Price is paramount to survival in the current healthcare market. With skyrocketing premiums, moving toward an affordable level
for both the employer and the employee/member is essential, experts agree.
"Many of the traditional cost management solutions have either run their course or are in the late stages of maturity," Brian
Dolan, executive vice president of ActiveHealth Management, a health management data analytics company based in New York,
says. "That's why innovative strategies such as personal health records, which are supported and driven by decision-support
technology, are becoming key differentiating capabilities for all health plans."
At Empire Blue Cross Blue Shield, President Mark Wagar, noted that this year, employers are purchasing products with higher
copay levels and/or increasing the employee contribution amount in an effort to control their costs. "We noted that some employers
are choosing to move away from open access plans and back to plans that require a gatekeeper in order to take advantage of
the cost savings that a gatekeeper provides," Wagar says. "The No. 1 challenge faced by all insurers is how to contain the
cost of healthcare premiums when the cost of healthcare services continues to rise."
For this reason, Empire Blue Cross Blue Shield provides its members with programs and tools which can help them lead healthier
lives and help to control rising healthcare costs. "For example, our HMO members have access to our 360° Health program, the
industry's first program to integrate all care management programs and tools into a centralized, consumer-friendly resource
that provides information to help them to access appropriate care," Wagar says. "Pilot programs at Empire have shown that
group customers achieved a 2:1 return on investment on all employees enrolled in the program." The 360° Health program is also available through Empire's CDHP products.
THE EFFECT OF HSAs
Using HSAs can further control costs and bring in the consumer-oriented perspective. HSAs will follow the trajectory of 401(k)s
in financial services, according to Shawn Jenkins, CEO of Benefitfocus, a provider of CDHC software and services located in
Charleston, S.C.
Jenkins predicts that there will be very slow adoption followed by education efforts, then early adoption by white-collar
workers, and eventually broad adoption by 10 years.
"Eventually, HSAs will be mandatory," he says. "Health plans ... perceive they will lose HSA business to banks. Luckily for
health plans, banks largely don't know how to properly capitalize on the opportunity. Health plans can do a better job, followed
next by financial services companies such as Fidelity or Vanguard, then individual banks."
According to Jenkins, CDHC cannot happen without integration. "Integration will bridge the CDHC islands of data healthcare
IT that promotes integation and self-service will be a critical element in delivering CDHC," he says. "The technology must
support related information that is segregated across multiple systems into one CDHC portal that supports not only consumers
but benefit administrators." Jenkins believes that a number of key interfaces must integrate to provide a CDHC solution:
- enrollment, renewals and consumer maintenance;
- personal health and wellness;
- personal healthcare finance planning and management; and
- provider payment authorization and payment events.
Tracey Walker is senior editor of Managed Healthcare Executive.
