Member engagement Featured

7:00pm EDT January 29, 2008

Consumer-directed health plans (CDHPs) continue to gain momentum in the marketplace. More and more businesses are turning to these plans as a way to reduce costs and help employees become better health care consumers. As a result of this shift, nearly 10 million Americans are now covered by some form of a CDHP.

As employees take a more active role in managing their health benefits, it is both important and necessary to provide them with tools and information about health care costs and quality to help them make informed decisions that are based on overall value.

“Integrated data and information tools empower consumers to make more informed and responsible health care decisions,” said Bill Berenson, senior vice president of sales and service for Aetna’s Small and Middle Market Business for the North Central Region. “Research shows that with helpful information and support, consumers are more likely to demonstrate the kind of behavior that leads to better health outcomes and reduced health care costs.”

Smart Business spoke with Bill Berenson about the offerings and information tools that support member engagement.

What are some of the keys to member engagement?

To promote member engagement you must first provide the price information that members need to be good consumers. Through price transparency, members know what they can expect to pay for health care services before visiting the physician or hospital. This information can help members manage their annual out-of-pocket expenses and make better decisions about how to use their benefits and insurance plans.

You must also recognize that many members prefer to base their health care decisions on overall value and not simply on price alone. As a result, insurers have expanded their efforts to provide members with information on the clinical quality and cost-efficiency of physicians. Performance networks recognize physicians who perform well against a number of clinical and cost measures, which can result in improved access to quality care that may be more cost-effective for employers and their employees.

Are there other ways health plans can support member engagement?

Yes, a variety of tools, programs and services are available. A Personal Health Record (PHR), for example, can promote better informed and better coordinated care by organizing a member’s health history information in a single, portable online file. In many cases, medical and pharmacy information is added by the insurer. However, the member can further enhance the PHR, adding personal information like family history of disease, over-the-counter medications taken and allergies.

Wellness programs, on the other hand, can promote healthy behavior by offering employees a wide variety of services, such as discounts on memberships at fitness clubs or home exercise equipment, weight loss or weight management programs, smoking cessation programs, and discounts on alternative health care options. These discount programs are not insurance but are free, added features to many insurance plans.

How can employers foster member engagement?

Communicating the major features of CDHPs to their employees is just the first step. It is essential for employers to keep members engaged after enrollment and support employees throughout the plan year so they can get the most from their new plan. Employers should find an insurance carrier that provides best-in-class, secure interactive tools that allow members to access their own personal data and find other relevant health-related information, such as price and performance comparisons between doctors and hospitals.

As employees are asked to be more involved in their health care decisions, they need to be able to make educated, informed choices. Giving them the resources to do so is one of the building blocks of consumer-directed 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 berensonw@aetna.com.