Variety of tech tools in demand for using CDHPs

As insurers and employers turn to consumer-driven health plans to cut benefit costs, they also look to technology to engage employees in their health care decisions, leading to an array of software as diverse as the challenges CDHPs pose.

“It's to no one's advantage for people not to know” how their health care benefits are structured, said Michael Wolf, director of the Center for Communication in Healthcare at Northwestern University's Feinberg School of Medicine in Chicago.

He cited a 2007 study by the University of Connecticut that estimated the cost of low health literacy is between $106 billion and $238 billion annually.

It's a drain on employers, patients and insurers that can be plugged only by keeping patients aware of healthy habits, when and how often they need to use health care services, and how to find the cheapest care.

It's especially important to keep CDHP patients informed because of the greater independence they have in making decisions about their care, Mr. Wolf said.

A variety of software has been developed to help CDHP users navigate their plans—some to be offered through employers or insurance companies; some directly to the consumer. Some are meant to be used at home; others at work; and some, for mobile devices.

Still, more diversity exists in the programs' emphases—with some focusing on point-of-care decisions and others on preventive care, some focusing on health literacy, others purely on cost reduction.

RedBrick Health Corp. Chief Executive Officer Kyle Rolfing said his company aims to improve patients' habits.

Mr. Rolfing, a veteran of Definity Health Corp. and UnitedHealth Group Inc., said he started RedBrick to provide a system that rewards preventive care and healthy habits.

His Minneapolis-based company offers online health assessments and education, and sets up an infrastructure to reward employees for good habits like quitting smoking or losing weight.

Though he admitted some programs depend on the honor system, he said it's important to provide incentives to reward healthier lifestyles to reduce health care costs.

Other programs aim to synchronize data necessary for doctors and patients to make good decisions. Philadelphia-based CIGNA Corp.'s Cost of Care Estimator takes information about all costs associated with a treatment, considers features in a patient's plan and relevant factors from their health assessment, and makes treatment recommendations for the patient and doctor to consider.

Some help patients shop around.

San Francisco-based Canopy Financial, a self-described health care banking technology company, offers an iPhone application that enables patients to search procedures using keywords, and then find out where they're available and if they qualify for payment from health savings accounts. It also uses a patient's ZIP code to estimate costs. CEO Vikram Kashyap said the company plans to make similar software for all mobile devices.

The Consumer Choice Plan from Franklin Lakes, N.J.-based Medco Health Solutions Inc. provides Web-based tools to compare plans and purchase prescriptions. It also provides benefit coaching and structures payments to encourage patients to use preventive medications.

And some companies aim to make confusing programs understandable. Charleston, S.C.-based Benefitfocus, which says it is the largest health care software provider in the United States, produces videos that answer health-related questions and helps users choose between complex benefit packages and how to navigate them afterward. It also offers software that incorporates expected health care costs to help users choose their health plan.

Boston-based Health Dialog Services Corp. offers 24-hour health coaching and online videos to patients through health plans, employers and providers.

“Many decisions in medicine are gray,” said Dr. Lance Lang, the company's medical director. “How much it's going to cost is only part of (the decision).” Dr. Lang said information necessary to make a choice often is absent or more than one evidence-based treatment is available, making it tough to choose between options. The Health coach's role is to talk patients through these decisions, he said.

Additionally, Microsoft Corp. and Google Inc. have established health record management tools. Both allow patients to input information and doctors to upload records to set up the health profile. Google Health enables users to search physicians by specialty and location, and shows reviews aggregated from other sites. Redmond, Wash.-based Microsoft also has added a tool that lets users get health advice from physicians at Mayo Clinic.

While CDHPs and the technology developed to help them work more efficiently are more than five years old, the insurers, consultants and tech-sector giants that built them remain challenged to get people to use them.

While experts in health literacy and employee behavior agree the technology shows the potential to improve health care decisionmaking, it has not taken the place of long-trusted sources of health information.

According to a nationwide survey in May 2007 by Watson Wyatt Worldwide Inc., 57% of employees listed “friends and family” as their regular source of information about doctors and hospitals, while only 36% listed their health plan's Web site.

As for why this trend exists: “People don't trust their health plans,” said Barbara Flitsch, senior consultant for Watson Wyatt in Minneapolis.

“People still tend to go with their gut,” Northwestern's Mr. Wolf said. “The bottom line with health care in the past 20 years is that the average consumer knows very little about what they should be doing.”

He characterized the technology options available to health plans as ranging from “Plymouth Neon to Cadillac.” But their complexity, he added, makes it difficult to tell the difference—leading health plan members to make uninformed choices.

The lack of trust has continued even as companies rely more on health-administration technology.

A March Watson Wyatt survey found 19% of employers increased outsourcing of health and welfare benefits administration and 16% outsourced human resources and benefits services in the previous two years.

It also found 72% of companies surveyed report increased use of their intranet and 61% percent used more e-mail to communicate with employees during the same two-year period.

While more companies have come to rely on technology-driven means of reaching employees, it's also true that CDHP-technology industry has arrived in a climate of uncertainty for health care. With the prospect of health reform legislation looming, it's difficult to predict what CDHPs and CDHP technology will look like, or how common either will be, in the coming years, experts say.

Despite uncertainty about health care reform, Ms. Flitsch said she expects demand and innovations in health care software to continue.