The health insurance program for West Virginia’s public employees is a necessary but expensive proposition. The Public Employees Insurance Agency projects expenses of over $1 billion annually for its nearly 220,000 members.
PEIA is continually trying to find ways to hold down costs, and thus keep premiums for the state and local government employees and the employer (taxpayers) from rising exorbitantly. (The state pays 80 percent of the costs, the employees pay 20 percent). One such effort is the Healthy Tomorrows initiative, which leverages PEIA members to take more responsibility for their health.
Active employees and non-Medicare retirees in PEIA’s self-insurance plans can sign up for Healthy Tomorrows during the current open enrollment period, which lasts until May 15. The program is broken down into three one-year cycles.
The first year, participants are required to establish a relationship with a family doctor. The following year, plan members must report to PEIA numbers for their blood pressure, blood sugar, cholesterol and waist circumference. In the final year, they have to bring those numbers into an acceptable range (waist circumference is excluded).
PEIA executive director Ted Cheatham says it’s surprising how many people don’t know the most basic information about their health. “There are a lot of preventable diseases—high blood pressure, high cholesterol, heart disease—and we want to make people aware of that.”
Previously, PEIA has tried to incentivize policyholders to take better care of themselves by offering cash rewards and premium reductions. That hasn’t worked, so now PEIA has decided to impose a penalty for those who ignore their health.
“If you don’t get active with your healthcare and don’t do certain things you could face a $500 increase in your deductible beginning in July,” Cheatham said on Metronews “Talkline.” There is one important caveat: A plan participant can avoid the penalty if they have a statement from their doctor saying the numbers cannot be met.
While the purpose of Healthy Tomorrows is to save money by making people healthier, Cheatham admits that initially costs may rise as policyholders learn their numbers and get treatment. However, “in the long term we’re trying to avoid strokes, people having to take insulin… we’re trying to avoid these long-term illnesses and get people healthy.”
Some PEIA members may feel as though the changes are a bit heavy handed. People are going to be forced to accept more personal responsibility for their health or it’s going to affect their pocketbook. But the plan makes sense.
West Virginia’s population is older and sicker than most states. We continually rank among the worst in the nation for debilitating and costly medical conditions such as diabetes and high blood pressure. Identifying the health risks earlier through Healthy Tomorrows should help prevent more serious problems later, as well as save the policyholder and the taxpayers from skyrocketing premiums.