Hawaii Medical Service Association

HMSA is the largest provider of health care coverage in the state of Hawaii. Its HealthPassprogram is a comprehensive health promotion and disease prevention program available to members of the PPO and POS plan. The eligible population averages approximately 375,000 members per year and, in 2001, nearly 22,000 individuals utilized the program at least one time.

The HealthPass program was developed in 1990 as a way to introduce a preventive benefit that was both cost effective and integrated with participating providers; clinical practices. The program model incorporates the entire continuum of care with a strong emphasis on prevention and early detection. The mission includes striving to prevent and/or delay the onset of disease and provide for early detection of impactable diseases whose morbidity may be lessened with timely intervention.

Program Description

Narrative Description of Program

This comprehensive program exceeds traditional HRA and risk reduction programs by ensuring personal contact with a health professional as well as on-going follow up with the participants and their care providers. Qualified health educators review individual findings with the participant and determine a health action plan based on the member's readiness to change. Risk-based referrals to clinical interventions are made simultaneously for such screenings as bone density, sigmoidoscopy, mammographies, etc. HealthPass is also intricately connected with community-based programs such as smoking cessation and HMSA-sponsored interventions such as disease management, health & safety programs, and health education classes.

HealthPass is the primary way that HMSA proves its commitment to prevention. "HMSA believes that prevention detection and early treatment of disease are the most effective means of maintaining and protecting good health." (HMSA 2001 Annual Report).

The program components include:

Demand reduction strategy
Behavior change strategy
Annual birthday invitations
Confidential Health Risk Assessment
Biometric screening
Individualized counseling
Risk-based referrals to clinical interventions
High risk/chronic condition interventions
Referral to related interventions
Regular follow-up to determine compliance
Communication with the member's provider to ensure continuity of care
Educational information
Assisting members in finding a PCP

HealthPass is 100% funded by the health plan and is included in the PPO and POS Benefit Certificates. There are five locations throughout the Hawaiian islands which are staffed by Managers, Health Consultants, Medical Assistants and support staff. Program oversight is provided by the Program Director and a HealthPass advisory panel led by two Medical Directors and six community physicians.

Contact Summary

General Information
Program Name	HealthPass
Company Name and Address	Hawaii Medical Service Association (HMSA)818 Keeaumoko St., PO Box 860Honolulu, HI 96814
Contact Person	Caryn Ireland, Director Health Management Services
Program Information
Program Category	Integrated System of Care, Chronic Disease, Insurance, High Risk
Year begun	1990
Total number of individual participants	56,000 employees, 144,095 family members, 9,070 retirees
Number of currently actively enrolled	21,752
Access to Program	All adult members 18 and over inrolled in the Preferred Provider Plan for HMSA. subsets include: a)All members for the purpose of risk screening, stratification, and behavior change counseling b) "At risk" members for secondary screenings, further individualized counseling, and physician intervention and c) Diseased members for referral into HMSA's disease management programs
Program targeted at Healthy People 2000 and/or Healthy People 2010 goals	Yes
Program goals (in priority order)	(1) Reduce health risks and improve health status long term. (2) Reduce medical cliams costs. (3) Motivate positive change in modificable health risk Behaviors. (4) Integrate health promotion and preventive services for all members along the health care continuum.

Evaluation Summary

HealthPass is a health promotion/disease prevention program offered to subscribers of Hawaii’s largest provider of health care services, HMSA. Of the 375,000 members in HMSA, approximately 18,000 individuals utilized the program annually. The comprehensive program included health risk screenings, personal contacts with health professionals, risk-based referrals to clinical intervention programs, and connections to community-based programs for smoking cessation, disease management, health and safety, and health education. The program is 100% funded by the health plan. Approximately 13,000 participants completed two health risk assessments, with an average 5.2-year time interval between assessments. Risk reductions were found in the following categories: driving safety (49%), smoking/tobacco use (29%), mental health (22%), alcohol use (19%), exercise/activity (17%), eating habits (15%), preventive screenings (13%), stress management (11%), self care (8%), blood pressure control (3%) and back care (3%). The program realized a $75 per participant per year savings in total medical claims, thus yielding a 1:1 (break-even) return on investment in only two years.

Evaluation Documentation

hmsa_health_pass

Critique

The following are verbatim remarks made by the reviewers:

A

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

B

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.

C

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.

D

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

E

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.

F

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.

G

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