Department Focus: Health Plans - Consumerism Aid

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Six ways health plans can make sure consumer-driven plans do what they're supposed to do.

The premise behind consumer-driven healthcare seems sound: Create savings vehicles for enrollees' out-of-pocket expenses to encourage wiser spending, which will in turn reduce costs overall. But many in the industry remain unconvinced that CDH yields the promised results. Do CDH products actually create educated healthcare consumers, or are they just a ploy to charge members more money, which in turn can prompt those members to avoid services and prescriptions?

The short answer is: It depends on the plan. Or as Jay Savan, principal at Towers Perrin, a St. Louis consulting firm, puts it: "If you have seen one CDH plan, you have seen one CDH plan." With some in healthcare souring on CDH, is there anything health plans can do to help consumer-directed plans fulfill their promise? Yes. Here are six ideas.

Watch what you call CDH
High-deductible health plans are a well-known consumer-directed vehicle. But should health plans and employers put them under the CDH umbrella?

Some experts say these plans simply shift more costs onto members. Alexander Domaszewicz, principal at benefits consulting firm Mercer in Newport Beach, CA, says a real CDH plan includes education that helps a member become a better healthcare consumer. Creating CDH plans that shift too much cost onto the consumer gives the concept a bad name and will drive people away from CDH.

Be honest
Employers often rush to CDH to reduce costs without fully understanding what makes a successful consumer-driven plan. Health plans have the experience to know what works and what doesn't, but employers view insurers only as the plan administrator—so the health plan implements the program rather than confront the employer about a subpar plan.

Savan says health plans must take a more proactive role and tell an employer when a plan is not going to work. It's better to tell the employer up front than wait until the plan bombs in a year.

Beware unintended consequences
CDH plans that move costs to consumers may temporarily reduce health plan and employer health costs, but health plans must be careful how that could impact patient compliance and long-term costs. One study reported that CDH plan enrollees are delaying buying prescription drugs because of added costs. Domaszewicz says the study differs from previous reports showing people do not delay care when they assume greater control of their health dollars.

"The biggest concern that I have is that we have unintended consequences, says Domaszewicz. "So monitoring and measuring and protecting against those unintended consequences, like avoidance of care, is important.

Healthcare is not a TV
Supporters promote CDH as shifting healthcare into the realm of retail. But no matter the spin, researching healthcare procedures is not the same as searching for a flat-screen TV. "Consumer products have an element of fun, fresh, and new," says Savan. "Healthcare is not fun, fresh, and new."

Savan says health plans should focus on making information accessible and easily understood. Putting information on an interactive Web site allows the user to choose topics of interest and provides supplementary materials for those who want more information.

Make friends with the employers
Health plans and employers aren't necessarily known for working together—but they need to in order to create an effective communications plan. Health plans usually have more generic member communications, but employers have the opportunity to reach members every day. The combination of a health plan's myriad avenues of outreach coupled with the employer's daily connection with its workforce can create a better-educated consumer.

Stay simple, not scary
When communicating about CDH, health plans should avoid industry jargon. Savan says health plans often fall into the trap of using off-putting phrases like "high-deductible health plan."

Instead, Savan says health plans should talk to enrollees in a more straightforward, casual way. Talk to them about the concept of a health savings account and how it works—and relay the message of how a more educated consumer is good for them. "High-deductible health plan is federal jargon. It's industry jargon, and people don't want to know about industry jargon," says Savan.

—Les Masterson

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