Monday, December 17, 2007

Health insurance companies - healthcare goes retail

" The average American now spends more than $6,600 a year on healthcare and, for the most part, has only vague ideas as to where that money goes, how to manage it or how to navigate the healthcare system. As a rule, the information provided by health plans is sparse, confusing and usually out of date.
Although health plans are increasingly embracing consumer-oriented product designs and strategies, many have left the consumer in the dark.
“It is hard to believe that an industry that plays such an important role in the lives of consumers
doesn’t provide regular statements that answer basic questions about benefits, funds and care,” says Dan Spirek, senior vice president and chief solutions officer of The TriZetto Group, Inc.
As healthcare costs continue rising to record levels,1 consumers are taking on greater responsibility for both costs and decision-making, and they need information with which to manage these responsibilities effectively, Spirek says.
“Here’s an opportunity for our industry to step up and deliver a solution to a fundamental consumer problem.”
Healthcare payers are ideally positioned to deliver the information and guidance that consumers
need, but few have taken steps to meet these needs. If payers hope to play a central role in the
changing healthcare market, they can’t afford to ignore their constituents’ needs for transparent
information. Payers that don’t take steps to deliver critical information to key constituents—members, providers, employers and brokers—will lose market share to those that do."
Making health and benefit information transparent through personalized consumer statements—the topic of this paper—is one innovative way that payers can advance their transparency strategies and further engage members.

The consumer statement also can direct members to appropriate health and wellness programs, provide discount coupons for fitness-center membership, explain incentive programs, deliver information about upcoming educational seminars, and more. The consumer health and benefit statement is more than just a snapshot in time; it is also a way for payers to drive greater usage of their web sites and further engage members to help them make sound financial and health decisions.

TriZetto® is releasing a series of papers that explore transparency and its implications for payers. This paper, the second in the series, focuses on transparent health and benefit information and how personalized consumer statements help meet member needs for information and guidance regarding benefits, funds and care.
To request a copy of the first paper, Healthcare Goes Retail: Consumer and Provider Cost
Transparency for the Emerging Consumer Retail Healthcare Market, please visit Upcoming papers will cover key areas such as how integrated technology solutions can help payers make the evaluation and selection of healthcare benefits and services more enjoyable for consumers; and why payers should focus on care coordination and integrating health incentives across members and providers, instead of settling for narrowly defined pay-for-performance programs for providers.

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