No Worry (for companies with 51–299 employees) and SmartResults (for companies of more than 300 employees). “That may not sound like a lot, but most of these employers are 100 to 300 lives,” says Tait. “If you do the math, we’ve had a fair amount of customers try this.” They’re both multiyear programs (SmartResults is three years; No Worry is either two or three years, depending on the employer size). No Worry, for fully insured customers, comes with a maximum 6 percent rate increase in years two and three. SmartResults, for self-funded customers, guarantees to return some of its administrative fees if a specified level of claims is exceeded, but the employers and employees must participate in Humana programs that have demonstrated results in getting consumers more focused on their health and health care. These programs include the member participating in clinical programs, participating in wellness programs, and completing a healthrisk assessment, and the employer providing email addresses and phone numbers so that employees can receive timely health-related information from Humana. No Worry was rolled out in the first three quarters of 2007, depending on the market. SmartResults was launched last April. “Humana’s consumer-driven tools and programs encourage behavior changes that result in wiser health care consumers and healthier, more productive employees, and our rate guarantee demonstrates that,” says Jerry Ganoni, president of Humana Small Business. Humana isn’t the only one gambling here. Companies that cancel the plan before the three years are up will be charged a $25,000 penalty. And some benefit packages allow for employee deductibles to increase from $500 to $2,500 by the third year. “We want people to access the health care system when needed, and we want them to do so with as much information as possible — so that they can make good decisions regarding their health care options,” says Tait. “There is a significant amount of unnecessary health care prescribed in the system today. We want our members to receive what they need.” In No Worry, companies agree to submit 75 percent of their workers’ telephone numbers and email addresses, and at least 30 percent of workers must fill out a health risk assessment survey. Employers can get a 4.5 percent cap on premium increases in the second and third years of No Worry by adding dental coverage and by MARCH 2008 / MANAGED CARE 55
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