Members need to be shown how to make the right choices

February 1, 2006

The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.

The New York Times reports that patients in New York City often have trouble securing a reimbursement for a $75 visit to the nutritionist, who counsels them on controlling their diabetes.

What's ironic is that the same insurer will pay $315 for a single session of dialysis.

Control, choice and information are the drivers of consumer-driven healthcare (CDHC). Employees are becoming modern-day healthcare consumers before our eyes. They recognize that the market-driven healthcare system puts them in charge.

While this expansion shows a promising future for CDHC, CEOs are still faced with the challenge of controlling costs while addressing employees' top healthcare concerns. Savvy leaders are encouraging members to move into high-deductible plans and offering Health Reimbursement Accounts (HRAs) and Health Savings Account (HSAs) to make the process easier. The transition might not reduce members' costs in the short term, but it lays the groundwork by helping them accrue funds to use when unplanned expenses occur in the future.

In addition, many plans offer education tools that enable employees to make informed decisions about their healthcare and the dollars they spend. The most popular tools include the following:

Research indicates that 90% of employers greatly depend on these tools; it's no wonder that employee education and behavior change is essential to the employer's cost-containment goals.

As out-of-pocket costs increase, the value of HRAs and HSAs will become even more obvious. A lack of information for managed care consumers made it difficult for them to understand many healthcare issues, even before CDHC options appeared on the market. Consumer education and awareness of the little things can improve the members' experience. This positive experience will go a long way in assuring the ultimate success of a CDHC plan.

One health plan executive described his company's approach this way: "We decided to begin with an integrated solution to account setup because it gives our members the benefit of one-stop shopping. We were able to reduce our account set-up time from 45 days to seven days; therefore, it gave our members access to their cash accounts much more quickly. We've also given our members a debit card, so they can pay for some items at the point of service."

Future market leaders will need to educate their members and provide them with the tools they need to become effective healthcare consumers of tomorrow. The job for CEOs is to ensure their employees have the tools they need to make those decisions easily and effectively.

Kathy McAleer, a veteran in the rapidly growing field of consumer-directed healthcare, is vice president of operations for QCSI's MyHealthBank product line.