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SupportingHealth insurers

provide a growing range

of tools

Health insurersprovide a

growing range of tools

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CONSUMER DECISION-SUPPORT TECHNOLOGY, much of it Web-based, is giv-

ing health insurers more ways for consumers to participate knowledgeably in

decisions involving their health care. And with the momentum to raise con-

sumers’awareness of the true cost of health care and help them understand how

their choices impact health care costs, decision-support tools are proliferating.

“At the end of the day,we’re going to manage costs by having people consume health

care much as they do other things,” says Jeff Verney, senior vice president of E-Com-

merce for CIGNA HealthCare.“The technology is now available,so we can share infor-

mation with people so they can become better consumers of health care.”

An Industry TrendCIGNA, which has about one million

enrollees registered for individual Web pages through its

Select Quality Care system, is one of many health insur-

ers and plans offering an increasing array of decision-sup-

port tools. Others include Aetna, Blue Cross Blue Shield

of Minnesota,Destiny,Great-West Healthcare,Group Health

Cooperative, Health Alliance Plan, Highmark Inc., Hori-

zon,Humana, Independence Blue Cross,MVP,Vivius, and

WellPoint Health Networks.

CIGNA HealthCare offers members tools including

programs to assess their health risks;decide the best course

when experiencing specific symptoms; compare hospitals

in terms of costs,outcomes,morbidity rates, and other fac-

tors for specific procedures; and compare pharmaceutical

options. About 15,000 CIGNA enrollees use the

myCIGNA.com portal every day.

In its consumer-choice health plan options, CIGNA

HealthCare offers additional tools that provide data on pric-

ing differences between providers. Currently, its provider

rankings and related information focus on hospitals and are

based on self-reported Medicare data, says Verney.“Right

now, there’s not an equivalent tool for physicians.We’re

probably 18 to 36 months away from that as an industry.”

On its Mygreatwest.com site, Great-West Healthcare

offers what Cindy Donohoe, vice president of marketing

and products, calls standard Web tools that allow members

to find a doctor in their area, make online inquiries about

claims status, and check balances in

health reimbursement and flexible spend-

ing accounts.

In addition, Great-West Healthcare offers three online

decision-support tools,according to Marc Ver Straate,prod-

uct marketing manager. On MyCare, members can look

up nutrition and dietary information and can also take a

health risk assessment and store their scores. MyCare is a

product of Winning Habits, which provides personalized

interactive health and wellness systems.

The second tool is CareCompare, from Healthshare

Technology,Inc.,which provides hospital grading based on

Leapfrog Group data.To find a hospital, a member selects

specific criteria that are important to him or her, such as

patient volume,mortality rate,unfavorable outcomes, length

of stay, and average charges. The information is arranged

by zip code. The next step will be to apply CareCom-

pare to physicians, Donohoe says. Comparative physician

costs will be described as in a restaurant guide—using dol-

lar signs. And after that, the plan is to provide quality infor-

mation on physicians, she says.

Through the online Drug Compare tool from

Advanced PCS,Great-West Healthcare members can find

a pharmacy in their area, compare the cost of a generic vs.

a brand-name drug,make use of a mail-order prescription

benefit, and receive information on drug-food and drug-

drug interactions.

At Group Health Cooperative in Seattle, decision-sup-

Informed ChoiceInformed Choice

By Chris Rauber

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port tools are part of a broad effort to

use technology to coordinate and

improve the quality of care.Approx-

imately 84,000 of the integrated sys-

tem’s 560,000 members are registered

to use its MyGroupHealth.com web-

site, and 33,500 have signed up for

a second level of access that lets them

use a PIN number and password to

access clinical data and communicate

with providers via secure messaging,

according to James Hereford, Group Health’s executive director of

health informatics.

Central to the process is Healthwise Inc.’s Knowledgebase,which

includes 25,000 pages of health data sorted by topic.When a reg-

istered MyGroup Health member gets a lab test result or a diag-

nosis from a plan physician, that step triggers a query to the data-

base, resulting in a posting of relevant information to the patient’s

Web page.A paper version,which provides additional information,

is given to the patient at the point of care.

Each week the three-year-old MyGroupHealth site has 11,000

visitors, and approximately 1,000 e-mail “conversations” take place

between enrollees and Group Health providers using secure mes-

saging applications. In addition, more than 400 medical appoint-

ment requests, 2,100 prescription orders or refills, and 4,000 page

views of lab reports occur in a typical week. Previously,“all of the

[online users] would have to come into the facility or call.This obvi-

ously has operational benefits as well as customer satisfaction ben-

efits, because of the convenience of these services,” says Hereford.

And by the end of this year, “our projection is that we will have

100,000 members doing clinical business with us over the Web,

or about one-third of the adult enrolled population who get their

care from Group Health physicians,” says Hereford.“At that point,

it’s not a niche application or channel, it’s a very mainstream way

of conducting business.”

