Although health plans and employers recognize the importance of modifying risky health behaviors and managing chronic conditions, interventions tend to be "limited and piecemeal," according to a report by the Center for the Advancement of Health (CAH).
Health plans say they are reluctant to incorporate behavior change into their systems of care, in part, because of ROI ambiguities. On the other hand, few healthcare purchasers negotiate with health plans for specific behavior change services.
"Most employers or purchasers are unwilling to offer behavior intervention services directly to employees or negotiate for them separately with a health plan for fear of paying for these services twice," says Jessie Gruman, CAH's executive director.
The report is based on a 1999 survey of HMO medical directors in five states and D.C., interviews with public and private healthcare purchasers and an assessment of the scientific literature on health risk interventions in medical settings. According to the report:
- healthcare purchasers, providers and consumers have difficulty distinguishing effective risk reduction services from unproven ones; and
- many employers don't feel they have any leverage to negotiate for the type and quality of behavior change services health plans can offer members.
(CAH, Petrina Chong, 202/387-2829)