In its ongoing quest for more commercial business in Massachusetts’ highly competitive market, Neighborhood Health Plan (NHP) said Nov. 7 it will soon begin broadly offering certain prevention, rehabilitation and drug-free pain relief treatments and prescriptions cost-free to members — and waive their out-of-pocket expenses for some alternative therapies to opioids. The new benefit design is being offered across several of NHP’s commercial plan designs for large employer group customers.

Not-for-profit NHP says it is the first health plan in the U.S. to offer such a comprehensive benefit design, aimed at eliminating financial obstacles that discourage patients from seeking treatments to mitigate or prevent some serious health conditions. The Massachusetts-based insurer similarly touts its program, launched in April — which proactively offers money-back guarantees on prompt, efficient customer service to new large- and mid-sized employer-customers signing up groups for coverage (HPW 4/24/17, p. 5) — as a unique strategy to grow its commercial line of business.

Under NHP’s new “Care Complement” program, copays are waived for 11 common prescription medications that treat chronic conditions, including high cholesterol, high blood pressure, heart disease and depression. In addition, members get access to preventive services at no additional cost, and cost-sharing is waived for certain pain treatments offered in place of opioid prescriptions. If patients and their doctors determine alternative pain treatments will prove beneficial, NHP will cover costs for up to six physical or occupational therapy sessions, six chiropractic visits and six acupuncture visits.

NHP Waives Pain Services Cost-Sharing

Cost-sharing is also waived for cardiac rehabilitation services to improve recovery after a heart attack, and for certain services that reduce the risk of complications from diabetes, including an annual routine eye exam, diabetic education and nutritional counseling. The benefit also includes care management teams to personalize care for members with chronic conditions.

Katie Catlender, NHP’s chief commercial officer, says the new benefit design basically builds upon the insurer’s efforts to be member-centric. “From pain to treatment of chronic conditions like diabetes — instead of talking about how do we address costs, we wanted to change the paradigm to change behavior,” she tells AIS Health. “The other thing we’re trying to do is help people save money and really remove reasons not to manage their conditions.”

NHP is looking at this from a broad vantage point, Catlender says, explaining that while the opioid crisis is “absolutely central to this,” the program extends beyond it.

She notes that NHP will pick up medication-assisted therapy office visit costs and certain prescriptions for members with a drug dependency, and also cover individual coaches to guide them through the recovery process. “We have priced this, it’s been vetted actuarially…and it won’t cost a lot of money [for recovery coaches],” she says. “And it really improves outcomes and prevents the costs of more complicated care.”

NHP introduced the new benefit design Sept. 1 with Plumbers Union Local 12, which has 3,000-plus members, Catlender says. For the rest of the commercial book of business, the insurer will offer it as of Jan. 1 on three HMO and three PPO products, she says, citing strong interest from employers and brokers.

“Innovations in the area concerning opioid addiction are certainly of high interest for the clients of our members. The design of NHP’s Care Complement shows early promise related to barriers to care for employees and their dependents,” says Kate Bardsley, executive director of the Massachusetts Association of Health Underwriters.

Joe Paduda, principal with Skaneateles, N.Y.-based consulting firm Health Strategy Associates, LLC, describes NHP’s approach for Care Complement as “smart.”

“It removes the financial factor from patients’ decisions about their care,” Paduda says. “While cost is not the only reason for avoiding care, it can be a significant obstacle for some. Helping patients effectively manage their chronic conditions will improve health status and keep costs down, benefiting the patients, their employers, and NHP as well.”

NHP ‘Makes a Wager’ With Plan Design

Anton Dodek, M.D., NHP’s chief medical officer, says the new benefit design will encourage members to work with their doctors and optimally manage their conditions, leading to better outcomes and improved patient satisfaction.

“We’re basically assuming some risk here,” Dodek tells AIS Health. “We’re making a wager this evidence-based approach, and [helping] people take advantage of these services, is going to save money in the long run.”

Dodek says solving the opioid crisis will need to involve multiple components. “As a health plan, we want to do everything we can do,” he says. Following enactment of a Massachusetts law limiting opioid prescriptions to seven days, NHP took it a step further and limited the maximum daily dose over the seven-day period consistent with the CDC’s recommendation. “So we’ve done what we can do around prescriptions. Now we want to encourage people to take advantage of non-narcotic alternatives,” he says.

NHP limited alternative pain therapies without member cost-sharing to the first six visits, “so it wouldn’t have an impact on premium,” he says. “We wanted to limit it to the number of physical therapy visits people use after injury,” and as a way “to discourage new pain sufferers from starting narcotics.” Chronic pain patients will get their first six therapy visits of the year without cost-sharing for now, he says, but over time, “We’ll look. It might make sense to expand to a higher visit count or add services.”

The Northeast Business Group on Health recently reviewed musculoskeletal disorders, a common condition for which pain medications are prescribed. “[O]ur view is that alternative therapies such as ergonomics training, pain training, physical therapy and others can be very beneficial,” says Candice Sherman, the group’s interim CEO. “Benefit design that incentivizes employees to seek alternative therapies rather than prescription medications that can lead to dependence is well worth considering.”

NHP Says It Meets Performance Targets

Similar to Care Complement, NHP’s performance guarantee program has “generated a lot of industry interest as well as interest from our customer base” — and resulted in an uptick of more than 36% in NHP’s quoting on new commercial business since the end of 2016, Catlender says.

“In the large group space, we’ve seen about half a dozen accounts take us up on our proactive guarantees…and last year, looking at NHP’s quoting volume, we had on average every month maybe 20 large group accounts,” she says. “Now it’s 100 large group accounts every month.”

Most of NHP’s growth this year has been in large group, “where we wanted it to be and where we’re focusing our investments,” Catlender notes. NHP, which is part of Partners HealthCare, an integrated health care system, reports a 23% year-to-date increase in large group plans. Of its 368,219 total members, 124,392 are commercial and the rest are in MassHealth Medicaid.

In first quarter of 2018, NHP will issue its first annual report on its performance against seven guaranteed customer-service measures, paying any refunds upon the employer’s annual group renewal, Catlender explains. Measures include answering 80% of customer calls within 30 seconds, resolving 88% of member issues during the first call, and accurately processing 90% of claims within 10 business days and 99% of claims within 22 business days.

First Contact Resolution Is Key Focus

As things now stand, NHP is meeting targets, Catlender says, “so no payouts are anticipated next spring.” She says the insurer is paying closest attention to first-contact resolution, because it is driven by direct feedback from members. “We hover around 90%; our goal is 88%,” she says.

“It’s good to hear NHP has met the customer service performance objectives; however, we don’t know if the guarantee was a significant factor in employers’ decisions to switch to NHP,” Paduda says. He said in April he wasn’t sure the metrics were the right ones, and he offered further caution recently: “Response times and the like are pretty much table stakes; employers will want a lot more, including demonstrable health status improvements….That’s where this is headed.”