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2004

Supporting
Health insurers
provide a
growing range
of tools

Informed Choice
ONSUMER DECISION-SUPPORT TECHNOLOGY, much

of it Web-based, is giving health insurers more ways for consumers to participate knowledgeably in
decisions involving their health care. And with the momentum to raise consumersawareness 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,were going to manage costs by having people consume health
care much as they do other things, says Jeff Verney, senior vice president of E-Commerce for CIGNA HealthCare.The technology is now available,so we can share information with people so they can become better consumers of health care.

By Chris Rauber

ing accounts.
In addition, Great-West Healthcare offers three online
decision-support tools,according to MarcVer Straate,product 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 CareCompare to physicians, Donohoe says. Comparative physician
costs will be described as in a restaurant guideusing dollar signs. And after that, the plan is to provide quality information 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 drugdrug interactions.
At Group Health Cooperative in Seattle, decision-sup-

2004

CIGNA, which has about one million

enrollees registered for individual Web pages through its
Select Quality Care system, is one of many health insurers and plans offering an increasing array of decision-support tools. Others include Aetna, Blue Cross Blue Shield
of Minnesota,Destiny,Great-West Healthcare,Group Health
Cooperative, Health Alliance Plan, Highmark Inc., Horizon, 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 factors 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 pricing 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, theres not an equivalent tool for physicians.Were
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-

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Photos by Photos.com

An Industry Trend

port tools are part of a broad effort to

use technology to coordinate and
improve the quality of care.Approximately 84,000 of the integrated systems 560,000 members are registered
to use its MyGroupHealth.com website, 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 Healths 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 registered MyGroup Health member gets a lab test result or a diagnosis from a plan physician, that step triggers a query to the database, resulting in a posting of relevant information to the patients
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 messaging applications. In addition, more than 400 medical appointment 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 obviously has operational benefits as well as customer satisfaction benefits, 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,
its not a niche application or channel, its a very mainstream way
of conducting business.
Destiny Health, which operates consumer-choice plans with
current partners Tufts Health Plan and The Guardian Life Insurance 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 president 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 members
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 consumers to see how they are spending their health care dollar.
In addition, Destinys Vitality program uses incentives to support members decisions to follow wellness guidelines. For example,Vitality members earn points for lowering their cholesterol,

enrolling in a disease management

program, not using tobacco for 12
months, or exercising (for reinforcement, they can log their workouts on
Destinys website).
Members begin at the bronzeVitality status and can progress to platinum,
as they make healthier lifestyle decisions and their health improves.Each
Vitality status comes with a set of
rewards,such as movie tickets and airline 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 members receive 3 percent interest and platinum members 10 percent.
According to Levin, independent research showed that 79 percent of Vitality members started an exercise and nutrition program
within the last 12 months, vs. 32 percent of nonmembers. Eightysix percent ofVitality members said they believed a persons 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 members said yes, vs. 39 percent of nonmembers.

| H E A LT H P L A N | J A N U A R Y / F E B R U A R Y

2004

We see full
cost-transparency as
an integral part of
decision suport.

Focused Technology

Generally speaking, health insurers are moving away from posting static content on their websites toward offering customized
decision-support information, says Bob Tavares, manager of consumer products at HealthShare Technology,a decision-support firm.
Insurers realize theyre never going to be an all-encompassing,
broad health care portal, says Tavares, noting that consumers are
looking for tons of depth and breadthwhen 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.Theyre moving to fewer,better-content modules rather than a broad, trying-to-please-everyone approach.
Insurers are just part of the market for this focused technology,
according to Jerry Reeves, MD, chairman and CEO of Las Vegasbased WorldDoc Inc., which counts among its customers large selfinsured 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 physicians, offers a suite of products that analyze symptoms and compare treatment options;evaluate new or controversial tests and treatments; rate regional hospitals on outcome, cost, and safety measures; and allow communication with physicians via email.
Other decision-support firms including Health Grades Inc. and

Selected Firms Offering Consumer Decision-Support Tools

Health Dialog Services Corp.

HealthShareTechnology Inc.

Protocol Driven Healthcare, Inc.

60 State Street, 11th Floor,

Boston, MA 02109
800-893-5532

360 Massachusetts Ave., Suite 200,

Acton, MA 01720
978-263-6300

George Bennett, chairman and CEO

www.healthdialog.com

Rick Siegrist, president and CEO

www.healthshare.com or
www.selectqualitycare.com

75 Claremont Road, Suite 201,

Bernardsville, NJ 07924-2262
908-630-9380
www.pdhi.com

Specializes in health coaching, providing

evidence-based data on health care
options and encouraging patients to collaborate with their doctors.
CLIENTS: Highmark, Definity, Independence
Blue Cross, and several other Blue Cross
Blue Shield plans.

