The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who
counsels them on controlling their diabetes.
What's ironic is that the same insurer will pay $315 for a single session of dialysis.
Control, choice and information are the drivers of consumer-driven healthcare (CDHC). Employees are becoming modern-day healthcare
consumers before our eyes. They recognize that the market-driven healthcare system puts them in charge.
Hewitt Associates has found that on average, more than 56% of all employees at companies who were offered a consumer-driven
customized design plan for 2005 enrolled in it, up from 50% in 2004. Employee interest in consumer-driven healthcare plans
continues to increase with enrollment expanding. While this expansion shows a promising future for CDHC, CEOs are still faced with the challenge of controlling costs while
addressing employees' top healthcare concerns. Savvy leaders are encouraging members to move into high-deductible plans and
offering Health Reimbursement Accounts (HRAs) and Health Savings Account (HSAs) to make the process easier. The transition
might not reduce members' costs in the short term, but it lays the groundwork by helping them accrue funds to use when unplanned
expenses occur in the future.
In addition, many plans offer education tools that enable employees to make informed decisions about their healthcare and
the dollars they spend. The most popular tools include the following:
- Health plan comparison charts—these allow employees to compare the coverage and cost for different health plan options.
- Provider directories—directories inform and educate consumers about which doctors and hospitals are included in each plan.
- Healthcare cost summaries—claims information shows employees their total healthcare expenses.
- Healthcare spending account estimator—allows employees to model healthcare expenses and make recommendations on the amount
that should be contributed to a flexible spending account.
Research indicates that 90% of employers greatly depend on these tools; it's no wonder that employee education and behavior
change is essential to the employer's cost-containment goals.
As out-of-pocket costs increase, the value of HRAs and HSAs will become even more obvious. A lack of information for managed
care consumers made it difficult for them to understand many healthcare issues, even before CDHC options appeared on the market.
Consumer education and awareness of the little things can improve the members' experience. This positive experience will
go a long way in assuring the ultimate success of a CDHC plan.
One health plan executive described his company's approach this way: "We decided to begin with an integrated solution to account
setup because it gives our members the benefit of one-stop shopping. We were able to reduce our account set-up time from 45
days to seven days; therefore, it gave our members access to their cash accounts much more quickly. We've also given our members
a debit card, so they can pay for some items at the point of service."
Future market leaders will need to educate their members and provide them with the tools they need to become effective healthcare
consumers of tomorrow. The job for CEOs is to ensure their employees have the tools they need to make those decisions easily
and effectively.
Kathy McAleer, a veteran in the rapidly growing field of consumer-directed healthcare, is vice president of operations for
QCSI's MyHealthBank product line.
