BCBSMA 2012 Annual Report

Health and Wellness

In 2012, we continued to develop–often in collaboration with our employer partners–innovative, outcome-focused programs, tools, incentives, and information channels to promote prevention, health improvement and care management.

We added new programs designed to engage our members in making positive lifestyle changes in areas like physical activity, healthy eating, and tobacco-free living. Especially noteworthy is Healthy Actions, a program that offers individuals and small businesses the kind of wellness programs and incentives that were previously available only to large employers.

We refined our care management services, which focus on helping members with chronic, complex, or acute medical problems.

Our new Chronic Condition Management program includes a highly-trained team of clinicians and support staff that helps members better understand their chronic illnesses, and connects them to appropriate care management resources and wellness programs. We continuously evaluate our member population to identify high-risk members, so that our Care Management team can actively reach out with interventions that address potential health problems before they escalate, and thereby reduce costly emergency care and avoidable hospital admissions.

Care Management

Bown Family

Rich Bown and his wife, Arlene, had more than their share of health challenges in 2012. Midway through the year, a spinal infection caused Rich to lose all movement in his lower body and he had to be rushed to the hospital.
The infection was brought under control, but he still faced a long and grueling period of recovery and rehabilitation. It has been a difficult ordeal, says Arlene, but with ongoing help from a special care management team we set up to help patients like Rich, he is making progress.

The Bowns have been members for many years with coverage through the town of Middleboro where Arlene was a school teacher. Middleboro is one of 120 municipal entities that participate in an enormously successful, 20-year partnership between our company and the Massachusetts Interlocal Insurance Association (MIIA), a nonprofit corporation created by the Massachusetts Municipal Association. Overall, more than 55,000 people receive their health insurance through MIIA.

"When a community has Blue Cross, it shows that they care about their employees, because they're providing the very best..."


Last year, as part of an ongoing effort to improve both outcomes and affordability, we launched a comprehensive new care management program that includes a team of nurse case managers who work exclusively with MIIA members. One of those nurses reached out to the Bowns as Rich was starting his rehabilitation, and, over the course of the next few months, helped ensure that he was getting the most from his care and his coverage.

"Our Blue Cross nurse was a wonderful resource for us, and she was always available to answer my questions," says Arlene. "She

Care Management

really wanted Rich's recovery to succeed, and she took care of a lot of the details that helped get us through a very difficult period."

A key challenge for the Bowns was making sure Rich was getting the right level of rehabilitative care after his hospitalization. When our Care Management team discovered that Rich's condition prevented him from participating in the rehabilitation recommended for him, they brought his case to a Blue Cross medical director. Together, they collaborated with Rich's doctor and determined that he should be admitted to a long-term care facility until his condition improved. As a result, Rich received the right care in the right setting, and he was able to use his rehabilitation benefit when he really needed it most.
Geoff Beckwith, executive director of the Massachusetts Municipal Association points out that intensive care management is only one of many special services MIIA offers its members. "We focus MIIA on maintaining high quality while bringing economic savings and the best value to our membership," he says. "When a community has Blue Cross, it shows that they care about their employees, because they're providing the very best for the people who are teachers, police officers, firefighters, library workers, and public works' employees. That's a powerful statement they've chosen a company that's been innovating and providing families with health security for 75 years."

Healthy Actions for Small Businesses

ATI Systems
Wendy Trayers and Paul Pietro at ATI Systems.
The introduction of our Healthy Actions wellness program has presented individuals and small businesses with an effective new way to engage in health improvement. Healthy Actions participants can earn rewards of up to $300 for meeting personal health goals, and small businesses that offer Healthy Actions can be rewarded for employee participation and success rates.

"Blue Cross stepped up with a very innovative program," says Paul Pietro, chairman of Mid-State Insurance, an independent agency based in Worcester. "It's light years ahead of the competition." Pietro says that the simplicity of Healthy Actions makes it very easy to engage both employers and individuals, which is the key to a successful wellness program. "It's appealing to all types of businesses that are committed to workplace wellness, but
previously felt they were too small to take it on. I've signed up a high-tech company, a car dealership, a hotel, a newspaper, and even a junkyard!"

One of the companies that has enthusiastically embraced Healthy Actions is ATI Systems in East Boston, which specializes in advanced emergency warning, and mass notification systems and has 35 employees. "It's a great incentive for people to pay closer attention to their health," says ATI Comptroller, Wendy Trayers. "From the small business perspective, the cost is next to nothing, and if you get enough participation, you not only have healthier employees, but you'll also get a direct financial reward."