Destiny Health, which operates consumer-choice plans with

current partners Tufts Health Plan and The Guardian Life Insur-

ance Company of America, also gives members information from

Advance PCS and Healthwise. In addition, Destiny offers two

distinctive decision-support tools, says Ryan Levin, vice presi-

dent of product development and risk management. The first is “a

very detailed explanation of benefits,” showing what each provider

has charged for a service, whether it was paid from the member’s

personal medical fund or by the insurance plan, and how much

is left in the medical fund. “We see full cost-transparency as an

integral part of decision support,”Levin says,because it allows con-

sumers to see how they are spending their health care dollar.

In addition, Destiny’s Vitality program uses incentives to sup-

port members’decisions to follow wellness guidelines. For exam-

ple,Vitality members earn points for lowering their cholesterol,

enrolling in a disease management

program, not using tobacco for 12

months, or exercising (for reinforce-

ment, they can log their workouts on

Destiny’s website).

Members begin at the bronze Vital-

ity status and can progress to platinum,

as they make healthier lifestyle deci-

sions and their health improves.Each

Vitality status comes with a set of

rewards, such as movie tickets and air-

line miles. But the key, says Levin, is that members with higher

Vitality status earn more for each dollar they carry forward into

the next year from their personal medical fund. Bronze mem-

bers receive 3 percent interest and platinum members 10 per-

cent.

According to Levin, independent research showed that 79 per-

cent of Vitality members started an exercise and nutrition program

within the last 12 months,vs.32 percent of nonmembers. Eighty-

six percent of Vitality members said they believed a person’s lifestyle

choices had an impact on their health care costs, vs. 28 percent

of nonmembers.Asked if they had done something personally to

reduce the cost of their health care, 72 percent of Vitality mem-

bers said yes, vs. 39 percent of nonmembers.

Focused TechnologyGenerally speaking, health insurers are moving away from post-

ing static content on their websites toward offering customized

decision-support information, says Bob Tavares, manager of con-

sumer products at HealthShare Technology,a decision-support firm.

Insurers “realize they’re never going to be an all-encompassing,

broad health care portal,” says Tavares, noting that consumers are

looking for “tons of depth and breadth”when they research a health

care issue. That means they may choose to go to government or

clinical trial sites for some information, rather than to insurer

sites. So health insurers are “focusing on the two or three things

where consumers think of them first.They’re moving to fewer,bet-

ter-content modules rather than a broad, trying-to-please-every-

one approach.”

Insurers are just part of the market for this focused technology,

according to Jerry Reeves, MD, chairman and CEO of Las Vegas-

based WorldDoc Inc.,which counts among its customers large self-

insured employers, benefits consulting companies such as Deloitte

and PricewaterhouseCoopers,and multi-employer Taft-Hartley plans.

WorldDoc,founded in 1999 by a group of board-certified physi-

cians, offers a suite of products that analyze symptoms and com-

pare treatment options;evaluate new or controversial tests and treat-

ments; rate regional hospitals on outcome, cost, and safety mea-

sures; and allow communication with physicians via email.

Other decision-support firms including Health Grades Inc.and

“We see full cost-transparency as

an integral part of decision suport.”

Health Dialog Services Corp.60 State Street, 11th Floor, Boston, MA 02109800-893-5532

George Bennett, chairman and CEOwww.healthdialog.com

Specializes in health coaching, providingevidence-based data on health careoptions and encouraging patients to collab-orate with their doctors.

CLIENTS: Highmark, Definity, IndependenceBlue Cross, and several other Blue CrossBlue Shield plans.

Health Grades Inc.44 Union Blvd., Suite 600, Lakewood, CO 80228303-716-0041

Kerry R. Hicks, president and CEOwww.healthgrades.com

Provides decision-support tools to helpplan members select hospitals, physicians,nursing homes, and home health agen-cies.

CLIENTS: Blue Cross Blue Shield of Min-nesota, Medica, American Postal WorkersUnion Health Plan.

HealthShareTechnology Inc.360 Massachusetts Ave., Suite 200, Acton, MA 01720978-263-6300

Rick Siegrist, president and CEOwww.healthshare.com or www.selectqualitycare.com

Allows consumers to compare and selectthe best hospital for their individual needs,using evidence-based measures such aspatient volume, mortality rates, and out-comes.

CLIENTS: Aetna, CIGNA, Health Net, Great-West Healthcare, various Blue Cross/BlueShield plans.

Healthwise Inc.2601 North Bogus Basin Road, Boise, ID 837021-800-706-9646

Donald W. Kemperchairman and CEOwww.healthwise.org

Provides more than 5,000 evidence-basedtopics on health conditions, medical testsand procedures, medications, and everydayhealth and wellness issues based on up-to-date medical research and indexed toindustry-standard vocabularies like ICD-9.

Clients: Aetna, CIGNA, Group HealthCooperative, Definity Health, Humana,Kaiser Permanente, UnitedHealthcare, var-ious Blue Cross/Blue Shield plans.

SubimoP.O. Box 5335, River Forest, IL 60305312-409-5967www.subimo.com

Ann Mond Johnson, president

Provides comprehensive suite of decisiontools covering health management, hospi-tal rating, pharmaceuticals, and medicalprocedures.

