Recent trends in health care hold two important lessons for employers: First, that one of the most promising ways to control rising health plan costs is to expand employees’ roles in making cost-effective health care decisions; and second, that such an approach works best when employees are equipped with the information and tools to make sound choices.
The move to shared responsibility is part of a broader trend of consumerism in health plans. This approach is at the core of a new breed of consumer-directed health plans, which bring together high-deductible insurance with a fund or account controlled by the employee. But increasingly, employers want to infuse elements of employee decision-making into other types of plans, including HMOs and PPOs. According to a recent Mercer study, nearly half of all large employers say that promoting consumerism is part of their health care strategy.
Through consumerism, employees are asked to make better health care choices, such as pursuing healthier lifestyles or working with their doctors to explore using generic drugs that are equivalent to the more expensive name brands. In addition to reducing health claim costs, this can improve productivity by reducing absenteeism, chronic illness and disability.
Employee-empowered
Rapid advances in information technology are making this new employee-at-the-wheel approach possible. Technology is transforming health insurance and the medical field in general, just as it has helped consumerism thrive in other parts of society. Think about the way we buy cars today — consumers use the Internet to access unbiased reports, peruse detailed pricing lists and pose questions in online chat rooms, all before they venture into a dealer’s showroom.
Employees are relying on their company’s health plan provider for the tools and information they need to take charge of their health care decisions. And increasingly, providers are coming through with a host of online tools and resources geared to the employee’s level of knowledge, not a doctor’s.
If you are reviewing your health plan with an eye toward introducing consumerism, take a hard look at the information tools offered by your provider. Ideally, they should provide resources in three key areas.
* Control. Generic plan documents and pricing lists are helpful, but employees want personalized health information and interactive tools. These should include online access to their health-related accounts, recent claim activity, actual drug and treatment costs and other details. Some companies also let employees view typical costs for a variety of drugs or medical procedures.
* Knowledge. As employees assess their health care choices, they need to know more about the medical issues they may face and steps they can take to reduce the severity or prevent them from occurring. Health plan providers should be able to provide access to a useful database of common conditions, medications, treatments and wellness activities. Such information allows, for example, someone at risk of diabetes to find out more about the disease, explore treatment options and link to diet and exercise ideas for diabetes prevention. Make sure that the source of the information is reliable. A well-informed consumer is able to communicate with his or her treating physician more effectively.
* Planning. As they move through their careers, employees may encounter life events that can complicate how they finance their health care. Starting a job, getting married, having kids or losing a job or a spouse can have a dramatic impact on the employee’s overall financial integrity. Some health plan providers offer access to financial-planning information that guides employees through such decisions as choosing the right plan for their needs and planning ahead for life events and their financial implications. Again, check to ensure that the information comes from a reputable source.
With so many health plan options — not to mention the employee health management tools highlighted — it may be wise to work with your insurance broker or consultant to analyze your choices. He or she will help you find a health plan provider that offers the right amount of decision-making authority for your employees, and the tools and information they need to become careful stewards of their own health care dollars.
Thomas J. Scurfield is vice president of sales and service for Aetna’s north central east region and is based in Cleveland. He has more then 25 years of experience working in employee benefits and holds both the Chartered Life Underwriter and Certified Employee Benefit Specialist designations. Reach him at (330) 659-8020 or [email protected].
