1 Decision Support Tools A Key Element of Consumer Driven Healthcare The Consumer Driven Healthcare Summit John Mills Washington, D.C. September 14, 2006

2 Overview 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 Record Using These Tools to Differentiate Your Plan Empowering Consumers Driving Adoption Non-Web Enabled Members Conclusions Questions

3 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 About HIP

4 Source: Kaiser Family Foundation-HERT Study 2005 National Market Trends

5 Source: Forrester Research National Market Trends

6 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 2005* –Significant increase in quote requests for the 2 nd half of 2006 Increased interest in HSAs for the small and middle market * Source: HealthConnect Local Market Trends

7 Need for Decision Support Tools Consumer Directed Healthcare Plans (CDHP) demand a greater understanding of plan design and cost information –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

8 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 2007

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

10 Plan Comparison and Cost Calculator Tools HIP provides plan comparison and cost calculator tools –Can be setup to permit general use on health plan website –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

11 Compare 2 or more plan option Plan Comparison and Cost Calculator Tools

12 Cost Compare Estimate yearly medical utilization Plan Comparison and Cost Calculator Tools

13 Cost Compare Estimate out of pocket expenses in order to set pre-tax funds aside Plan Comparison and Cost Calculator Tools

14 Provider Cost and Quality Information Consumerism in healthcare is making members more interested in the price and quality of health services This is a fledgling area since actual cost has only recently become a priority to consumers and purchasers Hospital quality and cost measures can be obtained through a number of sources

15 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

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

17 Account Information Benefits provided to the member Account Information

18 Account Information Account balance information Account Information

19 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 questionnaire The information collected is confidential and can only be used to improve a member’s health

20 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

21 Health Risk Assessments Health Risk Assessment Personal Health Record

22 Health Risk Assessments Your results

23 Personal Health Records Permit member to enter their health encounters in an online record Can be integrated with health plan’s claims system First step towards electronic medical records –Participating in an America’s Health Insurance Plans (AHIP) pilot project on standardized data sets

24 Using Tools As a Market Differentiator Web tools are becoming a powerful plan differentiator –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

25 Integrated Suite of Decision Support Tools

26 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 family –Knowledge of the costs of health services including doctors visits, pharmaceuticals and hospitalizations

27 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 s to employers and members

28 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

29 Conclusions 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 employers

30 Questions ?