Consumer-directed Healthcare

Consumer-directed healthcare bandwagon loses steam

Washington, D.C.—Despite earlier promises that consumer-directed healthcare (CDHC) programs would reduce healthcare spending by encouraging more efficient purchase of health services, consumer confusion and higher out-of-pocket costs seem to be slowing enthusiasm for these plans.

Will CDHC affect HMO enrollment?

The rise in popularity of consumer-driven healthcare (CDHC) will challenge HMOs to be at the top of their game, say industry watchers.

More on Desktop Resources (Dec. 2006): Will CDHC affect HMO enrollment?

Price is paramount to survival in the current healthcare market. With skyrocketing premiums, moving toward an affordable level for both the employer and the employee/member is essential, experts agree.

Consumer connection: Jack LeFort aligns CRM with CDHC to improve service and strengthen loyalty and retention

Conventional wisdom says that to introduce real change, you need to bring in someone from outside. Jack LeFort, CEO and founder of Connextions Health, a company in the emerging field of consumer-directed healthcare (CDHC), has brought a similar paradigm shift to healthcare from the outside.

Real-time, point-of-service financial settlement: why health plans will lead the next revolution in healthcare

As the nation faces a healthcare "affordability" crisis, market forces are driving changes such as consumer-directed healthcare, which is fueling the next revolution in healthcare: real-time transactions. At the center of this momentous change sits the health plan and its enterprise systems.

HHS, Congress encourage e-health development

All health plans and providers that do business with Medicare, Medicaid and other federally sponsored health programs soon will have to adopt information technology standards and quality-measurement tools. The Medicare Modernization Act of 2003 (MMA) requires the Department of Health and Human Services (HHS) to establish standards for electronic prescription drug prescribing by 2008, and this policy is driving broader efforts to build health IT systems.

Medicare, insurers seek expansion of HSAs

Supporters of consumer-directed healthcare options want Congress to increase tax breaks and coverage limits to broaden the appeal of health savings accounts (HSAs) linked to high-deductible health plans. Health insurers and employers back legislation that would expand tax credits and higher HSA contribution limits plus increase flexibility in the use of HSA funds.

Can a $400 billion shift herald consumer wellness?

The issues have been framed brilliantly, debated enthusiastically and examined closely. While it might not resemble the California Gold Rush, employers that implement wellness programs can still find significant rewards.

Assess the price of paying for performance

Pay for performance (P4P) is touted as the magic bullet du jour for our healthcare cost concerns. In mid-2005, CMS released its "Quality Roadmap" aimed at delivering "the right care for every person every time." Consistent with this initiative, CMS has published quality measurements and information directed toward the beneficiary, the provider and, ultimately, the purchaser audiences.

Tax benefits make HSAs an attractive option

It's not the fig leaf that some would advocate for a fragmented healthcare system. But even though the jury appears deadlocked about the value of the health savings account (HSA), the movement toward consumer-directed healthcare (CDHC) is accelerating. In the midst of this fracas there is good news for the savvy healthcare consumer: The tax incentives for HSAs are compelling.

White House, industry promote health savings accounts

The main strategy of the Bush administration for controlling healthcare costs and expanding access to care is to encourage more individuals and employers to adopt consumer-directed healthcare (CDHC) programs. Coverage programs that combine a high-deductible insurance policy with a tax-advantaged savings account for paying healthcare costs are becoming more widespread, according to recent surveys. They can save employers money, provide less-costly insurance to individuals, and they fit conservative Republican policies that shift more responsibility for healthcare decisions from insurers and providers to consumers.

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Disease Management

Innovative plan designs focus on consumer engagement, wellness

The convergence of rising healthcare costs, increased cost sharing and demand by consumers for more participation in healthcare decisions is producing a variety of innovative health insurance solutions.

Shared decision making gains recognition as patient-centric care model

The practice of shared decision making (SDM)—the collaboration between patients and caregivers to arrive at an informed, value-based healthcare decision when treatment options have features that patients value differently—is gaining recognition among health plans as a key function of a patient-centric model of care.

MCOs break the cycle in chronic care with interventions

Although prevention has become a key element in traditional disease management programs—trying to prevent or mitigate a chronic disease before it exacerbates—that may not be sufficient when a patient has a late-stage or end-of-life condition. There is a new emphasis on caring for older adults with multiple comorbidities. Almost 80% of people 65 and older report having a chronic illness, according to the Robert Wood Johnson Foundation.

Updated Disease Management Guidelines Impact Investment Perspectives

Disease management programs don't come cheap, but thanks to industry collaboration, purchasers are increasingly learning how to assess the business case for these programs.

DME coverage guided by medical, regulatory necessity

As durable medical equipment (dme) becomes increasingly sophisticated, MCOs' challenges remain rooted in establishing medical necessity. To that end, most use strategies including prior authorization and coverage limits. Meanwhile, they must also satisfy changing state and national regulatory requirements.

Contracts with sports teams a true marketing coup

IN THE WORLD OF professional sports, the competition isn't only on the gridiron, the court or the diamond. Just ask an MCO.

Men's healthcare concerns don't receive equal attention

The economics and the politics behind the major healthcare problems affecting men, such as cardiovascular disease, cancer, obesity and depression, aren't receiving the attention they deserve. It has been the rule that women make health decisions for themselves and also for their male partners and their children. In contrast, most men have a more casual attitude toward their care: "if it ain't broke, don't fix it."

Best practices effective for in-patient heart attack care

Grace seems an unlikely acronym for a study of acute coronary events, but given the findings of the Global Registry of Acute Coronary Events published in the Journal of the American Medical Association, the name may be apropos.

