Technology less of a barrier to CDHC than business process

November 1, 2005

It's a given in today's world that most consumers want greater control over their healthcare choices and more transparency in healthcare costs. Health plans, for the most part, are thrilled at the notion that consumers will make their own choices and—at least in theory—manage their health better.

It's a given in today's world that most consumers want greater control over their healthcare choices and more transparency in healthcare costs. Health plans, for the most part, are thrilled at the notion that consumers will make their own choices and-at least in theory-manage their health better.

People in-the-know are referring to this period in the life cycle of consumer-directed healthcare (CDHC) as "the last 100 yards." This last stretch between concept and reality is by far the most difficult, but at least a workable solution is in sight, according to Richard Soules, director of product marketing for MyHealthBank, a CDHC application suite from QCSI.

"From a technology perspective, there are still a few loops that need to be closed," Soules says. "But technology, per se, is not the primary concern right now for plans looking to expand into this area. Before they can even ask about the technology, they need to think about CDHC as a new way of doing business."

Educating consumers is the answer, Soules believes. If the end-users of flexible spending accounts (FSAs), health savings accounts (HSAs) and health reimbursement accounts (HRAs) aren't taught how to use their spending accounts properly, all of the anger and confusion will land-rightly or wrongly-on the shoulders of the plan's customer service department.

THE HUMAN FACTOR COMES FIRST

Donald P. Sacco, a consultant based in El Dorado Hills, Calif., agrees that healthcare professionals must completely rethink the way they view CDHC before they can even begin to get into the technological questions. Sacco, formerly president and chief executive officer of Regence BlueCross BlueShield of Oregon and executive vice president of The Regence Group, says that the first mistake is thinking of this new healthcare option in traditional terms.

One of the toughest things for CEOs to do is manage and grow their current business, while still keeping up with tomorrow's needs, he says. CDHC falls into that category because it will require changes from everyone.

"For payers, CDHC is a new business model-not just a new benefit plan-and it's based on individuals, not the large groups they are used to dealing with," he says. "Consumers will have a new menu of rights and responsibilities regarding their health, while providers will have to learn how to service consumers who are more active and engaged in their healthcare choices."

Beyond being a new product and a new way of doing business, CDHC also will cause a culture shift with members who feel they've taken more responsibility and expect their plans to reciprocate with even better levels of customer service. Exceptional service supported by people and technology will further differentiate competing plans for their members.

"And that service will need to be available anytime and on the communication channel of their choice: a live agent, e-mail, speech recognition, chat, Web self-service portals, mobile devices, and devices in the home," says Dennis Schmuland, MD, Microsoft's global industry manager for health plans. "More than that is the expectation that when a member communicates with a personal physician or care management advisor about the next step in treating her cancer, or with a customer representative about his HSA transfer or balance, each point of contact will have real-time access to that member's history."

One thing that plans need to remember is that they aren't in CDHC alone, and problems that occur among providers and members are their problems, too.

ACCUMULATORS AND OTHER ISSUES

Imagine that a member with a CDHC plan goes for an office visit and rings up a $250 bill. If the member's deductible hasn't been met, he or she will be responsible for those charges, and the provider might be able to collect payment on the spot.