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Electronic Health Records How They Can Benefit HIP


Plan Comparison and Cost Calculator Tools. 13. Cost Compare ... Smoking cessation. Obesity. 21. Health Risk Assessments. Health Risk Assessment ... – PowerPoint PPT presentation

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Title: Electronic Health Records How They Can Benefit HIP

Decision Support Tools A Key Element of Consumer
Driven Healthcare The Consumer Driven Healthcare
Summit John Mills Washington, D.C. September 14,
  • About HIP Health Plans
  • Consumer Driven Healthcare (CDHP) Market Trends
  • Need for Decision Support Tools
  • Different Web Based Tools
  • Plan and Cost Comparison
  • Provider Quality and Cost Information
  • Account Information
  • Health Risk Assessments and Personal Health
  • Using These Tools to Differentiate Your Plan
  • Empowering Consumers
  • Driving Adoption
  • Non-Web Enabled Members
  • Conclusions
  • Questions

About HIP
About HIP
  • HIP Health Plan
  • Vytra Health Plan
  • Founded in 1947
  • Joined HIP family in 2001
  • ConnectiCare
  • Joined HIP family in 2005
  • PerfectHealth Insurance
  • Joined HIP family in 2006
  • Current membership is more than 1.4 million
  • Serves the New York City metropolitan area,
    Connecticut and Massachusetts
  • Product offerings include
  • HMO and POS
  • EPO and PPO
  • CDHP
  • Government programs
  • Dental insurance
  • Pharmacy benefit management

National Market Trends
National Market Trends
Source Kaiser Family Foundation-HERT Study 2005
National Market Trends
National Market Trends
Source Forrester Research
Local Market Trends
Local Market Trends
  • New York market has been slow to adopt CDHP
  • Seeing more interest in 2006 than past years
  • Recent up tick in quoting activity for CDHP
  • 1 of all small group quotes requested CDHP in
  • Significant increase in quote requests for the
    2nd half of 2006
  • Increased interest in HSAs for the small and
    middle market

Source HealthConnect
Need for Decision Support Tools
  • Consumer Directed Healthcare Plans (CDHP) demand
    a greater understanding of plan design and cost
  • HSAs and HRAs require access to both cost and
    quality information
  • Emergence of the Internet has made health
    information more accessible to consumers
  • Employers want their employees to be better
    informed about health costs, prevention and
    treatment of illness

Need for Decision Support Tools
  • Availability and quality of web tools has become
    a market differentiator among health plans
  • Accrediting agencies like NCQA are grading health
    plans on the tools they make available
  • Plans must have 4 out of 9 web tools such as
    Health Risk Assessments, Personal Health Records,
    ePrescribing to get full NCQA accreditation in

Web Based Decision Support Tools
  • Health plans have responded to the market need by
    assembling suites of decision support tools

Plan Comparison and Cost Calculator Tools
  • HIP provides plan comparison and cost calculator
  • Can be setup to permit general use on health plan
  • Can be customized to meet the specific offerings
    of an employer
  • These tools permit members and prospective
    members to
  • Compare their health plan offerings
  • Enter their anticipated health care usage and
    review their expected out of pocket costs for the
    upcoming year
  • Estimate the amount of money they should set
    aside in either their Health Savings Accounts or
    Flexible Spending Accounts

Plan Comparison and Cost Calculator Tools
Compare 2 or more plan option
Cost Compare
Plan Comparison and Cost Calculator Tools
Estimate yearly medical utilization
Plan Comparison and Cost Calculator Tools
Cost Compare
Estimate out of pocket expenses in order to set
pre-tax funds aside
Provider Cost and Quality Information
  • Consumerism in healthcare is making members more
    interested in the price and quality of health
  • This is a fledgling area since actual cost has
    only recently become a priority to consumers and
  • Hospital quality and cost measures can be
    obtained through a number of sources

Provider Cost and Quality Information
  • Data on the cost and quality of physician
    services is still difficult to obtain
  • Lack of centralized recordkeeping and data have
    made it difficult to develop indicators
  • Market demand for these data is increasing
  • These data are based on Medicare reimbursements,
    not health plan contracts, impacting its accuracy
  • A number of pilots have started in the past year
    where provider prices are being posted on the web

Account Information
Account Information
  • Member account information should be accessible
    with a single sign on to the health plans
  • Members should have access to
  • Coverage information including insurance and
    account funding
  • Account balances
  • Medical services paid including date, payee and
  • Incentive and rewards balances
  • Online customer service

Account Information
Account Information
Benefits provided to the member
Account Information
Account Information
Account balance information
Health Risk Assessments
  • Health risk assessments are used by the member to
    assess their behaviors and determine how those
    behaviors impact their health
  • This tool will help plans meet the NCQA
    accreditation requirements starting in 2007
  • Most health plans are currently using simple
    versions to encourage members to complete the
  • The information collected is confidential and can
    only be used to improve a members health

Health Risk Assessments
  • The tool provides information to the health plan
    to help devise disease management programs for
    chronic conditions including
  • Diabetes
  • Asthma
  • Smoking cessation
  • Obesity

Health Risk Assessments
Health Risk Assessment
Personal Health Record
Health Risk Assessments
Your results
Personal Health Records
  • Permit member to enter their health encounters in
    an online record
  • Can be integrated with health plans claims
  • First step towards electronic medical records
  • Participating in an Americas Health Insurance
    Plans (AHIP) pilot project on standardized data

Using Tools As a Market Differentiator
  • Web tools are becoming a powerful plan
  • Some employers are making them a requirement for
    health plans
  • Plans generally fall into three categories for
    web tools
  • Check the box
  • Generally a follower with no desire to lead
  • Fast Follower
  • Keep up with the competition by investing in a
    more integrated suite of off-the-shelf web tools
  • Market Leader
  • Lead by investing in robust suite of web-based
    tools including in-house development

Integrated Suite of Decision Support Tools
Empowering Consumers
  • Decision support tools empower consumers by
    creating an educated health consumer through
  • Access to a wide range of high quality, reliable
    health information
  • Cost and quality information
  • Instruments to track your health and that of your
  • Knowledge of the costs of health services
    including doctors visits, pharmaceuticals and

Driving Adoption of Decision Support Tools
  • Make tools easily available
  • Educate health plan sales force about the tools
  • Provide online demos for employers during sale
    and for employees during open enrollment
  • Highlight the availability of these services in
    health plan newsletters to members and providers
  • Send emails to employers and members

Non-Web Enabled Members
  • Many employees still work at jobs that do not
    involve daily contact with computers
  • Not possible to make all of these tools available
    on a paper basis but it can be done for some
  • Plan comparison
  • Cost calculators
  • Health risk assessment
  • Work kiosks can make these tools and services
    more available
  • Wireless laptops are making this easier

  • Consumers are demanding more information about
    healthcare as costs increase and employers move
    to HRAs and HSAs
  • Employers are starting to make robust tools a
    part of their decision making process
  • The Internet has created an opportunity to
    provide information that was too difficult and
    costly to organize in a paper environment
  • Many health plans have made an initial investment
    in decision support tools and will expand that
    investment as interest grows from consumers and

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