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Benefits Business AN - TI - CI - PA - TION Using CDHPs requires thorough understanding of client’s needs By Len Strazewski Consumer-directed health plans (CDHPs), the new dynamic duo of Health Savings Accounts (HSAs) and high-deductible major medical plans, may be the hottest new product in the employee benefits portfolio, but they come with lots of baggage—and responsibility for producers. Setting up the accounts and delivering the policy is just the beginning of the health-related services your clients will need to successfully execute the plans, say health care experts. “CDHPs really have three components,” says Stuart Slutzky, vice president of Destiny Health in Chicago, one of the nation’s top CHDP underwriters. “First, either a HSA or Health Reimbursement Account (HRA); second, a high-deductible health insurance policy and third, the tools and health information to support the consumer decisions the participants must make.” Without health information and decision-support tools, the average plan participant would be adrift in a sea of choices, he says. “The average health care consumer has no real understanding of the cost of health care and each individual health care component. Without guidance, an average consumer cannot know the cost and quality differences of brand name prescription drugs and their generic equivalents. They are unaware of the wide variance of complication rates and other indicators of success of various medical procedures within their area.” CDHPs also need to “incent” or reward wellness and lifestyle changes that improve health quality of individuals, but the ability to make those changes is linked directly to the availability of good information about smoking cessation, weight loss and chronic disease management, Slutzky says. For example, Destiny Health provides Vitality, a wellness incentive program that integrates with its CHDP programs. “CDHPs are not just another health care cost-shifting tool; they are integrated health care programs designed to improve both an individual’s health and the quality of care he or she receives,” Slutzky points out. Mark VerStraate, director of CDHPs at Great-West Healthcare in Greenwich Village, Colorado, agrees. He says that employer and employee preparation for CHDP begins before enrollment and the delivery of a policy with health analysis and assessment. Great-West guides employers and their employees through a health risk assessment that not only helps focus individual health information for CHDP decision-making but also tests the group’s relative skills for making good consumer choices. The assessment helps employers and their employees choose correct deductibles and plan design features for their own situation. The group or individuals may choose, for example, to provide preventive care outside the usual deductible range or carve out some prescription drugs for chronic disease treatment from the health account structure. After enrollment, the information burden shifts to consumer education. For example, the health plan provides cost estimation information and quality information about local providers. “Without this information, there’s no way a plan participant can make good choices,” says VerStraate. Destiny Health, Great-West and other CDHP underwriters already provide some health information for plan participants, and other vendors provide health consumer tools to underwriters and directly to agents and brokers for private labeling to their clients. Chicago-based Subimo, LLC, provides Internet-based health information delivery for about three-fourths of Blue Cross Blue Shield plans and other health insurance providers, as well as large employers and brokers. The Subimo Web-based content includes a large library of medical information as well as a health cost estimator that allows plan participants to estimate their annual health care costs in preparation for choosing a CHDP and make consumer decisions about health care treatment and procedure options. In May, UniCare, a subsidiary of Wellpoint, Inc., launched a new health information Web site powered by Subimo cost estimation tools to track the cost of medical information, prescription drugs and the safety and cost information for hospitals within the regions covered by UniCare plans. Subimo’s co-founder and president Ann Mond Johnson, says CDHPs present a serious challenge for agents and brokers. “Communicating and marketing these new plans require a high level of expertise on the part of the agent or broker,” she explains.” Because of the nature of their design, producers need to be informed on all aspects of the CHDP construction.” Moreover, agents and brokers must be prepared to deal with the new financial considerations generated by the HSA or HRA structures. “Brokers will find themselves competing with banks and other financial service providers for the account managements.” But most important, agents and brokers will need to be at the forefront of guiding their clients to the right health care consumer information, says Johnson. “Even before the advent of CHDP, health care consumers were demanding more health care quality information about doctors, hospitals and the relative cost and safety of medical procedures from their local providers. CDHPs now make that information critical to the financial success of the individuals within those plans,” she says. Agent technology companies are also in the competition to provide CDHP support resources, including AMS Benefits, OnlineBenefits, Inc., and Zywave. In April, AMS Benefits in Bothell, Washington, a division of Vertafore, Inc., announced a partnership with Harris Rothenberg International, LLC, a leading provider of Internet-based health and wellness information. The health information company will provide health and wellness content and disease management information to the AMS Benefits Center employee portal. Joe Thomas, AMS Benefits vice president of sales and marketing, says Benefits Center can be used internally by agents and brokers to manage their employee benefits business or be privately labeled for large clients to provide resources directly to their employees. The application already features two stages of benefits management resources, Thomas explains. First, the technology automates a health risk assessment that agents can complete for their client employees or make available to employers for employee self-service. Once the assessment is completed, the application can guide the agents, employers, or employees through plan options. The new HRI content completes the package and will allow participants in CDHPs to better manage their health care. Internet-based enrollment and health information sources may be the cornerstone of CDHPs, but don’t neglect the basics of health self-care, adds Don Powell, Ph.D., president of the American Institute for Preventive Medicine (AIPM) in Farmington Hills, Michigan. The organization provides health information resources, weight control and smoking cessation for more than 11,000 employers, including AT&T, Ford Motor Co. and Citibank. The AIPM Total Health program costs about $2.50 per plan participant and includes online health information, toll-free 24-hour telephone information services and a regular newsletter on preventive and self-care topics. The service is economical and helps participants avoid unnecessary expensive health care choices, Powell says. “More than 25% of all doctor visits are probably unnecessary and more than half of emergency room visits are probably not required for the medical problems they treat,” he explains. “But without accessible information about common medical conditions, people turn to the fastest and often the most expensive source of care.” Agents and brokers could do worse for their clients than providing a comprehensive handbook of self-care in addition to online and toll-free telephone resources, he says. “Putting health information content online is a great resource. It is inexpensive and easily updated, but not every family member is going to get on the Internet when he or she is confronted with a potential medical emergency. “A simple self-care manual is a cheap and easily accessible resource that is a good first step in helping people participate in their own health care,” Powell states. “And it makes a great promotion item for agents and brokers.” * The author |
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