Combatting spiraling health care costs Featured

7:28am EDT May 25, 2004
The United States has experienced drastic increases in health care costs five times throughout its history, mostly due to unsteady political and economic climates, as well as to the advancement of medical technology.

Now, at the turn of the millennium, we again find ourselves experiencing rapidly rising health care costs. For nearly two decades, health maintenance organization plans and other managed care products helped to control health care costs, but managed care as we know it no longer works.

For many reasons, health care costs are spiraling out of control and unleashing double-digit health benefit cost increases. Some of the reasons include:


* Skyrocketing malpractice insurance costs


* Legislative mandates


* Consumers increasingly choosing elective health care procedures


* Shortage of skilled hospital workers such as nurses and pharmacists


* Escalating costs of prescription drugs


This new environment has created a dilemma for employers, who must wrestle with providing affordable, meaningful health benefits to employees without damaging their bottom line.

Health benefit companies are developing new ways to control costs. Through the advent of consumer-choice health plans, these companies have sought to eliminate one-size-fits-all health plans and match benefit options with consumers' health and financial needs. In addition, many have made it possible to reduce administrative costs through the adoption of technology that allocates more of monthly premium dollars to pay medical claims.

Technology has brought about dramatic improvements in consumers' lives, but only recently has it begun impacting the health care industry.

Technology has delivered many improvements in health benefits, including:


* Access to real-time information. The Internet provides real-time information on treatments, prescription drug coverage and hospitals, empowering consumers to interact with physicians on a more informed basis with respect to clinical issues and cost. Access to real-time information can provide quantum improvements in disease management and preventive care. Patients and physicians can identify hurdles in advance based on the patient's family history, records and latest research in the medical field, now available online.


* Easier administration. Physicians and other providers can use the Internet to access patient eligibility and benefit information. This provides 24/7 access to coverage information and reduces the cumbersome task of waiting on the telephone for information.


* Control over health spending. Technology is making it possible for consumers to customize health solutions based on individual preferences. Web-based financial calculators have made it possible to weigh plan options based on financial impact.


* Smarter approach to cost control. Online enrollment, billing and reporting, provisions for online credit card transactions and electronic funds transfer payments streamline business processes, and save time and money.


Employers and consumers also can combat the rising cost of health benefits by becoming informed health care consumers. If consumers are encouraged to become engaged in the true cost of their health care and are given actionable, Web-based information to help them make informed health care decisions, health costs can be brought under more effective control. Alan Guzzino is president of Humana's Atlanta, North Carolina and South Carolina market health plan operations and is responsible for the management, strategic planning and growth of those markets. Guzzino, an eight-year veteran of Humana, serves on the board of the Georgia Association of Health Plans. Reach him at Robert S. Wolfkiel is vice president of sales for Humana's Atlanta market and is responsible for managing and directing the sales initiatives, enrollment process and profitability of Humana's product portfolio within that market. Reach him at GHC-16365(GA) 4/04 Offered by Humana Employers Health Plan of Georgia Inc. or insured or administered by Humana Insurance Co.