New Consumer Health Plans Mean
Changes All Over The Board
Everyone is scurrying to introduce high deductible Health Savings Account plans, reconfigure plan designs around consumer-centric business models, and deploy Web-based support tools for members to access cost, quality and clinical information. The action is fast and furious, but, pre-sale through enrollment, is everyone prepared?
The consumer directed health plan (CDHP) movement has surpassed its tipping point. Large and small employers are embracing these plans. Benefit consultants and brokers have made big bets on transitioning their clients in ?04 and ?05. New HSA tax preferences are stimulating the market. And, there’s an established group of trailblazer CDHPs, regional health plans, Blues and mega-national carriers vying for position in the consumerism game.
Employers have hit the wall as they balance employee expectations for comprehensive benefits with shareholder expectations for bottom-line performance. As a result, there is sweeping acceptance among employers that something must be done–and they are taking action. Large group benefit managers are introducing a new mix of benefit options, shifting roles and responsibilities between employer and employee. In the small group segment, there has been a surge in high deductible plans, health reimbursement and health savings accounts, and consumer-driven health plans that rely on employee decision-making at point of enrollment and at point of care.
Like lessons learned from PPOs of the 1980s and the POS of the 1990s, introducing nontraditional benefit plans can be an intimidating experience for customers–new benefits, new responsibilities and new terminology. Add to this the use of online displays of provider fee schedules, quality of care indictors and reams of medical diagnostic and procedure information–that’s asking a lot from the customer. On a good day, health insurance is bureaucratic and filled with red tape. Communicating accurate, understandable information is a huge undertaking.
For fully insured or self-funded plans, the communication challenge is exacerbated by diverse workforce demographics such as education, income, tech-savvy and geography. Employee communication must be creative and terminology simple if these new benefit plans are to work for consumers to see cost savings and health outcome improvements, and for plan sponsors to contain premiums and satisfy customers.
As employees are asked to drive upfront benefit decisions and stay involved throughout care delivery, they need to be informed, motivated consumers. This means employees must buy-in to their role of making economical, efficient choices about services they want and their willingness to pay. As they?re being asked to spend their own money after years under a system where they got used to spending someone else’s, they need help learning the true cost of a visit to the doctor, hospital and pharmacy. Success hinges on setting realistic expectations, explaining rules of engagement, re-training customer service and providing continuous member education.