Cigna is launching a new rewards program next year, targeting those who buy Affordable Care Act exchange plans. In this program, though, the rewards aren't tied to shedding pounds or joining a gym — instead, it focuses on teaching members about their insurance product.
"We had a tremendous number of people who came into an insurance product who had no familiarity with how insurance worked," Manish Naik, who leads the individual and family plans business for Cigna, told Healthcare Dive.
Consumers have always had an alphabet soup of insurance choices, but the options expanded under the ACA, giving more than 10 million consumers a chance to buy insurance on the individual market regardless of pre-existing conditions and separate from employer-sponsored coverage.
However, this new population was unfamiliar with insurance products and the confusing terminology that can come along with it, Naik said.
Cigna is the latest to use incentives to modify behavior.
Centene, the largest exchange insurer, offers a wellness program for its 2 million members who receive money for "taking charge of their health." The more a member does, the more money is applied to their prepaid Visa card, which can be used at Walmart and to pay a variety of bills, including utilities, transportation and rent. It can also be used on copays and deductibles.
A member earns $50 when they complete a wellbeing survey in the first 90 days of enrolling and $50 for going to their annual checkup with their primary care physician. The reward for an annual flu shot in the fall is worth $25.
"We offer our members incentive programs to encourage healthy activity, such as regular check-ups and routine screenings, to strengthen the relationships between members and their caregivers while promoting personal healthcare responsibility," Centene said in a statement.
Cigna plans to rollout the "Take Control Rewards" program in Florida, Missouri, Tennessee and Virginia after a successful pilot in select markets.
The messaging from Cigna is simple: Learn about your plan and you can get rewards.
For example, if members pick a primary care physician, they can earn points. Actions including visiting the doctor for an annual wellness visit, setting up a myCigna account, and watching short videos that explain basic insurance concepts generate points.
Members can exchange those points for items such as gift cards, movie tickets and Visa cards.
Cigna found new members in ACA plans weren't using their insurance. They would "buy a plan and never use it. They're afraid to make the wrong decision," Naik said.
Many would use the emergency room after waiting too long to receive care, Naik said, and it's a habit Cigna is trying to break with its new rewards program.
"We're trying to empower them to make decisions," Naik said.
A majority of those who shop on the exchanges have low incomes and receive subsidized coverage, or financial help, to afford the plan they choose. As prices have gone up, the unsubsidized population has fled the market.
The populations on the exchange are similar to those in the Medicaid population, or low-income individuals who qualify for state-run coverage.
Centene has used its exchange business to complement its core Medicaid business. It aims to keep Medicaid members who earn more and no longer qualify by attracting them to its Ambetter exchange plan brand.
Research has shown that low health literacy is associated with poor health. "Researchers also found an association between limited health literacy and an increase in preventable hospital visits and admissions," according to a previous report from HHS.
The numbers on health literacy are dismal. Only 12% of Americans have proficient health literacy skills.
The concept is particularly important as more Americans have "skin in the game" through high-deductible health plans that put them on the hook for more of their health costs.
Meanwhile, President Donald Trump's administration is rolling out a new ACA exchange wellness program that aims to reward members for improving their health or health-related behavior. For example, members could receive rewards such as lower premiums for losing weight. Though critics have slammed the demonstration project as an "end-run" around pre-existing condition protections.
Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University, warned previously on Twitter that insurers will be able to "jack up premiums for people who can't meet insurer-determined health targets."