Employers reach large populations with progressive DM programs

Worldwide, 388 million people will die from chronic diseases in the next 10 years. Chronic diseases account for about 75% of all healthcare costs. Clearly, disease management and prevention is sorely needed, but it's been a struggle to change the behaviors of large groups of people. A number of programs are finding success using non-traditional methods.

Rheumatoid arthritis takes its place among chronic conditions

LOW-PREVALENCE rheumatoid arthritis (RA) has not gained attention equal to that of more common chronic diseases, but it has earned a spot on the list of complex diseases ripe for disease management.

New math provides epiphany for measuring ROI

Disease management as we now define it may be on its last legs, though no one knows it yet. The Disease Management Purchasing Consortium has noticed that the savings in all but a few diseases doesn't offset the costs, and nowhere does it generate the level of return on investment (ROI) that some people think they are getting.

Case management for seniors requires heightened coordination

The centers for Medicare and Medicaid (CMS) says that 23% of Medicare beneficiaries have five or more chronic conditions but account for 68% of costs—not quite the 80/20 rule. And they tend to see many different doctors—about 14 a year with almost 40 office visits—and take as many as 10 medications at a time, according to Partnership for Solutions.

Revised HIV testing guidelines for adults scrutinized

Last year acknowledged the 25th year since AIDS was first recognized, and to coincide with that anniversary, the U.S. Centers for Disease Control and Prevention (CDC) revised its recommendations for HIV testing for adults, adolescents and pregnant women in healthcare settings. The new guidelines remove the onus of determining who is at high risk for HIV infection and makes testing a routine part of medical care for all patients between ages 13 and 64 years.

More on HIV testing

CDC's revised HIV recommendations that all people aged 13 to 64 should have routine HIV testing may be effective in the public health setting, but might not be as effective in the privat setting, according to one expert.

States seek enhanced DM for Medicaid patients

Medicaid Enrolees who suffer from expensive, chronic conditions tend to suffer from so many comorbidities and complicating social problems—such as homelessness and lack of transportation—that isolating a single disease state for intervention is ineffective. And states are beginning to recognize that.

Tech tools reduce labor costs for DM programs

For years, health plans have struggled to achieve one of their primary objectives: the ability to influence their members' healthcare habits and choices.

Depression can be a detriment to workplace productivity

The times they are a changin'," written and sung by Bob Dylan, was a popular protest song in the 1960s, and those words hold true today in the dynamic healthcare industry. The American industrial nation bred musculoskeletal problems but today's workplace presents new problems—depression and related conditions—the greatest impact on productivity, says Sean Sullivan, president and CEO of the Institute for Health and Productivity Management in Scottsdale, Ariz., and a member of the Managed Healthcare Executive editorial advisory board.

More on Disease Management (Oct. 2006): Employers weigh in on depression

Depressive disorders stand out as a major occupational health issue, and employers are feeling the burden in reduced productivity and higher healthcare costs for their work forces.

Single-source DM likely to increase as industry consolidates

When it comes to health, bigger is not necessarily better. The term "morbid obesity" has become common vernacular in recent years, even outside of clinics and hospitals. But can bigger mean better when it comes to finding the best approach to managing DM? Two schools of thought preside in the health plan market today: Compile a stable of disease-specific vendors and coordinate them in-house (also referred to as "best-of-breeders"), or choose a single vendor to handle all the disease management programs.

More on health coaching (Disease Management, August 2006)

The educational and professional qualifications of health coaches is relative to the type of health coaching that is being done, according to industry experts.

In their corner: Health coaches support consumer efforts to alter behavior

When his daughter was born seven years ago, Dan Schach had been smoking and chewing tobacco for 32 years. He knew then that it was time to make a lifestyle change.

Create a flexible disaster plan to curtail negative impact of pandemic

Southeasterners dread their hurricanes, Californians remain a bit wary when anything shakes or rattles, and now many of us are keeping an eye on the possibility of an avian flu pandemic. Although we hear about its possibility in the news almost daily, most Americans don't seem to be taking any special precautions or preparing an emergency plan to cope with the H5N1 strain of the avian influenza virus.

Care management and P4P programs face the same challenge: getting physicians to trust and use payer data

Care management and pay-for-performance (P4P) programs couldn't be more popular in the industry. Although often thought of and managed separately, their goals are really the same: to focus attention and dollars where they will have the greatest impact on patient care. With care management, the focus is on finding and providing specialized services to those who either have chronic illnesses or who might be heading down the path toward them. P4P merely casts the net wider with its assumption that tying physician payments to standards of care will deliver optimal care along the healthcare continuum.

Plans take initiative in disaster planning through partnerships (More from Disease Management, July 2006)

Some health plans are partnering with public health departments and statewide services to develop disaster plan to help avert the potential catastrophic effects of a flu pandemic. As an integrated delivery system, SelectHealth in Salt Lake City is working with the Utah Department of Health, which developed the Utah Pandemic Influenza Response, a preparedness plan in coordination with efforts by WHO and the U.S. Department of Health & Human Services. The state's primary goals are to minimize serious illness and deaths, societal disruption and economic loss.

Chronic conditions need continual care

According to the Centers for Disease Control, chronic diseases have become the leading cause of death and disability in the United States, account for 7 out of every 10 deaths and affect the quality of life of 90 million Americans. In 2002, direct medical costs reached $92 billion and indirect costs (including disability, work loss and premature mortality) totaled $40 billion. Perhaps the most confounding fact is that although chronic diseases are among the most common and costly health problems, they also are among the most preventable.

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