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Creativity key in employee use of online health care tools

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Advancing Internet technology is helping employers encourage their employees to make better health care purchasing decisions and adopt healthy behaviors, eventually lowering health care costs, experts say.

The online tools range from the most rudimentary--such as online enrollment and plan comparison tools listing premiums, copayments and deductibles--to more elaborate calculators that help determine individual tax savings if users contribute to a health care spending account.

There also are tools to compare prescription drug costs, hospital costs and quality measures, health risk assessment programs and even digital online health "coaches."

Among the recent innovations:

c In September, Golden, Colo.-based HealthGrades Inc. launched HealthGuide, a suite of decision support tools that empower consumers to shop for high-quality health care as well as manage their finances and conditions. The program includes a budgeting tool that allows users to plan their health care finances and a cost calculator that provides likely out-of-pocket costs for hospital, doctor, drug and laboratory expenses.

c Also in September, San Francisco-based Healthline Networks Inc. unveiled HealthLinks, a health care search vehicle that provides content on symptoms, conditions and treatments that has been screened by a team of medical experts.

c In July and August, New York-based WebMD Health Corp. introduced an estimator that allows users to find out what an episode of treatment costs, including medication, office visits, etc. It also added a retirement cost calculator to project how much employees would have remaining in their health savings accounts at retirement based on current utilization. Last year, WebMD introduced Select Quality Care, a tool that evaluates cost and quality for every U.S. hospital based on outcomes for specific procedures.

Regardless of which tools are used, benefit communication experts strongly advise employers to make sure such tools are interesting, that they be advertised regularly and that employers always think of long-term results.

"A lot of companies that have embraced consumerism understand that you have to take a long-term strategy to change the way people think about health care and engage the health care system and how they modify behaviors," said George Thomas, a principal and communication business leader at Mercer Human Resource Consulting in Philadelphia. "That doesn't happen overnight. That's why companies invest in communication strategies so that people re-evaluate how they think about health care."

GM rolls out pilot

General Motors Corp. has introduced consumerism tools to its Dayton, Ohio-area HMO enrollees with the idea that education will ultimately lead to optimal health care service use even in a managed care environment, said Sam Shalaby, director of community health initiatives for GM in Dayton.

Beginning Sept. 25, GM employees enrolled in WellPoint Inc. HMOs in the Dayton area were given access to detailed hospital cost information about 40 common procedures. The costs, all taken from the Indianapolis-based insurer's claims database, include everything from the initial doctor's office visit to lab work, radiology, emergency room care, surgical procedures, pharmacy and follow-up visits.

"It provides you with specific cost information about not only the procedure, but the entire episode" all bundled together, Mr. Shalaby said.

Information on the number of procedures performed by a given hospital is included as a quality indicator since frequency is generally linked to better outcomes, he said.

"For our consumers in the Dayton area, GM wants to make sure the plan members seek the information, make appropriate provider selections and communicate with their physicians, establishing a partnership throughout the episode. It is also hoped that the plan members practice prevention when they see how much certain procedures cost and pursue a healthier lifestyle," Mr. Shalaby said. "On the provider side, we expect them to focus on initiatives to improve the quality of care and reduce costs and identify and eliminate any sources of waste and improve their organization's efficiency."

Though the pilot in Dayton, where about 40% of GM's employees are enrolled in managed care plans, is limited, GM and WellPoint intend to expand access to all of the automaker's health plans by January 2007.

Drive toward engagement

In another approach to engage clients' employees, Buck Consultants L.L.C. now is developing an interactive Web site that allows users to assign certain symptoms and/or conditions to an "avatar" that simulates the process of going to a doctor's office, talking with the provider, interacting with the medical billing clerk regarding payment and going to the drugstore to fill a prescription.

"The avatar is a person," says Scot Marcotte, principal-electronic communications in Buck's Chicago office. "You can change its gender, hair or skin color to look like the user. The entire process is role-played before the employee goes to the doctor. This even provides a list of questions," he said.

"What we're finding is that with CDHPs, the provider or billing coordinator doesn't know how the plan works and so the employee needs to run interference to explain it to them," Mr. Marcotte said.

Buck also is designing online tools to target employees' family members, who often influence decisions regarding what and when to eat as well as exercise, he said.

"The kids' portion of the site has online games to help them understand the basics of health care and why it's important to eat well and exercise," Mr. Marcotte said. "We even tie it in with professional motor sports and TV game shows to make it fun."

While such creative tools may seem like overkill in the often staid world of benefit communications, "these more creative tools help boost usage to as high as 80% or 90%," Mr. Marcotte said. Most consultants say usage of online tools of 20% to 30% is about average.

In fact, because of the additional tools as well as training, Mr. Marcotte said one of his employer clients achieved a 60% enrollment rate in its new CDHP.

"Employers with higher utilization are those who really make an effort to educate employees that tools are available and how they can help them," said Sara Taylor, national annual enrollment leader at Hewitt Associates Inc. in Lincolnshire, Ill.

For best results, employers should design their benefit portals to be similar to the Internet sites that consumers use for commerce, advises Michael Rudnick, national portal practice leader at Watson Wyatt Worldwide in Stamford, Conn.

"Employers that want their employees to change their behavior have to build health benefit Web sites that are on a par with the commercial Web sites," he said. "People use the Web all day long, so they compare their experience against commercial Web sites. It's what MTV did to corporate video years ago."

"What companies like Amazon have done on the consumer side in taking these different points of data--price, independent reviews, multiple places to buy them, all those things that they've done around a camera or a book--is what participants want from their health care portals," Mr. Rudnick said.

Interactive Web sites that make the benefit communication experience more interesting are more likely to capture employee attention, agreed Mercer's Mr. Thomas. "The best health portals will have people keep coming back--to make a portal 'sticky' you have to make value."