That is a good question. It is difficult to assess this using any usable metrics. Most insurers seem to focus on preventive measures, annual wellness exams, and denying unnecessary testing or procedures. The denial rate ranges from vary greatly, according to a recent study with UHC at about 17% (higher than BC/BS or Elevance (former Anthem.) However, a study done about two years ago revealed that annual wellness exams are not productive, and the ROI is low. Perhaps the PAP smear, Mammograms, and colonoscopy are the highest in the ranking. Chronic illness is the major burden to insurers. Insurers are beginning to focus on nutrition and offer cash incentives but only to those below the poverty line. Although insurers are spending on marketing these aspects, how do we measure the results?
You're right that blanket prevention has mixed results. Annual wellness visits don't seem productive, even sometimes in the higher risk Medicare population. Using the word productive means implicitly there is some outcome we are basing it on, and I'm not sure we've nailed that down. What kinds of outcomes do you think people would want to pay for? What measures would we want to see encouraged by an insurance pamphlet so we could choose on it? Cholesterol levels? long-run BMIs in healthy ranges? Or something like the CVS near by house that claims "CVS customers are better at filling their prescriptions"?
Could you elaborate on what you mean by insurance companies focusing on preventive measures? Are you suggesting they cover these generously because they expect a higher ROI? If you're referring to more affordable coverage, I wonder how much of that is attributable to the ACA vs. being a true bet on ROI.
When I'm thinking of preventive actions with long term payoffs, I have in mind things like nutrition counseling, sleep interventions or checkins, smoking cessation and obesity programs that focus on time and counseling versus prescription solutions. All of these things move behavior and knowledge slowly over time, but you could imagine this nudges the trajectory of the patient over a 30 year period away from expensive comorbidities in their 60s. How do we stop an enrollee from not only becoming diabetic, but also not approaching pre-diabetic status?
The ACA's mandate on covering a list of preventive services does try to hit this problem, in that it forces all insurers into the "cooperate" part of the Prisoner's Dilemma for these services, since it is now illegal to "defect" and not offer those preventive services. More generally though, I think this bad incentive structure is holding back innovation in insurance- why don't we have plans that reward healthy behaviors? If I'm going to the gym regularly I get a discount? The insurance company can reward me now, but I may jump ship with my next job and the insurers won't get the payoff.
What kinds of services have your found in your work that could have long term ability to nudge the trajectories toward healthy old age?
That is a good question. It is difficult to assess this using any usable metrics. Most insurers seem to focus on preventive measures, annual wellness exams, and denying unnecessary testing or procedures. The denial rate ranges from vary greatly, according to a recent study with UHC at about 17% (higher than BC/BS or Elevance (former Anthem.) However, a study done about two years ago revealed that annual wellness exams are not productive, and the ROI is low. Perhaps the PAP smear, Mammograms, and colonoscopy are the highest in the ranking. Chronic illness is the major burden to insurers. Insurers are beginning to focus on nutrition and offer cash incentives but only to those below the poverty line. Although insurers are spending on marketing these aspects, how do we measure the results?
You're right that blanket prevention has mixed results. Annual wellness visits don't seem productive, even sometimes in the higher risk Medicare population. Using the word productive means implicitly there is some outcome we are basing it on, and I'm not sure we've nailed that down. What kinds of outcomes do you think people would want to pay for? What measures would we want to see encouraged by an insurance pamphlet so we could choose on it? Cholesterol levels? long-run BMIs in healthy ranges? Or something like the CVS near by house that claims "CVS customers are better at filling their prescriptions"?
Could you elaborate on what you mean by insurance companies focusing on preventive measures? Are you suggesting they cover these generously because they expect a higher ROI? If you're referring to more affordable coverage, I wonder how much of that is attributable to the ACA vs. being a true bet on ROI.
When I'm thinking of preventive actions with long term payoffs, I have in mind things like nutrition counseling, sleep interventions or checkins, smoking cessation and obesity programs that focus on time and counseling versus prescription solutions. All of these things move behavior and knowledge slowly over time, but you could imagine this nudges the trajectory of the patient over a 30 year period away from expensive comorbidities in their 60s. How do we stop an enrollee from not only becoming diabetic, but also not approaching pre-diabetic status?
The ACA's mandate on covering a list of preventive services does try to hit this problem, in that it forces all insurers into the "cooperate" part of the Prisoner's Dilemma for these services, since it is now illegal to "defect" and not offer those preventive services. More generally though, I think this bad incentive structure is holding back innovation in insurance- why don't we have plans that reward healthy behaviors? If I'm going to the gym regularly I get a discount? The insurance company can reward me now, but I may jump ship with my next job and the insurers won't get the payoff.
What kinds of services have your found in your work that could have long term ability to nudge the trajectories toward healthy old age?