The state-financed health insurance program serving Arkansas state and public school employees, retirees, and their dependents covers approximately 130,000 lives. To help plan enrollees lead healthier lives, ACHI was asked to evaluate and propose health promotion and disease prevention strategies the health insurance plan could implement that would ultimately increase employee productivity and health, and manage the ongoing rise in related healthcare costs.  ACHI considered three critical and sequential components to garner support for linking financial incentives to premium payments: (1) awareness, (2) support, and (3) engagement.

Awareness: ACHI initially developed a Health Risk Assessment (HRA) for the State and Public School Life and Health Insurance Board for use within the state employee plan population. The HRA is used to increase member awareness of health-related lifestyle behaviors.  Members voluntarily self-report lifestyle behaviors in areas such as, tobacco use, obesity, physical inactivity, safety belt use, and binge drinking.

Support:  Upon completion, a wellness summary report is generated and provides members with important health information to assist in moving the member along a path of personal health management. The report provides resources within the health plan and across the state that the member can access if they chose to take a step toward improving their health.  The HRA also provides a means for compiling data to determine which unhealthy behaviors are most prevalent, and through aggregated analyses, documents costs incurred in order to support further investment in prevention and wellness initiatives. Additionally, in an effort to provide a supportive environment for improved health behaviors, the Board began covering evidenced-based preventive screenings at a $0 out-of-pocket cost to its membership. 

Engagement: To engage members in actively participating in this process, EBD provides financial rewards for healthy behavior.  Member’s monthly insurance premiums are reduced $10 per month for completing the HRA and additional discounts are offered to individuals with low-to-no health risks, as identified on the HRA. These financial incentives are not tied to the actuarial estimates of direct medical cost (i.e. indirect and direct medical cost of tobacco use). Instead, incentives were set to offer nominal financial incentives to those leading healthier lifestyles and thus assisting the plan in minimizing its future health care liabilities while enhancing the potential of engaging the members in managing their own health care.  In the future, additional personal behaviors reflecting engagement in risk-management strategies will be incorporated into the incentive program, (i.e. actual measured improvements such as weight reduction in obese individuals, or selecting into an approved health behavior change program).