Post on 14-Jul-2016
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SupportingHealth insurers
provide a growing range
of tools
Health insurersprovide a
growing range of tools
Supporting
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CONSUMER DECISION-SUPPORT TECHNOLOGY, much of it Web-based, is giv-
ing health insurers more ways for consumers to participate knowledgeably in
decisions involving their health care. And with the momentum to raise con-
sumers’awareness of the true cost of health care and help them understand how
their choices impact health care costs, decision-support tools are proliferating.
“At the end of the day,we’re going to manage costs by having people consume health
care much as they do other things,” says Jeff Verney, senior vice president of E-Com-
merce for CIGNA HealthCare.“The technology is now available,so we can share infor-
mation with people so they can become better consumers of health care.”
An Industry TrendCIGNA, which has about one million
enrollees registered for individual Web pages through its
Select Quality Care system, is one of many health insur-
ers and plans offering an increasing array of decision-sup-
port tools. Others include Aetna, Blue Cross Blue Shield
of Minnesota,Destiny,Great-West Healthcare,Group Health
Cooperative, Health Alliance Plan, Highmark Inc., Hori-
zon,Humana, Independence Blue Cross,MVP,Vivius, and
WellPoint Health Networks.
CIGNA HealthCare offers members tools including
programs to assess their health risks;decide the best course
when experiencing specific symptoms; compare hospitals
in terms of costs,outcomes,morbidity rates, and other fac-
tors for specific procedures; and compare pharmaceutical
options. About 15,000 CIGNA enrollees use the
myCIGNA.com portal every day.
In its consumer-choice health plan options, CIGNA
HealthCare offers additional tools that provide data on pric-
ing differences between providers. Currently, its provider
rankings and related information focus on hospitals and are
based on self-reported Medicare data, says Verney.“Right
now, there’s not an equivalent tool for physicians.We’re
probably 18 to 36 months away from that as an industry.”
On its Mygreatwest.com site, Great-West Healthcare
offers what Cindy Donohoe, vice president of marketing
and products, calls standard Web tools that allow members
to find a doctor in their area, make online inquiries about
claims status, and check balances in
health reimbursement and flexible spend-
ing accounts.
In addition, Great-West Healthcare offers three online
decision-support tools,according to Marc Ver Straate,prod-
uct marketing manager. On MyCare, members can look
up nutrition and dietary information and can also take a
health risk assessment and store their scores. MyCare is a
product of Winning Habits, which provides personalized
interactive health and wellness systems.
The second tool is CareCompare, from Healthshare
Technology,Inc.,which provides hospital grading based on
Leapfrog Group data.To find a hospital, a member selects
specific criteria that are important to him or her, such as
patient volume,mortality rate,unfavorable outcomes, length
of stay, and average charges. The information is arranged
by zip code. The next step will be to apply CareCom-
pare to physicians, Donohoe says. Comparative physician
costs will be described as in a restaurant guide—using dol-
lar signs. And after that, the plan is to provide quality infor-
mation on physicians, she says.
Through the online Drug Compare tool from
Advanced PCS,Great-West Healthcare members can find
a pharmacy in their area, compare the cost of a generic vs.
a brand-name drug,make use of a mail-order prescription
benefit, and receive information on drug-food and drug-
drug interactions.
At Group Health Cooperative in Seattle, decision-sup-
Informed ChoiceInformed Choice
By Chris Rauber
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port tools are part of a broad effort to
use technology to coordinate and
improve the quality of care.Approx-
imately 84,000 of the integrated sys-
tem’s 560,000 members are registered
to use its MyGroupHealth.com web-
site, and 33,500 have signed up for
a second level of access that lets them
use a PIN number and password to
access clinical data and communicate
with providers via secure messaging,
according to James Hereford, Group Health’s executive director of
health informatics.
Central to the process is Healthwise Inc.’s Knowledgebase,which
includes 25,000 pages of health data sorted by topic.When a reg-
istered MyGroup Health member gets a lab test result or a diag-
nosis from a plan physician, that step triggers a query to the data-
base, resulting in a posting of relevant information to the patient’s
Web page.A paper version,which provides additional information,
is given to the patient at the point of care.
Each week the three-year-old MyGroupHealth site has 11,000
visitors, and approximately 1,000 e-mail “conversations” take place
between enrollees and Group Health providers using secure mes-
saging applications. In addition, more than 400 medical appoint-
ment requests, 2,100 prescription orders or refills, and 4,000 page
views of lab reports occur in a typical week. Previously,“all of the
[online users] would have to come into the facility or call.This obvi-
ously has operational benefits as well as customer satisfaction ben-
efits, because of the convenience of these services,” says Hereford.
And by the end of this year, “our projection is that we will have
100,000 members doing clinical business with us over the Web,
or about one-third of the adult enrolled population who get their
care from Group Health physicians,” says Hereford.“At that point,
it’s not a niche application or channel, it’s a very mainstream way
of conducting business.”
