Background: A large proportion of health status is determined by personal behavior. One manifestation of unhealthy personal behavior is the development of elevated cardiometabolic risk. Because health plans already manage care for a large proportion of the United States population, they are in a position to make a significant contribution to the control of cardiometabolic risk if they are prepared to offer health assessment, feedback, and behavior change support. Our goal in conducting this research was to assess health plan awareness of cardiometabolic risk and their current activities aimed at preventing and managing cardiometabolic risk.
Methods: In January 2008, Americas Health Insurance Plans, in collaboration with the HealthPartners Research Foundation, surveyed 74 member health insurance plans that offer commercial Health Maintenance Organization, Point of Service and Preferred Provider Organization insurance. The response rate was 47%, representing 47 million lives.
Results: The 35 responding health plans reported that they identify members with cardiometabolic risk through referral from case or care management (89%), health risk assessment data (86%), claims data (82%), and pharmaceutical utilization data (79%). Nearly all (97%) plans currently offer interventions for tobacco use, obesity/overweight, and nutrition. Ninety-four percent of the plans reported that they offer interventions to increase physical activity. All plans reported that they offer health risk appraisal or assessment with feedback and education, 91% reported that they use web-based tools, and 85% reported that they use health coaching to help plan members lower their risk. Perceived barriers to broader implementation of cardiometabolic risk control programs included lack of resources (79%), limited availability of enrollee level data (74%), and lack the reporting systems that would be necessary to manage individual plan members (79%). While one-quarter of the responding health plans viewed lack of purchaser interest in cardiometabolic risk management programs as an important barrier to program implementation, only 6% named lack of purchaser interest as one of the three most important barriers to implementation.
Conclusion: While the responses probably represent the best case scenario because of potential response bias, US health plans appear to be well positioned to provide cardiometabolic risk control services.