Helping health care consumers

The “consumerism” movement in
health care involves employers sharing more responsibility for health benefits and health care decision-making
directly with their employees. This can
lead to these employees becoming more
involved and engaged in their own health
care — if they have the right information
to get the most from their health benefits.

Some insurers offer consumers access
to this type of information through various online resources. If done effectively,
both employers and their employees can
see tangible benefits.

“Our experience has shown that, with
helpful information and support, consumers are more likely to demonstrate
the kind of behavior that drives down
health care costs while maintaining quality of care,” says Bill Berenson, senior vice
president for Aetna’s Small and Middle
Market Business in the North Central
Region. “It also has shown that total
health spending is reduced when consumers assume more responsibility for
their health care expenses.”

Smart Business spoke with Berenson,
who explained what types of online
resources are available for consumers as
well as what features they usually have.

What type of online tools do insurers typically offer?

Many insurers offer their members a
self-service member Web site where individuals can retrieve their personal health
benefits information, such as the status of
claims they have filed and their Health
Savings Account or Flexible Spending
Account balances.

These sites also include a variety of
resources, such as directories of primary
care physicians and specialists in their
geographic area; health risk assessments
and wellness programs that can help consumers identify areas where they can
improve their health; action plans to help
them get started; and cost and quality
comparison tools that can help consumers estimate the cost of care for a
specific procedure or compare the quality of hospitals in their area.

Personal Health Records (PHRs) are a
relatively new resource. They offer consumers online access to all their personal
health information in one secure, online
location. PHRs are typically populated
with claims information by the health
insurer, and consumers are encouraged
to add their own health information (such
as family health history, allergies and
over-the-counter drugs) to get the most
from the tool.

What are some of the general characteristics
of these online resources?

With self-service Web sites, it is particularly important that the sites are easy to
use for consumers and that the personal
health information stored on these sites
is completely secure.

The simplicity of a site, as well as the
ability of a consumer to navigate through
it, are essential aspects of customer service for insurers. In some cases, consumers never call their member services
number, so this may be the only contact
they have with an insurer, and their experience will greatly affect their view of the
insurer.

In addition, consumers have some of their most personal and private information on these sites, so it is imperative for
insurers to guarantee that a consumer
has complete control over who accesses
this information.

In many cases, if you are not a member of a
particular insurance company, you can’t use
its online tools and information. Are there
sites that all consumers can use, even if they
are not a member?

There are several examples of free, public Web sites that can help educate all
consumers on both health care and
health benefits-related topics. Aetna
InteliHealth (www.intelihealth.com) contains consumer health information from
Harvard Medical School, as well as articles from industry-leading doctors in a
wide variety of fields, recent headlines in
health news and interactive consumer
tools.

Other sites, such as Plan for Your Health
(www.planforyourhealth.com) and All
About The Benefits (www.allabout
thebenefits.com) can help consumers
improve their overall knowledge of
health benefits. These sites contain informational articles and tools based on different life stages — such as starting a
career, getting married, having a child
and retiring — making it easier for consumers to make the most of their health
plan.

When you consider the information
available to consumers through these
types of sites — as well as the personal
health information they can access safely
and conveniently through secure, member-specific sites — it becomes apparent
the tremendous impact these online
resources can have on health care consumers. That is why it is so important for
an employer to find an insurer that is
committed to providing its members with
the right tools and information, enabling
them to make educated, well-informed
decisions on their health care.

BILL BERENSON is senior vice president of Aetna’s Small and
Middle Market Business for the North Central Region. Reach him
at (312) 928-3323 or [email protected].