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Real-Time Information Crucial To Informed Healthcare Decisions

Facing increased pressure to control costs, the health insurance industry must empower consumers to make informed healthcare decisions by providing them with access to real-time information.

Q: What are the major challenges and regulatory issues currently facing health insurance carriers?

Mark Boxer, WellPoint

A: Mark Boxer, WellPoint: IT will be a critical enabler in dealing with the important regulatory issues and challenges in the healthcare system. The rapid advancement and application of technology will positively impact how care is delivered to consumers and how health benefits companies such as WellPoint help manage the benefits portfolio. One issue is expanded access to affordable care. Through the use of innovative products and services -- such as TONIK, which is a health plan targeted to young people who don't necessarily feel they need insurance -- we will help improve healthcare for those who are underserved and uninsured. Another major issue is transparency -- members want more information about their healthcare options and greater ability to control their dollars.

Beth Bierbower, Humana

A: Beth Bierbower, Humana: Costs continue to be an issue. Even though overall healthcare cost increases have slowed, they're still double the standard inflation index and will continue to rise. Employers want to make sure they're doing what they need to do to [control] costs. Most carriers and employers understand the need to focus on increasing consumers' involvement in their health. Involving consumers and making them an active part of the healthcare decision-making process will help us keep costs in check. Along those lines, we still need to get better at sharing information with consumers and be more transparent. If we want them to be savvy healthcare consumers, they need to understand costs and quality and other things that they understand when shopping for a car, for example.

Ross Gosnell, Delta Dental of Illinois

A: Ross Gosnell, Delta Dental of Illinois: One of our major competitive issues is health plan pricing -- finding that middle ground where the plan design and changing functionality meet the group budget. This is always a balancing act. Another issue is managing the growth of the provider network, which is critical for success. A growing issue is ease of use -- the application of technology to facilitate interaction with members and other stakeholders is becoming critical, especially for consumer-directed healthcare. In addition, states' departments of insurance and even the federal government are getting into the business of verifying the application of security standards.

Q: How is the consumer-directed healthcare (CDH) movement impacting insurers' business strategies and operations? What are the key technologies for a CDH model?

A: Boxer, WellPoint: The consumer-driven movement is about empowering members to better manage their healthcare and take greater accountability for the decisions around their care -- and we are committed to providing them with the right tools and information to do just that. For example, we can help members improve their health by offering a leading personal online health risk appraisal that can help them populate their personal health record [PHR]. This online health record -- which is automatically combined with medical, pharmacy and lab data -- offers members a total view of their health. We then use the PHR to send members condition-specific messages and information that can help them successfully manage their health. Providers can access these records at the point of care. We've also recently added online health communities so that members with similar health issues can connect with each other to learn more about what works best for each person.

It's also about convenience. Members can access 24/7 their personal health information, such as benefits, claim status, eligibility, health spending account balances -- most anything that up until a few years ago they would have to write, call or speak to someone in person about. We're continuing to optimize convenience for our members by creating more mobile, portable healthcare technology. More and more of these tools will be available to all healthcare members, which will enable them to manage their health from literally anywhere at any time.

A: Bierbower, Humana:All major group carriers have adopted consumer-driven strategies, products and direction. All major carriers understand that consumers really need to be a part of the healthcare decision-making process. As a result, this alignment helps to drive the industry collectively toward the same goals. We are all in agreement that it's important for consumers to be engaged to understand healthcare costs and the impact on their wages, their company and their health; and how they can take advantage of things like health savings accounts [HSAs] and get information on costs and quality.

Real-time claims adjudication is an important new technology that is helping to bring about transparency. It will help employees understand the cost of care, and it will also help providers ease their concern over increasing bad debt. Technologies that can demonstrate the cost of care to individuals will allow them to estimate and compare cost and quality of medical facilities and services up front. Technologies that bring real-time information and transparency to the table will help transform the industry.

A: Gosnell, Delta Dental of Illinois: The consensus is that CDH will continue to grow, but we haven't yet seen the real impact in our business. Now and in the future, there is a need for expanded customer self-service to support CDH -- Web capabilities that can show cost comparisons for different processes and products so they can compare different charges and make informed decisions. It's a challenge for carriers to provide that information because it may segregate providers into pricing tiers, and you risk redirecting business from other providers in your network. However, as CDH grows, we do have to give consumers a platform to obtain information so they can make better choices.

Shawn Jenkins, Benefitfocus

A: Shawn Jenkins, Benefitfocus: Insurers understand that they have to reach the individual consumer. That has changed the focus from the traditional employer/broker model. They also have to differentiate themselves from each other and provide a transparency into the process. Insurers need to make the life cycle of insurance processes -- from buying to enrolling to paying for care -- as pain-free and as automated as possible. Consumers are holding the insurance companies to the same standards that they hold their bank or credit card companies. The technology should be intuitive to the consumer, including tools and resources that make the experience seamless. These tools include account setup at point of enrollment; online provider payments and medical debit cards; account management; real-time claims adjudication; employer ease of management; automated enrollment; HSA comparison shopping experience/ability to offer multiple account options; HSA contribution and fee management; and receivable programs and gift cards to encourage enrollment.

Q: What is the state of security, privacy and fraud prevention in the health insurance industry? How do health insurers balance the need for access to information with protecting customer data?

A: Boxer, WellPoint: Advances in information management and information security technology play an increasing and more effective role in protecting the confidentiality, integrity and availability of information, as well as in reducing fraud. At WellPoint, we use the classic defense-in-depth architecture approach, which allows us to implement multiple layers of protection of our data, such as the use of physical access controls, such as building access, and logical access controls, such as firewalls and intrusion-prevention tools, to proactively deny unauthorized access to the internal network. Given the geographic and national footprint of our workforce, we allow remote access to our internal applications through a Virtual Private Network (VPN), which provides encrypted tunnels for secured communications. We validate that these solutions are working properly to limit network access only to authorized individuals by performing real-time, 24/7 monitoring of the enterprise network. This allows early warning of unauthorized attempts and confirms that such attempts are appropriately denied.

Another layer of protection is access to internal and public applications. WellPoint limits associates' and affiliates' access by granting levels of access in line with their job duties. We allow customers and members to do business with us through the Internet by authenticating the credentials of the registered user. Data is transmitted using secure transmission solutions, such as secure FTP and encryption. E-mail containing customer data is exchanged using encrypted E-mail to protect confidentially of customers and business partners.

In addition, an individual consumer has the ability to choose whether to share his or her information with healthcare partners and provides his or her consent. When individuals choose to share their health information, we employ appropriate security measures, including authentication of the user and tracking the consent action.

Peggy Bresnick Kendler has been a writer for 30 years. She has worked as an editor, publicist and school district technology coordinator. During the past decade, Bresnick Kendler has worked for UBM TechWeb on special financialservices technology-centered ... View Full Bio

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