Health Grades Inc.

44 Union Blvd., Suite 600,
Lakewood, CO 80228
303-716-0041
Kerry R. Hicks, president and CEO
www.healthgrades.com
Provides decision-support tools to help
plan members select hospitals, physicians,
nursing homes, and home health agencies.
CLIENTS: Blue Cross Blue Shield of Minnesota, Medica, American Postal Workers
Union Health Plan.

Allows consumers to compare and select

the best hospital for their individual needs,
using evidence-based measures such as
patient volume, mortality rates, and outcomes.
CLIENTS:

Aetna, CIGNA, Health Net, GreatWest Healthcare, various Blue Cross/Blue

Shield plans.

Healthwise Inc.
2601 North Bogus Basin Road,
Boise, ID 83702
1-800-706-9646
Donald W. Kemper
chairman and CEO
www.healthwise.org
Provides more than 5,000 evidence-based
topics on health conditions, medical tests
and procedures, medications, and everyday
health and wellness issues based on up-todate medical research and indexed to
industry-standard vocabularies like ICD-9.

Jennifer Jolley, president

Provides health, wellness, and disease
management programs designed to
empower consumers to take control of
their health and develop positive changes
in behavior.
CLIENTS:

Aetna, Humana, Wausau Benefits

WorldDoc Inc.
500 N. Rainbow, Suite 314,
Las Vegas, NV 89107
702-821-0818
Jerry Reeves, M.D., chairman and CEO
www.worlddoc.com
Analyzes users responses to questions
about hundreds of symptoms, conditions,
and risks; explains the relevant associated
conditions as well as prevention and treatment options.
CLIENTS: self-insured employers; health
plans, including Medicare Advantage
plans; and Taft-Hartley plans.

CR

Clients: Aetna, CIGNA, Group Health

Cooperative, Definity Health, Humana,
Kaiser Permanente, UnitedHealthcare, various Blue Cross/Blue Shield plans.

Subimo

Ann Mond Johnson, president

Provides comprehensive suite of decision
tools covering health management, hospital rating, pharmaceuticals, and medical
procedures.
CLIENTS:

Anthem of Virginia, Oxford Health

Plans, WellPoint Health Networks

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P.O. Box 5335,

River Forest, IL 60305
312-409-5967
www.subimo.com

2004

HealthShare Technology focus primarily on hospital ratings, although

Health Grades also rates other types
of providers. Subimo provides software for general health management,
hospital ratings, pharmaceuticals, and
specific medical procedures.
Health Dialog was created to disseminate material and insights developed 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 Dialog focuses on coaching consumers on collaborating with their
physicians to achieve the best health results.
Healthwise Inc. provides both Internet-based and printed content on health conditions and health and wellness issues. Not
that long ago, recalls Donald Kemper, chairman and CEO of
Healthwise, most Americans didnt realize they were capable of
buying or selling stocks on their own, or making informed decisions about their health care. That mindset has changed, and consumers now clamor for information about virtually all products
available for their purchase.

employers can choose to offer (the

average number chosen is 10.)
Another company that allows consumers to design their own health
plans is Vivius, which partners with
insurers including Health Net and
HealthSpring to offer products under
the insurers 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 expected 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 physicians recommended specialists and hospital. The tool then gives members quality and credentialing information about the doctors, such as their office location, educational background, foreign language fluency and professional or legal sanctions (if any).The member is free to choose
among the list of providers recommended by the family physician or select others, based on information provided by the doctors themselves and on information that the insurer partner makes
available.
The Vivius website shows how members can make their premium 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.

Once people
use these tools,
they tend to
use them again
and again.

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2004

Choose a Hospitalor a Build a Plan

CIGNA HealthCare uses decision-support firm HealthShare Technology 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 Driven Healthcare, Inc., and HealthShare Technology, along with proprietary tools that let consumers choose health benefits and compare 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, Highmark vice president of e-marketing and customer relationship
management.
Highmarks BlueChoice program features interactive selection tools that allow members to indicate general preferences and
receive a list of plans ranked by how well they meet those preferences. So far, about 70,000 members use BlueChoice to select
variables such as size of copayments for physician office visits, coverage 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

Rapid Strides

Overall, 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
HealthCares Verney. Weve seen a lot of movement among a
lot of payers, he says,but theres a huge opportunity to increase
awareness.
CIGNA HealthCare is working with employers to broaden
awareness of its consumer decision-support tools and is exploring linking its site to employer portals so that enrollees can receive
more personalized information on health risks and specific conditions 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 and
consultant.
Copyright 2004 by the American Association of Health Plans