In a nod to changing trends in the wellness industry, San Francisco-based insurer Blue Shield of California has built a new network meant to connect members with vetted community-based programs and digital therapeutics.
Done in partnership with Phoenix, Arizona company Solera Health, the program represents a major revamp of the insurer’s longstanding Wellvolution wellness platform that provides tools and resources to help members live healthier lives.
“We realized that that the old way of doing things, which was identifying a single point solution and putting that out to members wasn’t going to work,” said Bryce Williams, Blue Shield of California’s vice president of lifestyle medicine.
“There’s been so much innovation in community health and digital therapeutics that there was a real opportunity to build something different.”
There is growing body of evidence that the generalized approach taken by many employer-based wellness programs hasn’t worked as intended. A JAMA study published earlier this year found that access to wellness programs at BJ’s Wholesale Club had little effect on employees’ health outcomes and health spending.
“That study is just the latest in a long line of research that shows that the traditional worksite wellness model is all smoke and no fire,” Williams said, pointing to the facile nature of most programs and their tendency to lead to over screening and overprescription.
So how does Blue Shield’s approach differ?
When one of the insurer’s 4.3 million members enrolls with Wellvolution they are given a survey that asks what the individual’s goals are and how they prefer to receive care and support.
From there, users are given ranked options of potential digital or community-based solutions, as well as weekly action plans that provide a personalized guide to meet their health goals. If a certain application or tool doesn’t work for the individual, Blue Shield makes it easy to switch to a new program for no cost.
The idea is to offer consumers multiple solutions for the organization’s key focus areas which include cardio-metabolic disease prevention, diet and nutrition, smoking cessation, stress management and chronic disease reversal.
“It’s by design to offer people’s choice. You don’t need to look too far to understand how to be healthier. Stress less, love more, eat healthier, exercise and get some sleep, but how you go about it can be really quite different,” Williams said.
Solera and Blue Shield take on the burden of vetting and selecting digital applications for inclusion on the network based on consumer satisfaction rankings and well as outcomes data.
Currently, Wellvolution 70 distinct digital health applications from companies like Better Therapeutics, Betr Health and Virta Health. That’s in addition to 30,000 brick and mortar locations accessible through the platform including gyms like Crunch Fitness, community centers and weight loss clinics.
All of Blue Shield’s fully insured and self-insured members have access to Wellvolution and the company is looking to expand the program to the Medicare population next year.
The program launched a few weeks ago and Williams said the company has seen good uptake, with a few thousand members enrolling each week.
One positive early signal has been that around half of enrollees are signing up for higher acuity programs meant to address serious health risk factors, manage chronic disease or reverse chronic conditions.
An important part of the Wellvolution model is its outcomes-based payment scheme, in which providers on the network are only reimbursed for meeting certain benchmarks around engagement and helping members meet their health goals.
“We’re not batting a thousand, but a lot of the more forward thinking and innovative partners realize that the old model is not sustainable. You can just look at the consolidation in the wellness industry – and the companies going out of business – to see what the road to perdition looks like,” Williams said.
“We’re giving you an accelerated laboratory to help improve the lives of those we serve, but we’re not just going to pay you to show up like its kindergarten.”
The relaunch of Wellvolution builds on a collaboration established with Solera back in 2017 when the companies worked on building a network of clinically validated diabetes prevention programs for members.
As Solera broadened its focus from DPP and strengthened its relationships with health plans across the country, they provided the ideal partner for Blue Shield’s ambitions. The insurer took a stake in the company as a strategic investor in Solera’s $42 million Series C financing round earlier this year.
“Once you build the scalable technology platform its easy to add and scale up other clinical conditions, other risk factors and eventually down the road, social needs and social determinant plays,” Williams said.
Blue Shield’s strategy fits into a growing understanding within the industry that a successful benefit providers needs to have a pathway for integration with digital solutions.
In recent weeks CVS Caremark started a new Vendor Benefit Management platform dedicated to help its employer and insurer clients to manage new digital health tools and leading PBM Express Scripts announced that it was developing a standalone digital health formulary.
Photo: ipopba, Getty Images