Destiny Health, which operates consumer-choice plans with
current partners Tufts Health Plan and The Guardian Life Insur-
ance Company of America, also gives members information from
Advance PCS and Healthwise. In addition, Destiny offers two
distinctive decision-support tools, says Ryan Levin, vice presi-
dent of product development and risk management. The first is “a
very detailed explanation of benefits,” showing what each provider
has charged for a service, whether it was paid from the member’s
personal medical fund or by the insurance plan, and how much
is left in the medical fund. “We see full cost-transparency as an
integral part of decision support,”Levin says,because it allows con-
sumers to see how they are spending their health care dollar.
In addition, Destiny’s Vitality program uses incentives to sup-
port members’decisions to follow wellness guidelines. For exam-
ple,Vitality members earn points for lowering their cholesterol,
enrolling in a disease management
program, not using tobacco for 12
months, or exercising (for reinforce-
ment, they can log their workouts on
Destiny’s website).
Members begin at the bronze Vital-
ity status and can progress to platinum,
as they make healthier lifestyle deci-
sions and their health improves.Each
Vitality status comes with a set of
rewards, such as movie tickets and air-
line miles. But the key, says Levin, is that members with higher
Vitality status earn more for each dollar they carry forward into
the next year from their personal medical fund. Bronze mem-
bers receive 3 percent interest and platinum members 10 per-
cent.
According to Levin, independent research showed that 79 per-
cent of Vitality members started an exercise and nutrition program
within the last 12 months,vs.32 percent of nonmembers. Eighty-
six percent of Vitality members said they believed a person’s lifestyle
choices had an impact on their health care costs, vs. 28 percent
of nonmembers.Asked if they had done something personally to
reduce the cost of their health care, 72 percent of Vitality mem-
bers said yes, vs. 39 percent of nonmembers.
Focused TechnologyGenerally speaking, health insurers are moving away from post-
ing static content on their websites toward offering customized
decision-support information, says Bob Tavares, manager of con-
sumer products at HealthShare Technology,a decision-support firm.
Insurers “realize they’re never going to be an all-encompassing,
broad health care portal,” says Tavares, noting that consumers are
looking for “tons of depth and breadth”when they research a health
care issue. That means they may choose to go to government or
clinical trial sites for some information, rather than to insurer
sites. So health insurers are “focusing on the two or three things
where consumers think of them first.They’re moving to fewer,bet-
ter-content modules rather than a broad, trying-to-please-every-
one approach.”
Insurers are just part of the market for this focused technology,
according to Jerry Reeves, MD, chairman and CEO of Las Vegas-
based WorldDoc Inc.,which counts among its customers large self-
insured employers, benefits consulting companies such as Deloitte
and PricewaterhouseCoopers,and multi-employer Taft-Hartley plans.
WorldDoc,founded in 1999 by a group of board-certified physi-
cians, offers a suite of products that analyze symptoms and com-
pare treatment options;evaluate new or controversial tests and treat-
ments; rate regional hospitals on outcome, cost, and safety mea-
sures; and allow communication with physicians via email.
Other decision-support firms including Health Grades Inc.and
“We see full cost-transparency as
an integral part of decision suport.”
Health Dialog Services Corp.60 State Street, 11th Floor, Boston, MA 02109800-893-5532
George Bennett, chairman and CEOwww.healthdialog.com
Specializes in health coaching, providingevidence-based data on health careoptions and encouraging patients to collab-orate with their doctors.
CLIENTS: Highmark, Definity, IndependenceBlue Cross, and several other Blue CrossBlue Shield plans.
Health Grades Inc.44 Union Blvd., Suite 600, Lakewood, CO 80228303-716-0041
Kerry R. Hicks, president and CEOwww.healthgrades.com
Provides decision-support tools to helpplan members select hospitals, physicians,nursing homes, and home health agen-cies.
CLIENTS: Blue Cross Blue Shield of Min-nesota, Medica, American Postal WorkersUnion Health Plan.
HealthShareTechnology Inc.360 Massachusetts Ave., Suite 200, Acton, MA 01720978-263-6300
Rick Siegrist, president and CEOwww.healthshare.com or www.selectqualitycare.com
Allows consumers to compare and selectthe best hospital for their individual needs,using evidence-based measures such aspatient volume, mortality rates, and out-comes.
CLIENTS: Aetna, CIGNA, Health Net, Great-West Healthcare, various Blue Cross/BlueShield plans.
Healthwise Inc.2601 North Bogus Basin Road, Boise, ID 837021-800-706-9646
Donald W. Kemperchairman and CEOwww.healthwise.org
Provides more than 5,000 evidence-basedtopics on health conditions, medical testsand procedures, medications, and everydayhealth and wellness issues based on up-to-date medical research and indexed toindustry-standard vocabularies like ICD-9.
Clients: Aetna, CIGNA, Group HealthCooperative, Definity Health, Humana,Kaiser Permanente, UnitedHealthcare, var-ious Blue Cross/Blue Shield plans.
SubimoP.O. Box 5335, River Forest, IL 60305312-409-5967www.subimo.com
Ann Mond Johnson, president
Provides comprehensive suite of decisiontools covering health management, hospi-tal rating, pharmaceuticals, and medicalprocedures.
