Connecticut Health Enhancement Program (HEP)
Program Location:
Hartford, CT
Payer Type:
Other
Payers:
Connecticut State Employee Health Plan
Reported Outcomes
Description:
Connecticut State Employees implemented the Health Enhancement Program (HEP) in October 2011. HEP includes robust Value-Based Insurance Design (VBID) principles, including that HEP enrollees benefit from cost sharing reductions if they commit to: yearly physicals, age- and gender-appropriate screenings and preventive care, two free dental cleanings, and (as appropriate) participation in disease management programs. Specific guideline-based clinical services are required of HEP enrollees with diabetes, high blood pressure, heart disease, asthma, and chronic obstructive pulmonary disorder (COPD).
About 98% of the approximately 54,000 eligible Connecticut state employees and retirees voluntarily enrolled in HEP. After 15 months of follow-up, the Office of the Comptroller estimates that more than 99% of enrollees had met program expectations by complying with program requirements.
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Payment Model:
HEP enrollees pay lower premiums and lower out-of-pocket costs at the point of service than beneficiaries who do not elect to participate. Specifically, HEP offers enrollees:
- Exemption from a health insurance premium surcharge imposed on non-enrollees (savings of $100 per month)
- No deductibles (potential annual savings of $350 per person, up to $1,400 per family)
- Reduction or elimination of copayments for medication associated with the management of chronic medical conditions (savings of up to $25 per prescription fill)
- Copayments for diabetes drugs are waived. Copayments for cholesterol, blood pressure, heart disease, asthma, and chronic obstructive pulmonary disorder medications are tiered at $0 / $5 / $12.50 (generic/preferred brand/other brand) versus $5 / $10 / $25 for non-HEP enrollees.
- Elimination of copayments for office visits for chronic conditions (savings of $15 per visit)
- Incentive payments of $100 annually if a member with a targeted chronic condition, including his/her dependents, complies with all of the HEP requirements in a given year.
- A $35 copayment for emergency department visits when there is a “reasonable medical alternative” and the beneficiary is not admitted to the hospital.
Fewer ED / Hospital Visits:
- 22.9% fewer monthly ED visits
Improved Access:
- 75% increase in primary care visits
Cost Savings:
- 70% reduction in medical trend growth rate
Increased Preventive Services:
- Modest improvements in adherence to heart disease, blood pressure, cholesterol and diabetes medication
Other Outcomes:
- 20.8% fewer specialty care visits
Last updated July 2015
