Passing additional financial responsibility for their health care to employees more premiums, higher co-pays, higher deductibles and coinsurance has stimulated the concept of health care “consumerism,” according to James Repp, Corporate Head of Sales for AvMed Health Plans.
“For an employer to require additional financial responsibility without giving (his or her) employees the proper support is irresponsible,” says Repp. “Providing them with the proper health care information will help them spend their out-of-pocket money more prudently.
“Consumerism starts with an awareness that quality, cost and service vary. And responsible employers should be urged to provide resources so that employees are better armed to make decisions.”
Smart Business spoke with Repp about how certain services can educate employees and also stimulate them to improve their health and well-being.
How can the Internet help?
If you start at the most basic level, the Internet is a tool to provide access to claims information, like how employees stand relative to their deductibles and their coinsurance limits. Such Web sites can also demonstrate the value that the health insurer brings through their network arrangement not only the bill charges but also the actual negotiated rate that the employee has to pay.
Some interactive Web sites also provide general health information. Patients can go online and enter in a specific disease or procedure, and as you navigate through those topics, the site asks additional questions. It then walks them through alternatives to the disease or procedure in question and lists questions that can be asked of the physician.
What if a person can’t access the Internet?
One of the missteps that a lot of health care carriers have made is that they’ve almost exclusively driven their consumerism platform through the Internet. The online tools are very important, but they shouldn’t be used in isolation.
It’s also important to provide 24-7 access to actual human beings who can help answer questions and let their subscribers or members know what information is available. A high percentage of the people accessing provider Web sites are simply overwhelmed with trying to navigate them. If they have an advocate who can help them, it becomes easier.
The next level of support is more attuned to helping find a doctor and a hospital. Members can put in criteria relative to quality or proximity, and the site will produce a report based on that criteria.
The most appealing model is to have online services available 24-7 but also to provide access to advocates through a telephone-based 24-7 system. The most advanced programs add access to registered nurses through a nurse-on-call service 24-7. When you fuse those services together, you get the most powerful combination.
What cost-saving measures can an employer recommend?
When you start to get into financial engagement, that’s when the awareness and understanding of the variability become important.
Members need access to the cost of certain procedures and the cost of using network versus non-network providers.
Ultimately, employers must begin to impact the thought process of their employees by convincing them that making some simple lifestyle changes today can minimize future out-of-pocket costs. In the past, there wasn’t that incentive to stay healthy because their out-of-pocket expense was relatively low and fairly fixed.
Getting your employees to take at least some of these low-cost actions today can be driven by providing incentives.
How will the health care system change in the near future?
One is that there promises to be further transparency of costs, which will really cement consumerism into the health care model. Most of the cost information being communicated today is coming from the carrier side of the business, it’s not broadly available, it’s built on averages, and it doesn’t break down to a specific disease, facility, procedure or physician. We’re looking at full disclosure of the entire health care model, and the Internet will be one of the components that can provide that information.
The other piece is the creative financial arrangements around providing additional incentives for employees to save for health care: the health savings accounts, health reimbursement arrangements, flexible spending accounts -- all those mechanisms that provide favorable tax treatment. In the past, there were relatively low premiums, high levels of coverage and low outof-pocket expenses so people weren’t forced to save. Now, with higher deductibles and the cost-sharing increase, people are going to have to start saving for health care. Incentives make complete sense.
JAMES REPP is Corporate Head of Sales for AvMed Health Plans. Reach him at (305) 671-6122 or firstname.lastname@example.org.