CLIENTS: Anthem of Virginia, Oxford HealthPlans, WellPoint Health Networks
Protocol Driven Healthcare, Inc.75 Claremont Road, Suite 201,Bernardsville, NJ 07924-2262908-630-9380www.pdhi.com
Jennifer Jolley, president
Provides health, wellness, and diseasemanagement programs designed toempower consumers to take control oftheir health and develop positive changesin behavior.
CLIENTS: Aetna, Humana, Wausau Benefits
WorldDoc Inc.500 N. Rainbow, Suite 314, Las Vegas, NV 89107702-821-0818
Jerry Reeves, M.D., chairman and CEOwww.worlddoc.com
Analyzes users’ responses to questionsabout hundreds of symptoms, conditions,and risks; explains the relevant associatedconditions as well as prevention and treat-ment options.
CLIENTS: self-insured employers; healthplans, including Medicare Advantageplans; and Taft-Hartley plans.
—CR
Selected Firms Offering Consumer Decision-Support Tools
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HealthShare Technology focus pri-
marily on hospital ratings, although
Health Grades also rates other types
of providers. Subimo provides soft-
ware for general health management,
hospital ratings,pharmaceuticals,and
specific medical procedures.
Health Dialog was created to dis-
seminate material and insights devel-
oped by the Foundation for
Informed Medical Decision Making
and researchers John Wennberg,MD,
of the Center for Evaluative Clinical
Sciences at Dartmouth, and Albert
Mulley Jr., MD, at Massachusetts General Hospital. Health Dia-
log focuses on coaching consumers on collaborating with their
physicians to achieve the best health results.
Healthwise Inc.provides both Internet-based and printed con-
tent on health conditions and health and wellness issues. Not
that long ago, recalls Donald Kemper, chairman and CEO of
Healthwise, most Americans didn’t realize they were capable of
buying or selling stocks on their own, or making informed deci-
sions about their health care. That mindset has changed, and con-
sumers now clamor for information about virtually all products
available for their purchase.
Choose a Hospital—or a Build a PlanCIGNA HealthCare uses decision-support firm HealthShare Tech-
nology to help consumers choose a hospital and Subimo to help
them make pharmaceutical decisions. Humana, too, uses support
tools from several vendors, including Healthwise, Protocol Dri-
ven Healthcare, Inc.,and HealthShare Technology,along with pro-
prietary tools that let consumers choose health benefits and com-
pare the costs of specific procedures or medical services.
Highmark Inc., a Pittsburgh-based Blue Cross and Blue Shield
plan, uses its own home-grown decision-support technology to
allow enrollees to “build their own plan,” customizing features
to meet their personal preferences.The process increases consumer
satisfaction with the plan selected,according to Kim Bellard,High-
mark vice president of e-marketing and customer relationship
management.
Highmark’s BlueChoice program features interactive selec-
tion tools that allow members to indicate general preferences and
receive a list of plans ranked by how well they meet those pref-
erences. So far, about 70,000 members use BlueChoice to select
variables such as size of copayments for physician office visits, cov-
erage options for drugs and preventive care, and the ability to see
a physician without a referral.
The BlueChoice program, launched in May 2000, started with
16 choices of health plans; it now includes almost 200 options that
employers can choose to offer (the
average number chosen is 10.)
Another company that allows con-
sumers to design their own health
plans is Vivius, which partners with
insurers including Health Net and
HealthSpring to offer products under
the insurer’s brand. According to
President and CEO David Teckman,
Vivius developed an online tool that
allows each family member to choose
providers and copayment levels based
on individual preferences and expect-
ed use; after members create their
individualized health plans, the tool calculates the premium.
In choosing providers, a member enters the name of a family
doctor, and a screen identifies the physician’s recommended spe-
cialists and hospital. The tool then gives members quality and cre-
dentialing information about the doctors, such as their office loca-
tion, educational background, foreign language fluency and pro-
fessional or legal sanctions (if any).The member is free to choose
among the list of providers recommended by the family physi-
cian or select others, based on information provided by the doc-
tors themselves and on information that the insurer partner makes
available.
The Vivius website shows how members can make their pre-
mium higher or lower based on choosing a particular doctor,
hospital, or copayment level.The technology developed by Vivius
is easy to use, allowing someone who reads at a sixth-grade level
to design a customized plan in 15-20 minutes,Teckman says.
Rapid StridesOverall, the health insurance market is behind other industries
in implementing decision-support technology, but it has made
rapid strides in about the last 12 months, according to CIGNA
HealthCare’s Verney.“We’ve seen a lot of movement among a
lot of payers,” he says,“but there’s a huge opportunity to increase
awareness.”
CIGNA HealthCare is working with employers to broaden
awareness of its consumer decision-support tools and is explor-
ing linking its site to employer portals so that enrollees can receive
more personalized information on health risks and specific con-
ditions like asthma or diabetes.
The motivation is obvious,Verney argues, in an environment
where consumer involvement and empowerment are seen as keys
to controlling cost and enhancing quality:“Once people use these
tools, they tend to use them again and again.” HP
Chris Rauber is a Walnut Creek, Calif.-based freelance writer andconsultant.
“Once people use these tools,
they tend to use them again
and again.”
Copyright 2004 by the American Association of Health Plans