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Smart Benefits: Healthcare Reform Drives Coverage Innovation

Monday, June 25, 2012


While the road to healthcare reform awaits its next turn at the hands of the Supreme Court, coverage is demonstrating real innovation.

Next week, the Supreme Court will announce its decision on healthcare reform’s individual mandate. And there are three possible outcomes:

  • The individual mandate will get repealed, with the rest of healthcare reform to follow
  • Parts of healthcare reform will be preserved
  • The individual mandate will be upheld and the other healthcare reform provisions will continue to be rolled out in stages between now and 2017


For employers who offer health insurance, and for employees who share in the cost of it, regardless of the healthcare reform outcome, the issue remains how to make coverage more affordable right now.  And there’s good news on that front.  Health insurers are expediting product innovation, announcing more cost saving options in the last couple of years than in the previous decade.

Carriers Get Creative

All three carriers in Rhode Island, BCBS, Tufts and UnitedHealthcare, offer new products that, while unique, share a theme:  focus on preventive care, improve the patient-doctor relationship, steer consumers toward higher quality/lower cost care and improve care outcomes – all designed to keep future costs in check.


Vantage Blue

Vantage Blue is a Value Based Health Plan that aligns benefits and incentives based on need. Copays are lower for certain disease conditions like diabetes, asthma or chronic pulmonary disease so that cost doesn’t interfere with access to care.  All members who complete personal health assessments receive $50 Visa gift card incentives. And preventive care is covered at 100%.

Lifestyle Blue

Lifestyle Blue is aimed specifically at small businesses – the first of its kind in the state. Lifestyle Blue offers three plans depending on a member's life stage. The first plan, On Your Own, is designed for young, active and healthy employees. Family Matters targets employees with families who need quality healthcare. And the House To Yourself plan is suited for empty nesters.

While the three plans offer different deductibles, urgent care, and emergency co-pays, including varying prices for prescriptions, employees pay the same rate regardless of the plan they choose. None of the plans have co-pays for primary care visits assuming the physicians used are designated as patient-centered medical homes (PCMHs). And built-in wellness incentives can be used to offset deductible expenses.


Your Choice HMO

With Your Choice Tiered Network, employees must choose a primary care physician (PCP) from the Tufts Health Plan Your Choice Tiered Network. The PCPs are grouped into two benefit tiers based on cost and quality measures, with those in Tier 1 having the lowest cost share for members. In most cases, a member’s PCP must give or refer their care.



Navigate is a suite of health insurance products built on the fundamentals of patient-centered care, with the goal of enhancing the patient-doctor relationship to promote better health and lower costs.

All Navigate plans provide well-rounded coverage for many services, including preventive care and an array of health and wellness resources, such as the Online Health Assessment, Personal Health Record and Online Health Coaching modules.

And while the savings vary from employer to employer, all the plans may cost members as much as 8-10% less than more traditional types of plans.

Regardless of Decision, Options Remain

These insurance carriers have showed their commitment to the marketplace with the investments they’ve made in these products. And by emphasizing the importance of preventive care, the primary care relationship and improved health outcomes, their efforts are likely to be around for a while, even if healthcare reform isn’t.

Amy Gallagher has over 19 years of healthcare industry experience.  As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.

For more health and business coverage, watch GoLocalTV, live every day at 4pm, and on demand 24/7, here.


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