A new health management program tries to close the gap on the health care continuum and dramatically impact claims costs. The program, FirstPath Advantage, was developed to reach health plan participants who have slipped through the cracks of the health care system before they experience a life-altering health event, which inevitably results in long-term chronic conditions and increased health care costs for employees and employers.

A departure from traditional health care programs, the system - which is HIPAA-compliant - is based on reaching out to people before they require chronic disease management and helps employees recognize dangerous, and often hidden, modifiable health risk factors.

A collaborative effort between FirstSolutions, based in Duluth, Minn., and BeniComp, Inc of Fort Wayne, Ind., FirstPath Advantage is designed to work alongside an existing health plan.

The two firms have a long history in the business. FirstSolutions, established in 1944, offers health management services including predictive health, disease management, case management, pharmaceutical management, care coordination, prenatal support, personal health advocacy and workplace wellness. Last year, its utilization management program saved customers over $7 million in health care costs.

BeniComp, Inc, established in 1962, has been featured in Employee Benefit News, American Banker, The Wall Street Journal, HR Magazine, Medscape and other publications for its innovative approach in providing solutions. BeniComp's approach is to help contain health care costs by addressing the impact of poor lifestyle choices.

The goal: predictive information

"People who are aware of their health status experience better overall health, resulting in fewer short- and long-term illnesses," says Joyce Mireault, VP of Health Management for FirstSolutions.

This awareness also helps employers by reducing health expenditures. "When people are healthier they are happier and more productive, company health care costs go down," says Joyce Mireault.

According to Doug Short, president of BeniComp, FirstPath Advantage combines voluntary biometric and online health risk screenings, incentives and personal outreach and coaching to assess health status and reduce the likelihood of major health complications in its participants. "The result is a predictive health program designed to immediately provide a return on company health care expenditures," says Short, "while improving the health of its employees."

Return on investment

According to Short, what sets the service apart is the integration of effective incentives, proactive outreach, and the ROI it offers.

In addition, the program can reduce the burden on employers faced with providing mandatory preventive benefits, which are part of the new health care legislation, by providing an ROI on health care costs. In effect, says Short, "an investment in FirstPath Advantage can easily be cost-neutral in the short-term, and provide a substantial return over several years."

Pilot testing showed 80%-90% of participants needing some type of active outreach for a health issue, many of whom were not even aware of a problem. Registered nurses provide coaching, education and support via phone and e-mail.

'Toolbox' approach

The FirstPath Advantage "health management toolbox" consists of seven elements:

1. an incentive-based wellness program, including screening for health risk factors and a health risk assessment

2. care coordination

3. case management

4. chronic and predictive disease management

5. personal advocacy

6. pharmaceutical management

7. prenatal management

These services are integrated into a comprehensive, turnkey worksite wellness process.

The system is also supported by a reporting function that graphically illustrates changes in health status.