Wellmark encourages education, personal responsibility

Opening the latest front in efforts to curb rising health-care costs, Wellmark Blue Cross and Blue Shield of Iowa is preparing a large-scale campaign aimed at consumers.

The insurance giant, which provides coverage for roughly half of the state population, plans to educate consumers and, hopefully, help them make smarter decisions about the amount of health-care services they use.

Wellmark’s campaign represents the third leg of a larger strategy that the insurer, led by Chief Executive John Forsyth, has been undertaking in recent years to dampen health-care costs, which have been rising annually at double-digit percentage rates. The company has also been slashing administrative costs and working to negotiate lower fees with service providers and drug makers.

“The sense is that no long-term solution exists for this problem short of heightening the knowledge and education of consumers about the health-care system and how they can be better purchasers,” said Cliff Gold, Wellmark’s senior vice president of marketing and external relations. “An educated consumer is a better and wiser user of services.”

For years, Wellmark has worked one-on-one with corporate clients to help them develop custom plans for boosting employee health and find ways to limit increases in insurance premiums.

Now, through the “Decisions Count” campaign, those efforts will be intensified and broadened. Consisting of an array of marketing and educational materials, it’s the largest campaign Wellmark has ever launched targeting consumers, and it follows a similar effort by Blue Cross and Blue Shield plans nationwide.

The campaign seeks to help consumers learn more about their health-care plans and the level of services they need. It encourages people to stay within their plan’s provider network, for example, and not to visit hospital emergency rooms unnecessarily.

The average visit to an emergency room costs $1,049, while a trip to a doctor’s office costs, on average, $56, Wellmark said. Last year, there were 10 million trips to emergency rooms for non-emergency care. One solution Wellmark offers clients is to develop closer relationships with their physicians.

“Not every illness or symptom requires a trip to the doctor,” reads a passage in the marketing materials that Wellmark has developed for the campaign. “Sometimes common sense actions like getting plenty of rest or drinking plenty of fluids can put you on the road to recovery.

“On the other hand, it’s best to seek medical care early for what could become a serious condition, … By knowing when and when not to visit the emergency room, you can cut medical costs,” the materials state.

One of the challenges that consumers, and insurers such as Wellmark, face is the lack of available pricing information for health-care services. It is difficult, if not impossible in certain cases, for a consumer to shop around for the best price for certain treatments.

Some big insurers have recently made moves to correct this problem, though the health-care profession is a long way from letting consumers compare prices the way they might, say, at a grocery store.

Principal Financial Group Inc. last week said it would post information on its Web site about the prices charged by dentists so policyholders can make cost comparisons more easily.

The other significant challenge Wellmark will likely face is from consumers themselves, who may grow wary of the insurer’s motives for wanting them to consider cost when making their health-care decisions.

Wellmark executives argue it is in both their and the consumers’ best interests to help cut health-care expenses, or at least blunt their rise. Wellmark’s goal is not to limit patient access to health care, Gold said.

“We’re not talking about taking the savings and dropping them into our bottom line,” Gold said. “Our intent is to try to positively influence the health-care-cost trends, which continue to rise in the double-digit range and are projected to continue to do that. Companies and individuals are at the end of their ropes in terms of being able to absorb these costs.”

Wellmark has a profit margin target of 2 percent, a goal it has reached once in the past 10 years, Gold said.

Wellmark studies show that accelerating utilization rates, particularly for prescription drugs, is the primary culprit for rising health-care costs. The use of name-brand prescription drugs has grown the fastest, Gold said.

About 43 percent of all prescription drugs taken in Iowa are generic, a rate that is slightly higher than the national average. Persuading customers to use generic drugs would have a dramatic effect on total health-related spending. For instance, a 1 percent increase in the number of generic drugs used in Iowa would translate into $5 million in savings, Gold said.

Residents of Iowa and South Dakota, where Wellmark also provides insurance, spent $33 million last year on cholesterol-related drugs alone last year, he said.

Increasing usage of health-care services stems from employee benefit plans, which have tended to shift the burden of most worker medical costs onto employers.

As a result, Gold said, many workers view the cost of a doctor’s visit as whatever their bill is that day for the service. Because most workers’ health-care expenses are subsidized by their employer and covered by insurance, an employee never sees or has to pay for the full bill.

A typical visit to a doctor that requires lab work could cost $200 or more. Patients may pay $10 of that, depending on their benefits and the level of co-payment. Some companies have recently shifted costs back to workers in the form of rising co-payments or smaller benefit packages.

“Consumers haven’t been trained [to shop for health-care prices] in the same way they know how to shop for a car or to buy anything else,” Gold said. “The purpose of this campaign is to heighten awareness of health-care costs and give consumers information on how they can use the system in a way that guarantees quality of care, but not necessarily quantity of care.”

There are a number of measures that Wellmark can use to determine if the “Decision Counts” program is succeeding.

The best measure, Gold said, is the rate of use of generic drugs. Another would be to study the number of outpatient visits versus hospital stays across the state.

Lastly, the company can conduct surveys to determine if employers are using Wellmark’s marketing materials and if those clients feel their workers are better informed.

“In the end, no matter how hard anyone tries, the expansion of technology, the aging population and the availability of new and better drugs will continue to negatively impact health-care costs,” Gold said. “The only cure for that is to get consumers more engaged in the use of health-care services without sacrificing the quality they deserve.”

THE CAMPAIGN, UP CLOSE

“Decisions Count,” Wellmark Blue Cross and Blue Shield’s new campaign to educate consumers to make better decisions about health-care services, will begin online.

Items such as payroll stuffers, articles for employee newsletters and posters will be downloadable from Wellmark’s Web site. To make the site more useful, Wellmark has added new features.

The site, www.wellmark.com, now includes tools that help locate pharmacies or cross-reference prescription drugs for potential conflicts. Wellmark customers also have access to their personal drug histories.

Along with “Decisions Count,” the insurer will initiate smaller campaigns that target different aspects of employee health. Wellmark plans to introduce one, called “Walking Works,” at this year’s Iowa State Fair to persuade workers to spend more time walking each day, according to Angela Feig, a spokeswoman at Wellmark.

“This is not a flash-in-the-pan effort,” she said. “We’re going to keep rolling out new materials. This is a multi-year campaign.”