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For years, health plans have struggled to achieve one of their primary objectives: the ability to influence their members' healthcare habits and choices.
FOR YEARS, HEALTH PLANS have struggled to achieve one of their primary objectives: the ability to influence their members' healthcare habits and choices.
The advent of disease management and, more recently, consumer-directed health plans (CDHPs) hasn't magically granted that ability, but it's definitely a step in that direction. The typical target is the chronically ill, since they make up a large part of the people who consume a disproportionate amount of healthcare resources.
Only a little more than 40% of members have ever visited their health plan's Web site, according to Forrester Research, and only 5% of all commercially insured consumers who report a disease diagnosis go to their plan's Web site for information on how to manage their conditions.
That's the position of Paula Sauer, vice president of care management for Cleveland-based Medical Mutual of Ohio, an editorial advisor for MANAGED HEALTHCARE EXECUTIVE. "On the chronic illness/DM front, we need more and better Web technology," she says. "Much of the cost of DM is the labor costs of putting nurses on the phone with people. If we can provide a convenient and secure way members can communicate with healthcare providers via the Internet, consumer confidence will go up and costs will go down."
Biometrics is one area that health plans can explore today-and potentially reap tremendous benefits soon-with almost no additional effort from members, Sauer says.
"People struggling with their weight might step on a scale every day, but they probably won't get on a computer or a phone to relay that information to their physicians. The technology exists to make that happen securely and automatically, and it meets both critical criteria for effectiveness: providers get better, more thorough information about their chronically ill members at a minimal cost, and consumers get convenience."
Medical Mutual also uses the Internet for "marquee events" with respected partners that garner plenty of interest from its members.
"We have a relationship with WebMD called 'WebMD University,' and twice a year we choose a topic to feature for our members," she says. "We make a lot of educational materials available and give our members the opportunity to go online and chat with a national expert."
The next marquee event will focus on obesity, and one week after announcing it, more than 6,000 members had already signed up to participate. That's a strong indication that the consumerism movement is a fit with the evolution of disease management and the technology that supports it.
Technology alone will never be a magic bullet for healthcare, because the human element can't be removed, says Ralph Prows, MD, chief medical officer for Regence Blue Cross Blue Shield of Oregon.
"Technology will provide the tools people desperately need to manage their health, but that's all it can be-a tool," he says. "No amount of technology can do the job itself. Even on Star Trek, they still needed Dr. McCoy on board the Starship Enterprise."
THE TENTATIVE ROAD MAP
In spite of the uncertainty, consumer-directed healthcare (CDHC) experts largely agree on what needs to be done to support consumerism. A tentative three-tier game plan might look like this: