Helping health care consumers Featured

8:00pm EDT June 25, 2007

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 berensonw@aetna.com.