1 decision support tools a key element of consumer driven healthcare the consumer driven healthcare...

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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

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