1 decision support tools a key element of consumer driven healthcare the consumer driven healthcare...
TRANSCRIPT
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Decision Support ToolsA Key Element of Consumer Driven Healthcare
The Consumer Driven Healthcare SummitJohn Mills
Washington, D.C.September 14, 2006
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Overview
• About HIP Health Plans• Consumer Driven Healthcare (CDHP) Market Trends• Need for Decision Support Tools• Different Web Based Tools
– Plan and Cost Comparison– Provider Quality and Cost Information– Account Information– Health Risk Assessments and Personal Health Record
• Using These Tools to Differentiate Your Plan• Empowering Consumers• Driving Adoption• Non-Web Enabled Members• Conclusions• Questions
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• HIP Health Plan• Vytra Health Plan
– Founded in 1947 – Joined HIP family in 2001
• ConnectiCare– Joined HIP family in 2005
• PerfectHealth Insurance– Joined HIP family in 2006
• Current membership is more than 1.4 million• Serves the New York City metropolitan area,
Connecticut and Massachusetts• Product offerings include
– HMO and POS– EPO and PPO– CDHP – Government programs– Dental insurance– Pharmacy benefit management
About HIPAbout HIP
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5%10%
20%
0%
5%
10%
15%
20%
25%
30%
2003 2004 2005
Percent of Employers Offering CDHP
Source: Kaiser Family Foundation-HERT Study 2005
National Market TrendsNational Market Trends
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1.2
2.7
5.9
0
1
2
3
4
5
6
2004 2005 2006 Est
CDHP Enrollment in Millions
Source: Forrester Research
National Market TrendsNational Market Trends
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• New York market has been slow to adopt CDHP– Seeing more interest in 2006 than past years
• Recent up tick in quoting activity for CDHP– 1% of all small group quotes requested CDHP in 2005*
– Significant increase in quote requests for the 2nd half of 2006
• Increased interest in HSAs for the small and middle market
* Source: HealthConnect
Local Market TrendsLocal Market Trends
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Need for Decision Support Tools
• Consumer Directed Healthcare Plans (CDHP) demand a greater understanding of plan design and cost information– HSAs and HRAs require access to both cost and quality information
• Emergence of the Internet has made health information more accessible to consumers
• Employers want their employees to be better informed about health costs, prevention and treatment of illness
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Need for Decision Support Tools
• Availability and quality of web tools has become a market differentiator among health plans
• Accrediting agencies like NCQA are grading health plans on the tools they make available– Plans must have 4 out of 9 web tools such as Health Risk Assessments,
Personal Health Records, ePrescribing to get full NCQA accreditation in 2007
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Web Based Decision Support Tools
• Health plans have responded to the market need by assembling suites of decision support tools including:
Provider Quality and Cost Information
Plan and Cost Comparison
Account Information
Health Risk Assessment -Personal
Health Record
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Plan Comparison and Cost Calculator Tools
• HIP provides plan comparison and cost calculator tools– Can be setup to permit general use on health plan website
– Can be customized to meet the specific offerings of an employer
• These tools permit members and prospective members to– Compare their health plan offerings
– Enter their anticipated health care usage and review their expected out of pocket costs for the upcoming year
– Estimate the amount of money they should set aside in either their Health Savings Accounts or Flexible Spending Accounts
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Compare 2 or more plan
option
Plan Comparison and Cost Calculator Tools
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Cost Compare
Estimate yearly medical utilization
Plan Comparison and Cost Calculator Tools
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Cost Compare
Estimate out of pocket
expenses in order to set pre-tax funds aside
Plan Comparison and Cost Calculator Tools
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Provider Cost and Quality Information
• Consumerism in healthcare is making members more interested in the price and quality of health services
• This is a fledgling area since actual cost has only recently become a priority to consumers and purchasers
• Hospital quality and cost measures can be obtained through a number of sources
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Provider Cost and Quality Information
• Data on the cost and quality of physician services is still difficult to obtain– Lack of centralized recordkeeping and data have made it difficult to
develop indicators
– Market demand for these data is increasing
• These data are based on Medicare reimbursements, not health plan contracts, impacting its accuracy
• A number of pilots have started in the past year where provider prices are being posted on the web
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Account Information
• Member account information should be accessible with a single sign on to the health plan’s website
• Members should have access to– Coverage information including insurance and account funding
– Account balances
– Medical services paid including date, payee and amount
– Incentive and rewards balances
– Online customer service
Account Information
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Account Information
Benefits provided to the
member
Account Information
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Account Information
Account balance
information
Account Information
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Health Risk Assessments
• Health risk assessments are used by the member to assess their behaviors and determine how those behaviors impact their health
• This tool will help plans meet the NCQA accreditation requirements starting in 2007
• Most health plans are currently using simple versions to encourage members to complete the questionnaire
• The information collected is confidential and can only be used to improve a member’s health
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Health Risk Assessments
• The tool provides information to the health plan to help devise disease management programs for chronic conditions including:
– Diabetes
– Asthma
– Smoking cessation
– Obesity
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Health Risk Assessments
Health Risk Assessment
Personal Health Record
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Health Risk Assessments
Your results
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Personal Health Records
• Permit member to enter their health encounters in an online record
• Can be integrated with health plan’s claims system
• First step towards electronic medical records– Participating in an America’s Health Insurance Plans (AHIP) pilot project
on standardized data sets
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Using Tools As a Market Differentiator
• Web tools are becoming a powerful plan differentiator– Some employers are making them a requirement for health plans
• Plans generally fall into three categories for web tools– Check the box
• Generally a follower with no desire to lead
– Fast Follower• Keep up with the competition by investing in a more integrated suite of off-
the-shelf web tools
– Market Leader• Lead by investing in robust suite of web-based tools including in-house
development
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Integrated Suite of Decision Support Tools
Account Information
Plan and Cost Comparison
Provider Quality and Cost
Information
Health Risk Assessment-
Personal Health Records
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Empowering Consumers
• Decision support tools empower consumers by creating an educated health consumer through
– Access to a wide range of high quality, reliable health information
– Cost and quality information
– Instruments to track your health and that of your family
– Knowledge of the costs of health services including doctors visits, pharmaceuticals and hospitalizations
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Driving Adoption of Decision Support Tools
• Make tools easily available
• Educate health plan sales force about the tools
• Provide online demos for employers during sale and for employees during open enrollment
• Highlight the availability of these services in health plan newsletters to members and providers
• Send emails to employers and members
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Non-Web Enabled Members
• Many employees still work at jobs that do not involve daily contact with computers
• Not possible to make all of these tools available on a paper basis but it can be done for some – Plan comparison
– Cost calculators
– Health risk assessment
• Work kiosks can make these tools and services more available– Wireless laptops are making this easier
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Conclusions
• Consumers are demanding more information about healthcare as costs increase and employers move to HRAs and HSAs
• Employers are starting to make robust tools a part of their decision making process
• The Internet has created an opportunity to provide information that was too difficult and costly to organize in a paper environment
• Many health plans have made an initial investment in decision support tools and will expand that investment as interest grows from consumers and employers
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Questions
?