One of the most persistent arguments used to debunk the underlying premise of consumer-directed health plans is that "the average Joe" is not going to make the effort to become informed about cost and quality, nor will he make the effort to make adjustments to his lifestyle to improve his health status.
Without this critical mass, the critics argue, the market will not be influenced in any material way and overall costs will continue to increase, quality will fail to improve, and people will continue to need expensive care to treat preventable conditions.
While a great deal of effort has already gone into creating educational materials and providing various tools for general price and quality comparisons, the fact is shopping for gall bladder surgery is just not as fun as shopping for a new car.
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There are, however, signs that health plans are taking cues from some of today's most successful retailers and they're developing programs that allow them to personalize messages, make comparing providers as easy as judging best sellers on Amazon.com, and they are paying cash rewards for healthy behaviors – a CDHC easy button.
For example Medica, a health insurance company headquartered in Minneapolis and active in the Upper Midwest, is offering a number of new programs and products during 2011 open enrollment designed to engage members in their health care decisions while personalizing their experience.
A central feature of Medica's new programs is a research-backed health assessment that is unique and proprietary. It identifies members' knowledge, skills and confidence levels for managing their health – valuable insights that help tailor support for each individual.
Medica also is introducing a new physician transparency program for care and cost information. Medica Premium Designation uses evidence-based, medical society and national industry standards to evaluate individual physicians across 20 specialties for quality and cost efficiency. Physicians who achieve a quality rating will receive one star, while physicians achieving both quality and cost-efficiency ratings will receive two stars. Physicians must first achieve a quality rating before being evaluated for cost efficiency.
In Maryland, CareFirst BlueCross BlueShield (CareFirst) introduced a new portfolio of health plans called HealthyBlue. These products are specifically designed to make it easy for patients to seek necessary care, make them aware of their health risks, and provide them information and incentives to get and stay healthy.
Members who enroll in HealthyBlue first select a primary care physician and complete an online health assessment. They then go to their selected PCP for a health and wellness evaluation. Members who meet certain health criteria can earn rewards of up to $300 for an individual and $700 for a family. Rewards will be paid as a Healthy Rewards gift card or as a contribution to a health savings account. Members who do not immediately qualify for a reward will work with their PCP to develop a Healthy Action Plan and can receive the reward if they achieve the goals of the plan.
Medica and CareFirst have discovered two things that today's successful retailers already knew: Shoppers (consumers) respond best when offers are tailored to their specific interests and they love rewards programs.
To turn members into savvy consumers health plans will need to continue to develop and offer choice architecture that makes it easy for "the average Joe" to make good decisions.
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