Information highway helps patients make decisions

May 1, 2005

Consumers who are aware and diligent about cost and quality have long been ready and able to exercise self-direction when purchasing numerous products and services.

Consumers who are aware and diligent about cost and quality have long been ready and able to exercise self-direction when purchasing numerous products and services.

But relative to healthcare, they often allowed employers, relatives, or friends to make medical decisions. The big problem with such advice is that it often came predicated on the importance of cost or quality, seldom both, and sometimes neither.

That has changed. A better-educated population, aided by resources such as the information highway, is increasingly being heard before medical treatment goes forward. And it is the tools that are provided by advanced technology that make those decisions easier and more informed.

Katherine H. Capps, president of Health 2 Resources, a Washington-based consulting firm working with employers and healthcare plan suppliers for employers, said information is available and consumers are eager for the right to use that information to make an array of medical decisions. That includes choosing physicians, venues, and treatment options.

"(Consumers) must have enough information to make them partners with providers. And the information must not be biased nor an attempt to steer them in a particular direction," Capps said. "It must be evidence-based and it must be ongoing so that they can manage their own health."

Controlling costs A study by Watson Wyatt and the National Business Group on Health showed that companies that encourage their workers to take responsibility for healthcare decisions are having greater success at controlling costs.

The study showed that these companies expect a median 7% increase in healthcare costs, whereas companies that fail to encourage workers to make healthcare decisions are seeing increases as great as 17%.

"A difference of 10 percentage points is hard to ignore," said Ted Chien, global director of group and healthcare consulting at Watson Wyatt. "The results of this study strongly suggest that employers with programs that encourage employees to be more responsible for their health-care decisions are beginning to reap the rewards."

The study indicated that traditional methods of trying to control costs are not always useful.

Companies are less willing to absorb premium increases than they have been before, and fewer employers are trying to contain costs through changes in plans or vendors.

While three out of 10 employers changed vendors as recently as 2002, only one out of 10 made such a change in 2003. Also, fewer than one out of 10 changed pharmacy vendors in 2003, while 23% did so in 2002.

Helen Darling, president of the National Business Group on Health, said employers recognize that a new reality requires new choices.

"Employers and employees must work together to control health-benefit costs," she said. "The only viable way for employers to break the log jam may be to help workers become more educated consumers of healthcare."

Gail Knopf, senior vice president of The Trizetto Group, said there is no longer any other option: companies must use advanced technology to support the complexity of consumer-directed healthcare options. Trizetto, which is based in Newport Beach, CA, provides administrative software and services to the healthcare insurance industries.

"The best way to help consumers in decisions about healthcare is to provide products that offer comprehensive information," Knopf said. "There has to be in place health-plan administration with complete, comprehensive tools that support billing for premiums and claims processing, and can provide information for consumers."

Consumer-directed healthcare came about partly because of high premiums being paid by employers, as well as a better-educated population that is eager to know more about medicine and medical research.

Consumers do not want to be restricted relative to medical services, whether the restriction is due to limits placed by employers or insurance companies, or even geography or economic circumstances.

"Double-digit premium increases brought a response that gave consumers the responsibility of establishing the direction of their healthcare," Knopf said.

Employees have migrated from a wholesale approach for healthcare to one that is more retail-based.