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Consumer-driven health plans need better educational tools for employees


Communication and education tools available today to members of consumer-driven health plans are significantly better than when the plans were introduced a decade ago, but they're still not quite what the doctor ordered.

As more employers adopt CDHPs, health plans and third-party technology providers are rushing to develop more user-friendly tools to enable the plans to live up to their promise of transforming employees into savvy health care consumers.

“The hope and belief that we can give more transparent information to people is still a work in progress,” said David Slavney, a St. Louis-based partner in Mercer L.L.C.'s talent communications practice. “Health care remains a very complicated thing to manage. It's not like buying an airline ticket.”

Ron Barlow, managing director of PricewaterhouseCoopers L.L.P.'s human resource practice in Chicago, said “there are some third-party vendors that are doing a good job,” pointing to San Francisco-based Castlight Health Inc. as one technology firm that has developed a robust suite of tools that give detailed information on provider pricing integrated with plan design to help plan members make more educated health care purchasing decisions.

The tools also are available via smartphone apps so plan members can access them at the point of service, such as in a doctor's office or at a pharmacy.

“The problem is most employers have too little resources,” said Ron Agypt, chief employee benefits sales officer at Hub International Ltd. in Chicago. “Today, most of the resources are being provided by the carriers.”

But some employers may find that “health plan tools aren't always enough” to transform their employees into better health care consumers, Mr. Barlow said.

“Employers may have to supplement them with outside consumer tools, but they have to pay for this service,” he said, comparing the cost to the typical per-employee, per-month fee charged by employee assistance plan providers — about $2 in the case of larger employers.

“But the additional communication costs could be mitigated by lower costs of the plan itself” when employees become more engaged in making their health care decisions, Mr. Agypt said.

Keisha Olinger, senior change management and communications consultant at Towers Watson & Co. in Atlanta, said employers should prepare to spend at least 50% more than prior benefit communications during the first year after switching to a CDHP, a plan type that was introduced more than two decades ago.

Jennifer Harley, manager of welfare benefits at OneAmerica Financial Partners Inc. in Indianapolis, said the financial services company “at least tripled our communication budgets” when it introduced a CDHP for employees this year, though she declined to provide a figure.

“We kept it in front of employees monthly. It was mentioned in virtually every communications from benefits,” she said.

Finding its health plan's consumer tools lacking, OneAmerica also partnered with Castlight Health for an additional per-employee, per-month fee.

Fortunately, the competition being created by third-party providers of CDHP decision-support tools is prompting some health plans to enhance their own in-house tools, said Jim Winkler, chief innovation officer of health and benefits at Aon Hewitt in Norwalk, Connecticut.

“Vendors are taking real claims data and are building more specific unit-cost pricing,” he said. “That has pushed the health plans to make their tools provide more specific cost information.”

But in many cases, health care plans are stymied by contracts with providers that preclude them from making more specific cost information public, Mr. Winkler said. As a result, most health care cost estimators provided by health plans still provide average costs, such as the cost of an office visit or a procedure in a particular ZIP code.

“We do have some providers today who do not permit us to disclose negotiated rate information with members,” said Chris Riedl, Chicago-based director of national account products at Aetna Inc. But it's “a very small percentage of our overall network, less than 2%.”

Even when Aetna has the authority to disclose provider prices, “there is some level of subjectivity to these cost calculator tools,” Mr. Riedl said.

“Sometimes the doctor may not know the extent of what is required to be done from a care perspective until they are delivering the care, which could result in additional procedures and costs,” he said.

Recognizing this possibility, Castlight lists the typical components of a doctor's office visit or episode-of-care treatment regimen, noting that additional procedures could raise the unit cost for some plan members, said Gary Alpert, San Francisco-based vice president of solution consulting at Castlight.

To keep up with the increasing demand for greater health care consumerism tools in conjunction with CDHP offerings, some health plans are partnering with technology providers and others to augment their offerings.

Aetna, for example, offers a hospital comparison tool from WebMD, while Wellesley, Massachusetts-based Harvard Pilgrim Health Care Inc. has partnered with Castlight.