Hawaii Medical Service Association (HMSA) -

HealthPass (2002)

Critique

The following are verbatim remarks made by the reviewers:

• ROI + at 2 years
• Large scale
• Institutional commitment
• HRA, risk reduction, professional referral
• Participation high, percent participation not as impressive
• Reduction in amount of claims per person impressive
• High satisfaction

• Comprehensive set of program offering, making the program available to all members
• Providing follow-up from a nurse and then a physician for participants with health risks identified by the screening,
• Receiving coverage in the plan magazine and high member satisfaction.

• This disease prevention/health promotion program, while in the broadest sense addresses the entire continuum of care, does place special emphasis on chronic, high-risk individuals. Annual participation is about 8%, which suggests that they are able to engage a reasonable population of those at risk. A strength of this program seems to be the personal contact that is established for purposes of reviewing results and conducting follow-up. Both nurses and health educators work with the participants to direct them to appropriate screenings and community programs.
• The program is fully funded by the health plan and is supported by management through positive endorsement in the annual report and the health plan magazine.
• Participants reported high satisfaction (99%+) and did realize risk reduction with more is the low risk group and fewer in the high-risk group after intervention.
• Medical claims were examined for ’97 – ’00 and participants were compared to non-participants. Participants had lower claims/yr. Of $200 and in examining LOS participants had shorter stays by 2 days. A believable ROI of 1:1 is reported.

• Personalized interventions and individualized counseling
• Assistance to locate PCP
• Conservative approach to determine ROI

• Well written application and program. It is good to see a health plan with a proactive approach to health management of its members. More health plans should be made aware of this program example. Figure 5 provided a good illustration of cost savings. The early detection and referral portion of the program is excellent.

• Comparison of ppts. vs. non-ppts. medical claims, hospital stays, and associated costs.
• Use of repeat HRA data to demonstrate changes in health risks over time
• Meets Healthy People 2010 objectives.
• Program available to all POS and PPO members.

• Excellent design of the program
• Strong commitment by the plan’s senior management to the program
• Many of the proposed analytic methods make sense – although it is not clear as to how the analyses were actually carried out