Preventative Steps Tufts Health Plan Promotes a Culture Focused on Wellness

Employees at the Watertown headquarters of Tufts Health Plan don’t have to leave work to get to the gym.

In fact, the facility’s 12,000-square-foot WorkingWell Center, open seven days a week, includes state-of-the-art cardiovascular and strength-training equipment; group exercise classes — from Zumba and Pilates to cycling and kickboxing — during the morning, lunch hour, and evening; and on-site acupuncture and massage services to boot.

It would seem this is a company invested in its workers’ health.

“More and more, it’s being shown that keeping people healthy is better than trying to take care of them when they’re very sick. And wellness is a very big thing at Tufts Health Plan. We as an employer have a general culture of wellness,” said Sonja Hagopian, vice president of Corporate Communications and Public Relations.

“We have things like a subsidized salad bar and fruit bar,” she added. “We also have walking programs, smoking-cessation programs, Weight Watchers — and the on-site gym is beautiful; it can compete with any gym out there.”

There’s a reason for this emphasis on wellness at Tufts. According to a Harvard Study, every dollar spent on wellness and prevention saves $3.27 down the road in medical treatment costs.

So, in many ways, Tufts the employer is modeling what Tufts the health plan has long provided for its extensive network of 980,000 members throughout Massachusetts and Rhode Island.

“Certainly, our member employers are interested in providing wellness programs for their people as well, so we help them develop those. Some have bigger programs, and some have smaller programs they can expand.”

Keeping people healthy naturally lessens absenteeism, she noted, making investments in such programs a long-term money saver for employers.

“If an employer wants to institute something, we’ll work with them to determine what health and wellness programs they wish to start off with,” Hagopian said. “So, if a company wants to start a quit-smoking program, we’ll help them institute that, and employees who participate in that program can earn points they can redeem for awards.”

It’s all part of a series of wellness incentives, for companies and individuals alike, that speak to a growing focus among health plans on keeping people healthy, in addition to paying for doctor visits and hospital stays when they’re not.

Coordinated Care

This emphasis on wellness is one facet of what Tufts calls its ’coordinated-care model,’ a three-pronged model designed to change behavior through economic incentives.

The first prong involves care management and health promotion, through small details that can add up and improve members’ health. For example, members and their physicians receive alerts when prescription fills and refills are missed, in-home biometric monitoring picks up blood-sugar and blood-pressure changes for certain plan participants, and workplace resources from smoking-cessation programs to obesity-management initiatives help members make positive changes in their lives.

The second prong promotes efficiency through tiered products and limited-provider networks, which give employers options and can save money on premiums.

The third prong is an ongoing realignment of payments to physicians and hospitals in an effort to move away from the fee-for-service model — which pays for each treatment or procedure separately and rewards providers for volume — to value-based payment contracts in which providers are financially rewarded for keeping people healthy. This model — which is gaining traction throughout the health care industry (see story, page 17) — discourages unnecessary treatment, yet guards against inadequate patient care by offering incentives for meeting quality benchmarks.

“We certainly need to be mindful of the costs of health care, and that includes costs on the provider side as well as costs on our side; it’s expensive,” Hagopian said. “The coordinated-care model is basically an approach that blends innovative contracting with provider plan design that responds to the demands out there. The plans are designed with different levels of co-pays, and members can be more involved in their decisions and the wellness programs that keep people healthy.”

All these innovations complement a wide range of traditional PPO and HMO options, Hagopian explained. “Employers choose the plans that work for them and their employees. Having choice is important.”

Tufts has also partnered with Cigna on the CareLink plan, which allows employers with locations in multiple states to offer comprehensive coverage to all employees.

“So, say you work for a Massachusetts-based company but live in Ohio; you can get coverage through CareLink,” Hagopian said. “And employees of an Ohio company who live in Massachusetts get the same deal because of this relationship we have through Cigna.”

In addition, she noted, Tufts recently acquired Network Health, a managed Medicaid plan with nearly 180,000 subscribers throughout Massachusetts. Adding this line of business makes Tufts the only health insurer in its region to participate in commercial, Medicare, and Medicaid markets.

“We are one of a small handful of plans that can take care of its members in every situation of their life,” Hagopian said, “whether they’re getting insurance through an employer, or directly through us if they lose their jobs or their economic situation changes, or through Medicare Advantage; that’s exciting.”

Choosing to Be Healthy

Hagopian said Tufts has tried to stay on the cutting edge of payment reform, realizing, as many insurers have, that health care in Massachusetts is too costly.

“Six years ago, when the state tackled the issue of accessibility to health care, they knew very well that the second part of that was the cost, and that is where the state is now,” she said. “But our state is still so much further along than the rest of the country, as we await the Supreme Court’s decision [on national health reform] and where those chips will fall.”

Still, at the end of the day, any widespread restructuring of the health-insurance system will be inadequate if individuals don’t take steps to manage their own health.

Many years ago, Tufts was the first plan, to offer an incentive rebate to members who joined a gym — standard practice in the industry these days. And it continues to pioneer wellness initiatives, both for members and its own employees, who enjoy amenities from the WorkingWell Center to Sit-to-Walkstations, a device designed by Steelcase that links a computer work station to a treadmill.

Meanwhile, “in March, we opened up the Be Well Center, a clinic you can go, say, with a scratchy throat to get a throat culture. Or, if your doctor ordered you to go to a lab, you can get tests done here and sent to a doctor. It’s a way to help our employees remain healthy and help them with convenience as well.”

And there’s no reason, she said, why employers of all types can’t do some of the same things — which is why Tufts continues to help them do just that.

“Everyone should care about wellness,” Hagopian said. “Sometimes it’s hard to get started, but when you start, you feel better.”