Connecticut Health Enhancement Program (HEP)

Program Location: 
Hartford, CT
Payer Type: 
Connecticut State Employee Health Plan

Reported Outcomes


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.

Related News & Resources

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
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