CLIENTS: Anthem of Virginia, Oxford HealthPlans, WellPoint Health Networks

Protocol Driven Healthcare, Inc.75 Claremont Road, Suite 201,Bernardsville, NJ 07924-2262908-630-9380www.pdhi.com

Jennifer Jolley, president

Provides health, wellness, and diseasemanagement programs designed toempower consumers to take control oftheir health and develop positive changesin behavior.

CLIENTS: Aetna, Humana, Wausau Benefits

WorldDoc Inc.500 N. Rainbow, Suite 314, Las Vegas, NV 89107702-821-0818

Jerry Reeves, M.D., chairman and CEOwww.worlddoc.com

Analyzes users’ responses to questionsabout hundreds of symptoms, conditions,and risks; explains the relevant associatedconditions as well as prevention and treat-ment options.

CLIENTS: self-insured employers; healthplans, including Medicare Advantageplans; and Taft-Hartley plans.

—CR

Selected Firms Offering Consumer Decision-Support Tools

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HealthShare Technology focus pri-

marily on hospital ratings, although

Health Grades also rates other types

of providers. Subimo provides soft-

ware for general health management,

hospital ratings,pharmaceuticals,and

specific medical procedures.

Health Dialog was created to dis-

seminate material and insights devel-

oped by the Foundation for

Informed Medical Decision Making

and researchers John Wennberg,MD,

of the Center for Evaluative Clinical

Sciences at Dartmouth, and Albert

Mulley Jr., MD, at Massachusetts General Hospital. Health Dia-

log focuses on coaching consumers on collaborating with their

physicians to achieve the best health results.

Healthwise Inc.provides both Internet-based and printed con-

tent on health conditions and health and wellness issues. Not

that long ago, recalls Donald Kemper, chairman and CEO of

Healthwise, most Americans didn’t realize they were capable of

buying or selling stocks on their own, or making informed deci-

sions about their health care. That mindset has changed, and con-

sumers now clamor for information about virtually all products

available for their purchase.

Choose a Hospital—or a Build a PlanCIGNA HealthCare uses decision-support firm HealthShare Tech-

nology to help consumers choose a hospital and Subimo to help

them make pharmaceutical decisions. Humana, too, uses support

tools from several vendors, including Healthwise, Protocol Dri-

ven Healthcare, Inc.,and HealthShare Technology,along with pro-

prietary tools that let consumers choose health benefits and com-

pare the costs of specific procedures or medical services.

Highmark Inc., a Pittsburgh-based Blue Cross and Blue Shield

plan, uses its own home-grown decision-support technology to

allow enrollees to “build their own plan,” customizing features

to meet their personal preferences.The process increases consumer

satisfaction with the plan selected,according to Kim Bellard,High-

mark vice president of e-marketing and customer relationship

management.

Highmark’s BlueChoice program features interactive selec-

tion tools that allow members to indicate general preferences and

receive a list of plans ranked by how well they meet those pref-

erences. So far, about 70,000 members use BlueChoice to select

variables such as size of copayments for physician office visits, cov-

erage options for drugs and preventive care, and the ability to see

a physician without a referral.

The BlueChoice program, launched in May 2000, started with

16 choices of health plans; it now includes almost 200 options that

employers can choose to offer (the

average number chosen is 10.)

Another company that allows con-

sumers to design their own health

plans is Vivius, which partners with

insurers including Health Net and

HealthSpring to offer products under

the insurer’s brand. According to

President and CEO David Teckman,

Vivius developed an online tool that

allows each family member to choose

providers and copayment levels based

on individual preferences and expect-

ed use; after members create their

individualized health plans, the tool calculates the premium.

In choosing providers, a member enters the name of a family

doctor, and a screen identifies the physician’s recommended spe-

cialists and hospital. The tool then gives members quality and cre-

dentialing information about the doctors, such as their office loca-

tion, educational background, foreign language fluency and pro-

fessional or legal sanctions (if any).The member is free to choose

among the list of providers recommended by the family physi-

cian or select others, based on information provided by the doc-

tors themselves and on information that the insurer partner makes

available.

The Vivius website shows how members can make their pre-

mium higher or lower based on choosing a particular doctor,

hospital, or copayment level.The technology developed by Vivius

is easy to use, allowing someone who reads at a sixth-grade level

to design a customized plan in 15-20 minutes,Teckman says.

Rapid StridesOverall, the health insurance market is behind other industries

in implementing decision-support technology, but it has made

rapid strides in about the last 12 months, according to CIGNA

HealthCare’s Verney.“We’ve seen a lot of movement among a

lot of payers,” he says,“but there’s a huge opportunity to increase

awareness.”

CIGNA HealthCare is working with employers to broaden

awareness of its consumer decision-support tools and is explor-

ing linking its site to employer portals so that enrollees can receive

more personalized information on health risks and specific con-

ditions like asthma or diabetes.

The motivation is obvious,Verney argues, in an environment

where consumer involvement and empowerment are seen as keys

to controlling cost and enhancing quality:“Once people use these

tools, they tend to use them again and again.” HP

Chris Rauber is a Walnut Creek, Calif.-based freelance writer andconsultant.

“Once people use these tools,

they tend to use them again

and again.”

Copyright 2004 by the American Association of Health Plans