Healthy Actions for Small Businesses

"Blue Cross stepped up with a very innovative program. It's light years ahead of the competition."


ATI decided to split their premium-based reward with their employees in order to create an extra incentive, but employees who do not participate are not eligible. "I tell employees, you're the driving force behind our premiums, so we all need to have a hand in keeping premium costs down," Trayers says. Pietro stresses that the interest in workplace wellness is growing among small businesses, but "they tend to see wellness as an extra administrative burden that can only produce long-term benefits. What's unique about Healthy Actions is that it's simple to administer, and there are significant short-term rewards for both individuals and employers."

How Healthy Action Works for Small Businesses
  • To get started, a participating employee takes an online health assessment and schedules a visit with his or her doctor to document key health measures such as weight, blood pressure, smoking status, and record of preventive screenings.
  • If the doctor determines that the employee's health status is fine, the employee receives a $300 Visa debit card. If the doctor tells the employee to improve his or her health (for example, lose weight or quit smoking) the employee receives a $100 Visa debit card. If the employee achieves the health goal to the doctor's satisfaction, he or she receives an additional $200 Visa debit card.


  • Employers are eligible to receive a reward of up to five percent of premium charges based on their employees' participation rates and their success in meeting health goals.
  • The program also reimburses physicians for filling out the required forms and helping their patients set and attain wellness goals. There's a small initial cost to employers – a 0.3 percent increase in their premium charges.

Investing in Employee Wellness

Alkermes photo
Alkermes employees can use a workplace fitness facility.
Alkermes is a global biopharmaceutical company with a research and development center located in Waltham, Massachusetts, and manufacturing facilities in Georgia and Ohio. Shannon Smith, director of benefits and HRIS, and Jim Frates, chief financial officer, discuss how and why the company invests in employee wellness.

Shannon Smith: Our goal is to offer our employees the best in quality health care while trying to mitigate escalating costs. A few years ago, we made the decision to partner with Blue Cross to create a program with incentives for our employees to live a healthier, more balanced lifestyle. Out of this collaboration came the Wellness Incentive Plan, which offers employees financial incentives for participating in on-site biometric screenings, taking the Blue Cross health risk assessment, attending
nutrition and stress management seminars, and participating in physical fitness challenges.

We found Blue Cross to be a great partner in terms of our wellness objectives. We worked closely with their Wellness team to design a program around specific areas where we had high-cost claims–obesity, cardiovascular disease, joint degeneration, stress management, and smoking cessation. Because so many health problems are related to the lack of exercise and a poor diet, the program has a strong emphasis on nutrition and physical activity.

I think one of the biggest lessons is that there is no one-size-fits-all when it comes to wellness. Our manufacturing facilities in Ohio and Georgia and our corporate office in Massachusetts have three very distinct

Investing in Employee Wellness

cultures. Although there are some cross-over health issues that each site has in common, there are also some that are unique to each site. When thinking about program design, your wellness strategy has to be flexible enough to meet the needs of specific populations.

"We worked closely with their Wellness team to design a program around specific areas where we had high-cost claims."


The key to success with wellness-related programs is that they have to be meaningful and relevant to the employees in order for them to be motivated to participate. That's why we offer incentives throughout the year, and we are constantly promoting the program through emails, posters, and word of mouth.
And, as a team, we are always coming up with new ways to engage our employees. For example, we brought a chef and nutritionist to our Waltham facility last summer to hold a "healthy grilling" demonstration that focused on portion control, how to create a healthy barbecue sauce, grilling chicken and fish as an alternative to cheeseburgers, and reducing salt by using herbs to create more flavor. The session was a hit, with standing room only.

Jim Frates: Investments need to have a return. That return can take many forms, but it should be measurable. Unhealthy employees are less productive and more likely to be absent, and they are also more expensive in the long run when there's a major illness. That said, we know that the average tenure of our employees will be five to eight years, so we also need some short-term benefit.
Wellness programs that help employees stay healthy, exercise, eat better, and live a balanced life can create a more motivated and productive workforce. And I believe there's a benefit in having your employees see that the company values their wellbeing. Management can create an expectation that wellness will be part of the culture by offering healthy choices in the cafeteria and at company events, and by making visible investments in programs that support employee health.