Many premature deaths in the United States are due to unhealthy behaviors such as smoking, lack of exercise, poor diet, drug abuse, or risky sexual practices. HMOs could presumably help their members change some of these unhealthy practices. HMOs, in fact, are already making efforts in this area, but could do more, the Center for the Advancement of Health (CAH) in Washington, D.C., asserts in its Health Behavior Change in Managed Care: A Status Report.

The CAH surveyed 50 HMOs in five states and the District of Columbia. Most of these HMOs, it found, offer services to help members manage chronic conditions such as diabetes, asthma, cardiovascular disease, and depression, and such services tend to be fully covered. In contrast, HMOs do not offer as many services to help members relinquish unhealthy behaviors, and when members do take advantage of such services, they usually have to pay for them themselves.

What’s more, the CAH discovered, while most of the HMO medical directors surveyed think it is appropriate for HMOs to help members change their unhealthy behaviors, few of the HMOs actually offer members incentives to take advantage of their behavioral change services.

The CAH also interviewed 55 companies or labor unions that have purchased HMO coverage for their employees to see what they think about HMO programs for altering unhealthy behaviors. Most of these purchasers, the CAH found, think the HMOs should provide such services. However, most also believe that such services are already incorporated in the plans they have bought. Thus, they don’t want to pay extra for them.

In fact, the CAH reported, neither HMOs nor HMO purchasers appear to be very savvy at distinguishing between scientifically sound programs for altering unhealthy behaviors and those that are less scientifically based. Both need guidance in this area, the CAH concluded. For instance, the strategy that HMOs use most often to get members to change their health behaviors are brochures and pamphlets despite evidence indicating that the best health information is tailored in ways that match people’s learning preferences.

The CAH’s assessment of behavioral change programs at HMOs was funded by the Robert Wood Johnson Foundation.