How does behavioral economics play a role in HMSA member consumer engagement?

We've been working closely with Drs. Volpp, Navathe, and Emanuel to design provider reimbursement models and a system of care that would leverage behavioral economic principles to optimize consumer engagement. This includes a pilot for a joint provider member incentive to improve A1c values for members needing help with blood sugar control. We've also more recently begun working with the CHIBE team to help us think through how plan benefit designs might be altered to drive optimal use of health benefits. Finally, we are leveraging the power of the smartphone to drive consumer behavior by launching an "all-your-health-in-one-place" app (Sharecare) that implements behavioral tools that are critical to engaging consumers.

In what ways does HMSA’s payment transformation initiative change primary care provider payment in Hawaii? Have any other states moved in a similar direction already?

We've completely re-engineered how our primary care providers are reimbursed. Payment transformation moves us almost completely away from the volume-based fee-for-service (FFS) payment model to a global monthly payment that allows providers the flexibility to care for their patients without constraints of FFS billing. This global payment is affected by panel size, panel risk, quality performance, and total cost of care.  First and foremost, we are now paying for value (access, quality, and resource utilization) rather than volume of service.  In addition, by providing more stable revenue, we are furthering our goal of a creating a sustainable community health system that prioritizes the well-being of patients. 

We believe that primary care is so foundational to health that it was important to start payment transformation there. As far as we know, no other state has made these kinds of large scale changes to primary care reimbursement. 

How could other insurance providers learn from the experience of HMSA in applying behavioral economics to health care? Are there any ‘lessons learned’ you’d like to share? 

Change is hard for most, and perhaps harder still when it comes to changing a revenue methodology that's been in place for decades. Those who embraced the change and ran with the new model have unsurprisingly been the most successful in the pilot. Good communication, proper message framing, and multiple opportunities and avenues to understand the new payment model were important.  It was also critical that we phased in the program, allowing for time to learn from and respond to feedback from providers before expanding the program to its current scope. At present, 93% of our primary care providers and 98% of our membership are benefiting from payment transformation.