Skip to main content

Wellness-Based Health Plans

Web Exclusives

Employers and health plans are examining strategies to confront the rising costs of medical insurance by lowering the costs of insurance without reducing benefits or compromising quality of care. One of these strategies is wellness-based health plans, which are designed to reduce the costs of health plans by incentivizing employees to pursue healthy behaviors, reduce modifiable medical risks, and stay healthy. For example, an insurance provider might offer low-cost group health insurance options to businesses whose employees engage in activities to maintain good health, such as losing weight, quitting smoking, maintaining low levels of blood glucose, reducing blood pressure, and lowering cholesterol. Others might assess a higher premium for individuals who engage in unhealthy or preventable behaviors such as smoking or lack of exercise. In this sense, insurers can design their wellness benefit with “carrots or sticks” to change behaviors.

Figure 1
Figure 1
Figure 2
Figure 2
Figure 3
Figure 3
Figure 4
Figure 4
Figure 5
Figure 5
Figure 6
Figure 6

As part of its monthly PayerPulse analysis, Xcenda conducted a survey of key decision makers from the Managed Care Network (MCN) to examine the current environment for wellness-based benefit designs. MCN is comprised of more than 100 US medical and pharmacy directors representing more than 190 million covered lives (www.mcnweb.com).

The survey was conducted in October 2009 and focused on the availability and characteristics of wellness-based benefit designs in the US commercial insured market. The following findings (Figures 1-6) represent responses from up to 60 MCN medical and pharmacy directors of commercial health plan payers who participated in the survey.

Last modified: August 30, 2021