Arizona’s “Health Pulse” – Unanswered Questions, Part 2

Welcome to Part 2, the second unanswered question from Tuesday’s “Arizona Health Pulse Breakfast” sponsored by the Phoenix Business Journal and Blue Cross Blue Shield of Arizona.

Question 2: In essence, why don’t health care agencies pay for necessary preventive care or cover prescription drug costs when it comes to treating chronic conditions like diabetes or hypertension? Another excellent, but complex question. I’d like to address this question in two parts, first preventive care services and then the prescription drug costs.

First I’ll cover the question of preventive care. Dr. Smethers did answer this part of the question and I applaud BCBSAZ for their coverage of preventive services. Since leaving BCBSAZ I can confirm that other large insurance carriers do not cover prevention as a core part of the plan. Wise benefit managers can include a prevention option as part of their company’s plan, if this is something the company leadership supports (I will cover the importance of leadership support in future articles). Companies need to realize that they can either pay for prevention services up front or pay for the cost of disease later on. Clearly, the former is more cost effective.

The second part of this question asks about prescription drug coverage for certain chronic conditions. Dr. Smethers stated that charging reasonable co-pays for maintenance medications helps members realize the value of the service they are receiving. We have seen this demonstrated in health care and know that when services are offered at no or very low cost they are often taken for granted and sometimes abused (which opened the door for HMOs to reign in the system several years back). Although true, this is only half of the story. As a seasoned Health Promotion professional, I can shed some light on the other half, which is all about disease management.

Disease Management (DM) programs are growing in popularity and are put in place by companies to help employees with certain chronic conditions effectively manage their condition. Some of the more popular DM programs are offered for conditions like asthma, heart disease, diabetes, hypertension and chronic pain. DM programs offer educational materials and often health coaching. An important and often overlooked component of an effective DM program is incentives. Companies use many types of incentives like apparel items, event tickets an even earned days off. Cash happens to be one of the best incentives out there. Most companies can’t give employees cold hard cash due to gift limitations and tax laws, but there are other creative ways to save employees some cash. One of those ways is to encourage them to participate in their DM program by offering lowered or even waived prescription drug co-pays (for condition specific drugs). I wish I could take credit for this brilliant idea, but I know pharmacy benefit management companies like Express Scripts are working to promote these types of programs. If you are going to offer an incentive, why not offer something that connects back to the program, a real win-win.

In closing I’d like to say, keep up the good work Dr. Smethers and the health promotion team at BCBSAZ. Keep fighting the good fight against our sworn enemy, preventable chronic disease!

For more information on Health and Productivity Management, please visit my website: www.awbrooks.com.