Consumer-directed health plans
(CDHPs) continue to gain momentum in the marketplace. More and more businesses are turning to these
plans as a way to reduce costs and help
employees become better health care
consumers. As a result of this shift, nearly 10 million Americans are now covered
by some form of a CDHP.
As employees take a more active role
in managing their health benefits, it is
both important and necessary to provide
them with tools and information about
health care costs and quality to help
them make informed decisions that are
based on overall value.
“Integrated data and information tools
empower consumers to make more
informed and responsible health care
decisions,” said Bill Berenson, senior
vice president of sales and service
for Aetna’s Small and Middle Market
Business for the North Central Region.
“Research shows that with helpful information and support, consumers are
more likely to demonstrate the kind of
behavior that leads to better health outcomes and reduced health care costs.”
Smart Business spoke with Bill
Berenson about the offerings and information tools that support member
engagement.
What are some of the keys to member
engagement?
To promote member engagement you
must first provide the price information
that members need to be good consumers. Through price transparency,
members know what they can expect to
pay for health care services before visiting the physician or hospital. This information can help members manage their
annual out-of-pocket expenses and
make better decisions about how to use
their benefits and insurance plans.
You must also recognize that many members prefer to base their health care decisions on overall value and not simply on
price alone. As a result, insurers have
expanded their efforts to provide members
with information on the clinical quality and
cost-efficiency of physicians. Performance
networks recognize physicians who perform well against a number of clinical and
cost measures, which can result in
improved access to quality care that may
be more cost-effective for employers and
their employees.
Are there other ways health plans can support member engagement?
Yes, a variety of tools, programs and
services are available. A Personal Health
Record (PHR), for example, can promote better informed and better coordinated care by organizing a member’s
health history information in a single,
portable online file. In many cases, medical and pharmacy information is added by the insurer. However, the member
can further enhance the PHR, adding
personal information like family history
of disease, over-the-counter medications
taken and allergies.
Wellness programs, on the other hand,
can promote healthy behavior by offering employees a wide variety of services,
such as discounts on memberships at fitness clubs or home exercise equipment,
weight loss or weight management programs, smoking cessation programs, and
discounts on alternative health care
options. These discount programs are
not insurance but are free, added features to many insurance plans.
How can employers foster member engagement?
Communicating the major features of
CDHPs to their employees is just the
first step. It is essential for employers to
keep members engaged after enrollment
and support employees throughout the
plan year so they can get the most from
their new plan. Employers should find
an insurance carrier that provides best-in-class, secure interactive tools that
allow members to access their own personal data and find other relevant
health-related information, such as price
and performance comparisons between
doctors and hospitals.
As employees are asked to be more
involved in their health care decisions,
they need to be able to make educated,
informed choices. Giving them the
resources to do so is one of the building
blocks of consumer-directed health
care.
BILL BERENSON is senior vice president of Aetna’s Small and Middle Market Business for the North Central Region. Reach him at
(312) 928-3323 or [email protected].