Passing additional financial responsibility for their health care to employees — more premiums, higher co-pays, higher deductibles and coinsurance
— has stimulated the concept of health
care “consumerism,” according to James
Repp, Corporate Head of Sales for AvMed
Health Plans.
“For an employer to require additional
financial responsibility without giving (his
or her) employees the proper support is
irresponsible,” says Repp. “Providing them
with the proper health care information
will help them spend their out-of-pocket
money more prudently.
“Consumerism starts with an awareness
that quality, cost and service vary. And responsible employers should be urged to
provide resources so that employees are
better armed to make decisions.”
Smart Business spoke with Repp about
how certain services can educate employees and also stimulate them to improve
their health and well-being.
How can the Internet help?
If you start at the most basic level, the
Internet is a tool to provide access to
claims information, like how employees
stand relative to their deductibles and their
coinsurance limits. Such Web sites can also
demonstrate the value that the health
insurer brings through their network
arrangement — not only the bill charges
but also the actual negotiated rate that the
employee has to pay.
Some interactive Web sites also provide
general health information. Patients can go
online and enter in a specific disease or
procedure, and as you navigate through
those topics, the site asks additional questions. It then walks them through alternatives to the disease or procedure in question and lists questions that can be asked of
the physician.
What if a person can’t access the Internet?
One of the missteps that a lot of health
care carriers have made is that they’ve
almost exclusively driven their consumerism platform through the Internet. The online tools are very important, but they
shouldn’t be used in isolation.
It’s also important to provide 24-7 access
to actual human beings who can help answer questions and let their subscribers or
members know what information is available. A high percentage of the people accessing provider Web sites are simply
overwhelmed with trying to navigate
them. If they have an advocate who can
help them, it becomes easier.
The next level of support is more attuned
to helping find a doctor and a hospital.
Members can put in criteria relative to
quality or proximity, and the site will produce a report based on that criteria.
The most appealing model is to have
online services available 24-7 but also to
provide access to advocates through a telephone-based 24-7 system. The most advanced programs add access to registered
nurses through a nurse-on-call service 24-7.
When you fuse those services together, you
get the most powerful combination.
What cost-saving measures can an employer
recommend?
When you start to get into financial engagement, that’s when the awareness
and understanding of the variability become important.
Members need access to the cost of certain procedures and the cost of using network versus non-network providers.
Ultimately, employers must begin to
impact the thought process of their employees by convincing them that making
some simple lifestyle changes today can
minimize future out-of-pocket costs. In the
past, there wasn’t that incentive to stay
healthy because their out-of-pocket expense was relatively low and fairly fixed.
Getting your employees to take at least
some of these low-cost actions today can
be driven by providing incentives.
How will the health care system change in
the near future?
One is that there promises to be further
transparency of costs, which will really
cement consumerism into the health care
model. Most of the cost information being
communicated today is coming from the
carrier side of the business, it’s not broadly available, it’s built on averages, and it
doesn’t break down to a specific disease,
facility, procedure or physician. We’re
looking at full disclosure of the entire
health care model, and the Internet will be
one of the components that can provide
that information.
The other piece is the creative financial
arrangements around providing additional
incentives for employees to save for health
care: the health savings accounts, health
reimbursement arrangements, flexible
spending accounts — all those mechanisms
that provide favorable tax treatment. In
the past, there were relatively low premiums, high levels of coverage and low outof-pocket expenses so people weren’t
forced to save. Now, with higher deductibles and the cost-sharing increase,
people are going to have to start saving for
health care. Incentives make complete
sense.
JAMES REPP is Corporate Head of Sales for AvMed Health
Plans. Reach him at (305) 671-6122 or [email protected].