Health care reform passed, but that doesn’t mean your health care costs are going down anytime soon. Healthcare inflation is still forcing companies to find alternatives. Consumer-driven health care (CDH) seems to be the only option gaining real traction, says Andrew Ceccon.
Ceccon, former chief marketing officer at A.D.A.M., a provider of healthcare content and benefits tools for employers, health plans, and healthcare organizations, is president of Ceccon Marketing.
What is Consumer Driven Health Care?
In the CDH vision, Ceccon says, employers offer programs that give employees real incentives to consume medical services wisely. People seeking medical care have a wealth of comparative data at their disposal, just like somebody shopping for a consumer good. Armed with data, they can buy the best brand (doctor, hospital, lab, etc.) at the best price for their situation.
In theory, then, the forces of capitalism would compel insurance companies and doctors to find a reasonable balance between quality of care and cost to please consumers and plan sponsors.
Not all of the puzzle pieces have fallen into place yet, Ceccon notes. To this day, the delivery of medical care simply ignores the rules of free markets. Nevertheless, high deductible health plans (HDHP)/health savings account plans (HSA) are making inroads.
So what can employers do? When you boil it down, says Ceccon, there are seven major steps employees must take to become true healthcare consumers:
- Get educated about their health plans
- Get support making plan decisions and enrolling
- Educate themselves on health and weliness
- Manage their health proactively
- Manage their health accounts prudently
- Evaluate the quality of healthcare providers
- Know what things costs in advance and negotiate when appropriate
Step One: Health Plan Education
The goal is to create enough awareness of how medical plans work to allow people to use them wisely.
What’s Required?
- Plan rules and costs
- Summary plan descriptions and other compliance documents
- Forms and links
What’s Desired?
- Multimedia education
- Communication articles
Step Two: Decision Support and Enrollment
The next step is to help employees choose their plans and elect them efficiently.
What’s Required?
- Plan comparisons so employees can evaluate plans
- Change communications to explain new plans or modified plan rules
- Enrollment forms or links to complete enrollment
What’s Desired?
- Web-based enrollment. Employees go to your portal and walk through a process that filters out only what they are eligible to elect.
- Personal guidance. Grasping the moving parts of a high deductible health plan (HDHP)/health savings account plan (HSA) has proved challenging. Companies need to conduct face-to-face meetings with employees to prepare them for the new world of CDH. They should offer personalized and interactive planning tools online to model scenarios.
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Step Three: Health and Wellness Education
The goal of making health and wellness information available is to give access to reliable, unbiased health information in context with benefits planning.
What’s required?
- Trustworthy information on conditions employees face
- Education on wellness to prevent such conditions and enjoy a higher quality of life
What’s desired?
- Visuals and videos. There are millions of Web pages filled with medical content, but images and videos are much more instructive teaching tools. Employers should seek to connect employees to highly visual health education.
Step Four: Health Management
Learning facts about health and wellness is a great start, but health management makes such information actionable on a personal level. The goal here is to encourage employees to actively manage their own well being.
What’s Required?
- Health risk assessments (HRAs). HRAs (done in person or online) generate information about potential risks that may lead a person to seek proper care.
- Symptom checker. Symptom checking software can list potential culprits and maybe save a doctor’s visit.
What’s Desired?
- Comprehensive guidance on conditions and wellness
- Medical decision support
- Personal health records
- Wellness programs
- Health coaches
- Disease management
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Step Five: Account Management
This pertains particularly to HSAs where the consumer/employee now has an account to spend. The goal for HR is to make it easy for participants to manage their money prudently.
What’s required?
- Education on how to use plans.
- Online access to account balances.
What’s desired?
- Calculators to estimate medical expenses
- Financial modelers
In tomorrow’s Advisor, steps six and seven—health care cost negotiation—and an introduction to a wellness program guide that has helped thousands to set up wellness programs.