Shortly after Dr. Judith Monroe moved into the commissioner's office of the Indiana State Health Department in March
2005, her phone began to ring with calls from WellPoint Inc.'s offices less than two blocks away.
WellPoint, Indiana's largest health insurer, surprised the state's new health commissioner with its eagerness to help out on public health projects.
"I probably was surprised. It was a pleasant surprise," said Monroe, a former family doctor. She added that WellPoint has been one of the department's most willing partners during her tenure.
Now, WellPoint is making more noise than ever about what it's doing to help improve Hoosiers' and Americans' health. With state governments and presidential candidates proposing significant health care system reform, all health insurers are eager to show that they do far more than pay claims and rack up profits.
"Being active to improve people's health certainly will burnish their image as a good corporate citizen and in the eyes of lawmakers," said Paul Ginsburg, president of the Center for Studying Health System Change in Washington, D.C.
In November, WellPoint publicized a state-by-state health ranking it compiles, and listed its public health activities in 14 states, including Indiana. The State Health Index ranked Indiana No. 43 among all states, and identified three areas as a "road map" for future efforts here: reducing smoking and the rate of low-birth-weight babies, and increasing the number of adults who receive influenza immunizations.
While WellPoint has been compiling the ranking for years, and sharing it with government and industry officials, the company decided to publicize it this year because it "didn't really gain the traction," said Dr. Sam Nussbaum, WellPoint's chief medical officer.
"As an industry, we do not have a reputation for making a difference in health care even though our programs really do," Nussbaum said in an interview.
WellPoint is funding these public health efforts through the WellPoint Foundation. The foundation gave out $20 million in grants this year, most of them directed toward public health.
In 2007, the company is on pace to earn more than $3 billion in profit.
WellPoint is not alone in its public health efforts.
Minnesota-based UnitedHealth Group has published a state health ranking since 1990. It was a little kinder to Indiana this year, ranking the state's health No. 32 in the nation.
UnitedHealth is giving $100 million over 10 years to community and health organizations around Minnesota to improve the quality and availability of health care, as well as educational and community welfare services. It's an effort designed to "create sustainable improvements in health, education and well-being in the state," according to a program description on the company's Web site.
Louisville-based Humana Inc. passed out $500,000 in five major cities last year to support health care services, as well as arts and culture, education, and community development. In addition, Humana and its employees give nearly $100,000 a year to the March of Dimes, which supports moms with premature babies.
Other major insurers, such as Hartford-based Aetna Inc. and Philadelphia-based Cigna Corp., have similar programs.
Health insurers have multiple reasons to support these programs, industry observers said.
On one hand, large insurers such as WellPoint, which has an industry-leading 35 million customers, say they can mine their massive databases for helpful information that doctors and even large hospitals just don't have.
"Health systems and hospitals--they're embracing these models," Nussbaum said. "They're saying, 'Thank you. Thank you for this information.'"
At the same time, boosting public health can boost the company's bottom line. Particularly for WellPoint, whose Blue Cross and Blue Shield plans boast as much as 40-percent market share in some states, improving statewide health means fewer claims, lower costs and higher profit for the company. Reducing costs is particularly important for WellPoint as its customer growth has slowed in recent years.
"They try to do things that are ultimately in their best business interests," said Michael Wroblewski, project director for consumer education at the Consumers Union in Washington, D.C.
But the future of health insurers' business is likely to depend more and more on taxpayer-funded health insurance.
Multiple states have passed laws and set aside tax dollars to pay for health coverage for some of the uninsured. Indiana's Legislature raised cigarette taxes this year to pay for health savings accounts for 132,000 Hoosiers.
At the same time, Congress has been trying to increase spending for uninsured children through the State Children's Health Insurance Program. And federal spending is likely to accelerate if Sen. Hillary Clinton, one of the leading Democratic candidates for the presidency, is the next occupant of the White House.
"The more people insured, the better it will be [for health insurers]," said Les Funtleyder, a stock analyst of health insurers, or managed care companies, at Miller Tabak & Co. in New York.
Already, government spending on health care has inched up from 44 percent of all health care expenditures in 1993 to 47 percent last year, according to the Centers for Medicare and Medicaid Services. By 2016, the agency expects, government spending will account for 49 percent.
Health insurers don't mind that trend, but they don't want to see profit caps placed on them. WellPoint opposed such a proposal made by California Gov. Arnold Schwarzenegger. And Clinton has included a similar proviso in her health reform plan.
The good news for health insurers is that none of the leading candidates has proposed a single-payer system of health insurance, which would most likely turn health insurance companies into merely claims processors, with far more limited profit potential.
So shaping government expansions of health insurance is now more important than ever for health insurers.
"If you believe, as I do, that government will become a more important part of the managed care revenue base," Funtleyder said, "these types of [public health] initiatives will become more important to managed care companies."
'Right thing to do'
Nussbaum acknowledged that WellPoint's efforts to boost public health could buttress its standing in Washington, D.C., and state capitals. But he emphasized that the insurer's larger motive is to work to improve health because "we really want to make a difference in our communities" and "it's the right thing to do."
"The people that benefit the most are the citizens of the state," Nussbaum said, adding, "just paying claims does not get you to improved member health."
Consequently, WellPoint is providing claims data from its massive database to fuel quality-improvement efforts at the Indiana Health Information Exchange in central Indiana and the Kettering Medical Center in Ohio. The company is working with hospitals in several states, providing them data and offering them incentive payments to help improve quality.
In addition, WellPoint is trying to encourage electronic prescribing by giving computer equipment and other help to doctors. WellPoint put $1 million behind that program this year, which is focused mainly in Ohio and New Hampshire.
In Indiana, WellPoint's Anthem unit has been one of the main sponsors of the state's worksite wellness program, known as INShape Indiana. Also, it is working with the state to encourage Hoosier smokers to quit.
"I've found them to be ready partners for things like that that are communitywide," said Monroe, Indiana's health commissioner. She added, "I think they're genuine individuals. They're also in the insurance business, and they see the benefit of this."