Health & Medicine

A health plan that pays for Weight Watchers, gyms? Why this California insurer has it covered

Blue Shield of CaliforniaÕs program coordinator Kim Stotler poses for a portrait with the new Wellvolution platform from Blue Shield, Wednesday June 18, 2019, at the office in Rancho Cordova, Calif. SheÕs been using the Betr Health app to guide her eating habits and health routines.
Blue Shield of CaliforniaÕs program coordinator Kim Stotler poses for a portrait with the new Wellvolution platform from Blue Shield, Wednesday June 18, 2019, at the office in Rancho Cordova, Calif. SheÕs been using the Betr Health app to guide her eating habits and health routines. Lacy Atkins/Genesis Photos

Blue Shield of California is getting rid of the one-size-fits-all wellness program and offering choices to help members who want to tackle their health challenges through lifestyle changes rather than prescription medicines.

Would you like to try Weight Watchers to help improve your diabetes? Well, Blue Shield and Weight Watchers have worked out a deal that covers the cost of that.

Would you like to try one of several digital applications clinically proven to help lower blood pressure? Blue Shield’s medical team has vetted a number of them that have done so, and the insurer has arranged a pay-for-performance agreement with them that allows the insurer to cover the cost of members’ participation.

Do you think a gym membership would put you on track but you just don’t have the dough to cover a membership? Blue Shield has arranged a discounted rate for its members with gyms such as Fit Republic, Planet Fitness, Anytime Fitness and Crunch Fitness.

“The evidence is as clear as day that, for most health risk factors and most health conditions, changes in diet and lifestyle are often the most clinically effective, most cost effective and least invasive option available, not just to prevent disease but to treat and in many cases to reverse disease,” said Bryce Williams, Blue Shield’s vice president for lifestyle medicine. “But it’s also the most underutilized and under-prescribed option. In our universe of health care in America, there’s a pill for every ill.”

Williams said he doesn’t believe that is the way most people want it. The problem, he said, is that neither the medical system nor the wellness industrial complex is giving Americans a way to access affordable evidence-based programs that can help them achieve the lifestyle changes they need to improve their health.

Blue Shield didn’t want to create another take-it-or-leave-it wellness program or start out crafting a new program with the same lengthy questionnaire that focuses on ferreting out people’s bad habits, Williams said.

“We flipped the script,” he said. “When you enter, we have 10 short questions that ask you what you want to do. What are you interested in? Are you interested in reversing diabetes? Are you interested in losing weight? Are you interested in being more physically active? Are you interested in getting off your blood pressure medication? And, then there are questions about how you want to do that. Do you want to do it in person? Do you like group-based classes? Do you want to do it individually? Would you like to do it on the phone or over the web?”

Blue Shield uses its members’ answers to match them with the programs that best fit what they would like to do. Members are shown the best fit for them and a list of options, Williams said, and if they don’t agree with any of the suggestions, they can go shopping on their own from all the programs offered in the Blue Shield Wellvolution marketplace.

Through Wellvolution, Williams said, the insurer’s members can choose from more than 30,000 brick-and-mortar services such as Weight Watchers, gyms and community centers, and nearly 70 digital health programs. If a gym doesn’t work for them, he said, they can visit another one, and if the digital app they chose isn’t the right fit, they can pick a different one.

“The switch should be frictionless, unlike a lot of other plans who say, ‘Here’s your program. I hope you like it. Our flavors are vanilla, vanilla and vanilla,’” Williams said.

Blue Shield employees got to check out the choices before the program was introduced to Blue Shield members earlier this month. Kim Stotler, who works for the company in Rancho Cordova, decided to complete the quiz and see what programs got matched to her. She ended up going with Betr Health because she was looking to lose weight, she said, and many of the testimonials were from people who had notable success.

Stotler started working with the company May 13 and has lost 21 pounds: “I was on medicine for acid reflux and I’m no longer on that,” she said. “It only took about two weeks of doing this program to get rid of that.”

To stay on track, Stotler touches base daily via instant chats with a personal health coach assigned to her by Betr Health. She sends in photos of what she eats, she said, but the health coach doesn’t respond with lectures about calories. Rather, Stotler said, the coach provides information about how food choices will affect her nutritional health. There are also weekly chats with a physician at Betr Health.

The program has restricted Stotler’s diets to certain types of foods, and that has required her to invest more time in planning meals, shopping for ingredients and preparing the meals. But she said all that hard work has been worth it because it’s paid off with weight loss.

She has become something of a cheerleader for Betr Health, noting that the U.S. Centers for Disease Control and Prevention recently announced that the company had consistently demonstrated that its programs helped with diabetes prevention.

Williams said Blue Shield is being very intentional about how it introduces the program to its members, emphasizing that they are “as close to prescription medical services as you can get when it comes to diet and lifestyle.” Rather than taking medicine for the rest of their lives, he said, members have to build lifetime habits that will ensure their good health.

Blue Shield trusts that its members want to live a happier, healthier, longer life, Williams said, it is trying to give them options to achieve that goal.

“We won’t expect you or demand of you to succeed all the time every time,” he said. “Even I who teach this has fits and starts and back-and-forths, right? What’s important is you start to build a habit in your mind, so that you have something to go back to. If something doesn’t work, you can try something different. That’s the message we’re trying to get out to everybody.”

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Cathie Anderson covers health care for The Bee. Growing up, her blue-collar parents paid out of pocket for care. She joined The Bee in 2002, with roles including business columnist and features editor. She previously worked at papers including the Dallas Morning News, Detroit News and Austin American-Statesman.