Educating Consumers

Consumer-directed healthcare, a concept that has been gathering momentum over the past four or five years, now appears to be the dominant model for how health insurance coverage is designed, marketed and managed. A truly technology-enabled offering, the idea behind consumer-directed healthcare is that everyone (patients/employees, providers, employers and insurers) benefits when consumers have more information (about illnesses and conditions, treatments, medications, etc.).

A dramatic advance in the movement was last month's announcement from Aetna that it is launching what it describes as the first program to enable consumers to find out what they can expect to pay at the doctor's office before a visit. The program - which will be piloted with information for approximately 600 procedures provided by 5,000 physicians and physician groups in Ohio, Kentucky and Indiana - offers consumers access via Aetna's member Web site (www.aetna.com) to the discounted rates for the most common office-based services offered by primary care or specialist physicians. According to Aetna President Ronald A. Williams, "The biggest impediment to effective consumerism in healthcare has been the unavailability of relevant data on healthcare quality and cost." And anyone who has experienced the healthcare/health insurance system firsthand will agree that shared information is as critical to diagnosis and treatment as any clinical procedure or medication.

But what will patients really do with this information? Anyone who has been a patient or relative of a patient knows that there's a risk of information overload - or, worse, information and "empowerment" can become synonymous with reduction in benefits. Coincidentally, the same week that Aetna unveiled its new offering, The New York Times ran a series of articles on the theme "Being a Patient: Overwhelmed by Choices." The series explored the "good news/bad news" impact of the healthcare information explosion, noting, "As this new responsibility dawns on patients, some embrace it with a sense of pride and furious determination. But many find the job of being a modern patient, with its slog through medical uncertainty, to be lonely, frightening and overwhelming." Insurers that take their public missions seriously should acknowledge this technology-enabled dichotomy and recognize that, ultimately, we are talking about a responsibility that needs to be shared.

Katherine Burger is Editorial Director of Bank Systems & Technology and Insurance & Technology, members of UBM TechWeb's InformationWeek Financial Services. She assumed leadership of Bank Systems & Technology in 2003 and of Insurance & Technology in 1991. In addition to ... View Full Bio