Integrated programme shows product innovation

By Peter V O'Brien

Friday 7th April 2000

STEVE GOLDBERG: A move away from indemnity products

Aetna Health chief executive Steve Goldberg has a succinct phrase to explain his company's approach to health insurance: "We are looking at wellness versus illness."

Aetna has produced a programme called Health Works, with the slogan "healthy people/healthy business."

The company's literature quotes a 1998 survey showing New Zealand businesses lost $3 billion in 1997 to absenteeism from illness and injury. The direct impact on business was an estimated 4-12% of payroll but the indirect cost was likely to be much higher.

Aetna said its Health Works (which seemed to incorporate three apparent puns in the same expression) was "the first comprehensive workplace health and safety programme designed to combat the effect of employee injury and illness on large organisations."

It said overseas experience had proved integrated benefit programmes such as Health Works created a healthier workforce and saved companies money.

The concept was based on a five-point plan:

disease management;
health promotion;
health insurance;
injury management; and
injury prevention.

Mr Goldberg told NBR Personal Investor there was a move away from indemnity products and, if they were the only products in the market, new products were needed.

In the area of disease management, Health Works identified candidates by self-assessment or self-referral, or a company's human resources department may refer them after a pattern of absence from work.

"Once an employee, who may have asthma, diabetes, lower back pain or heart disease, is identified we invite them to enrol in the Health Works disease management programme. Participation is voluntary and all personal information remains strictly confidential."

The company noted that asthma, diabetes, heart disease and lower back pain were all chronic conditions having a profound impact on employee welfare and business costs.

Aetna assessed the severity of the employee's condition, after explaining the programme, and chose the appropriate level of programme.

A Health Works team was available for members who could benefit from improved management of their condition. It included a general practitioner, practice nurse and care manager who worked in consultation with the employee's own GP to improve the health outcomes.

The programme complemented, but did not replace, existing care and the member's GP always remained involved with Health Works activities.

Enrolled members of the disease management programme received printed materials tailored to their specific condition (including correct use of medication or equipment and lifestyle advice to reduce health risks) follow up and support from care managers and links to organisations and local resources to help manage the condition.

Health promotion involved provision of information related to health eating, facts about smoking, guides to physical fitness, flu vaccinations and preventive screenings.

The company said its health insurance included reimbursement for GP visits and laboratory and x-ray testing, as well as the usual benefits of hospital and surgical care.

"The reasoning behind this is simple: we want members to have routine health checks and to visit their GP at the first sign of a problem. The sooner they receive treatment, the less severe complications are likely to be and the less time they will be off work."

Aetna's injury management and injury prevention programmes were based on operations that included delivery of benefits under the workplace accident legislation enacted under the previous government.

The government's renationalisation of accident insurance may have altered the structure of those operations with a consequent change to Aetna's activities in the accident area.

Health Works is obviously an employer/workplace insurance programme and, as such, equally obviously comes at a cost, as does any system, whether traditional indemnification health insurance, income protection or other scheme.

Aetna's programme is another indication the field of private healthcare and insurance is dynamic, rather than static, with the scheme providers in all categories regularly refining their products to meet market needs and to keep an edge on their competitors.

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