Insurers Customize Health Plans

Healthcare providers aren't the only ones building personalized patient systems. Health plans and insurance companies - treasure troves for patient data - are also getting in on the action.

Armed with comprehensive information about their own health conditions and risks, patients are better prepared to transition to consumer-driven health plans that let them choose coverage based on what services they need most. "The healthcare industry is in the midst of a fundamental change in how healthcare is delivered, and technology is at the core of this," says Eric Consolazio, CIO at Cigna Healthcare, a division of Cigna Corp. (Philadelphia). Cigna is building an IT-based toolbox to help consumers choose their health plans based on individual health-risk assessments, past conditions, preventive-care options, cost and other factors.

These consumer-minded principles are also on the radar at UPMC Health Plan, the division of UPMC Health System that provides health coverage to the 35,000 employees at the University of Pittsburgh Medical Center and more than 300,000 members in western Pennsylvania. During open enrollment for UPMC's employees this year, the medical center will begin testing a new consumer-driven plan with a pilot group. The My Health plan will offer incentives - for instance, smaller deductions - to patients who take proactive measures to improve their health.

The My Health program is aimed at helping patients avoid illness and take better control of chronic health problems. Smokers who attend cessation programs might be eligible for reduced premiums as long as they don't smoke. To prevent fraud, UPMC might require those patients to take periodic tests with a device that measures carbon dioxide in the lungs to make sure the habit has indeed been broken, UPMC Health Plan CIO Ed McCallister notes.

Mind Your Own Business

As UPMC is developing its My Health plan, it is conducting focus groups on how the program might work best. McCallister admits that some patients become uncomfortable when asked personal health questions, such as whether they smoke, knowing that the information might be stored in a database somewhere.

If such questions continue to make consumers uneasy, the issue of how much and what kind of patient health data is collected for personalized healthcare offerings could become thornier, especially as sensitive information, including DNA traits, becomes available.

This article originally appeared in InformationWeek, a sibling publication of Insurance & Technology.