REDUCING COST

Reducing Cost    Home

The growing burden of ill health has a particularly large impact on America's workforce. Employers and health plans alike are actively pursuing strategies to help employer groups get healthy and stay healthy. The problem: While considerable bodies of clinical studies exist, the ability to leverage these into effective wellness programs—especially within health plans—is extremely limited.

Now, The Vitality Group offers a health enhancement solution that combines extensive experience with a highly diverse client base and a consequent rich data set that links healthy behavior to healthcare claims. Vitality is the world's first health enhancement program built by a claims payer. As such, the program is based on extraordinary insights into population health management. This proprietary program utilizes sophisticated behavior change models supported by an actuarially-sound incentive program to achieve meaningful, measurable health improvement results across your entire population.

The Vitality program drives engagement and motivates participants to modify behaviors that invite health risk, thereby reducing overall healthcare costs.

The success of the Vitality program derives from the following key advantages:

• SCIENCE-BASED Vitality is constructed with an understanding of behavioral barriers. It drives behavior through the use of rich and immediate rewards, which is far more effective than appealing to individuals to change behavior for health reasons alone.
• NON-DISCRIMINATORY The scope of the program stretches across the health continuum. Members already leading healthy lifestyles are rewarded for continued progress. Members with known health risks are rewarded for making positive changes to address their risk factors. Individuals with identified chronic conditions receive rewards for participating in their employer’s disease management program. In short, everyone has the opportunity to be rewarded for engagement in the program. Similarly, Vitality caters to the health needs of different age groups, ranging from children to the elderly.
• COMPREHENSIVE Vitality interventions address all major modifiable risk factors.
• EQUITABLE The program facilitates equitable access. Members are equipped with the knowledge and tools necessary to engage them in the behavior change process. Financial barriers to wellness also are removed or reduced, for example, via subsidized access to gyms and exercise clubs in our extensive partner network.
• ACCESSIBLE The web-based Vitality program is inspirational, aspirational, fun and easy to use.
• FLEXIBLE Where applicable, Vitality can be integrated into the employer’s health insurance plan and disease management programs.

EQUITABLE CONTRIBUTION MANAGER

Flexible pricing options

As payors of all types implement health and productivity initiatives to gain competitive position, new approaches to incentivizing engagement are developing. The Vitality Group offers flexible pricing options and consults with clients to determine which approach to incentives fits most comfortably with the needs of their population and their corporate culture. Our sophisticated financial models can help you calculate the savings you can anticipate with any option.

Many corporations today are considering program structures that aggressively promote both participation and strict adherence to risk-reducing behavior modification programs for identified risk factors. Those who wish to adopt this “carrot and stick” approach will want to consider the Vitality Equitable Contribution Manager.

Making members financial partners can save even more — we guarantee it

The Vitality Equitable Contribution Manager is a proprietary tool that allows employer groups to allocate a higher or lower share of the healthcare costs to employees based on their level of engagement in Vitality and employer preference. Employees become active partners in cost reduction as they participate financially in the consequences of their behaviors . This flexible structure can guarantee health costs savings when integrated with a health benefits system. In fact, we are so confident in our ability to reduce your costs that we will put 20 percent of our administration fees at risk if the healthcare cost trend for your engaged employees is not lower than that for your non-engaged employees.

Your Vitality corporate wellness consultant will work with you to determine the right level of contribution adjustments, if any, appropriate for your corporate culture.

Streamlined administration

Vitality makes it easy to administer your Equitable Contribution program. We can integrate with your payroll system to ensure that implementing health plan contribution adjustments is a seamless process. Once contribution rules are agreed upon, we take your eligibility file and determine each employee’s contribution adjustment, which is based on their level of engagement in Vitality, and provide you with a payroll file containing that information. Adjustments can be administered at any frequency you choose, typically monthly, quarterly or annually.

A note on HIPAA compliance

There are no HIPAA restrictions on programs that do not base rewards on an individual satisfying a health-factor-related standard (for example, failure to complete an HRA).

Programs that do include such conditions for receipt of a reward, however, must satisfy five additional requirements:

1. Rewards may not exceed 20% of the individual’s health plan coverage cost.
2. Program(s) must be reasonably designed to promote health or prevent disease.
3. Eligible individuals must have the opportunity to qualify for a reward at least once per year.
4. A reasonable alternative standard must be provided to any individual for whom it is unreasonably difficult to satisfy the initial standard due to a medical condition or medical inadvisability.
5. All plan materials must disclose the availability of the reasonable alternative standard(s).