ASK THE EXPERT
I’m a self insured employer. What can I do to help my
employees while keeping costs down?
ou may be realizing that introducing new consumer-
BY RANDALL E. GEBHARDT, PRESIDENT AND CHIEF
ask the expert
directed health care insurance products designed to OPERATING OFFICER, QUANTUM HEALTH
contain costs into your beneﬁt package is leading to
problems as employee-consumers are confused and making Each issue of CDHC Solutions magazine features advice from one of our
leading experts in consumer-directed health care. In the column, they tackle
a challenge you might be facing now or in the future, offering concrete
Web sites are used by only a portion of the population. solutions for your beneﬁts program. We encourage you to take advantage of
And many experts now say that it may take 10 years to have our experts’ knowledge and post questions to one of the experts on the
sufﬁcient quality data available for effective consumer Ask the Experts forum at www.CDHCSolutionsMag.com.
decision-making. In the meantime, patient dissatisfaction
with consumer-directed health plans (CDHP) is signiﬁcant. should start with a call or visit to a PCP. Studies show that
The EBRI/Commonwealth Fund Survey found only 42 consumers who use a PCP as their “medical home” have, on
percent consumer satisfaction with the plans. average, 33 percent lower health care costs and 10 percent
A new generation of health plans, known as coordinated lower mobility. Therefore, an important role of integrated
health care plans, are putting the human touch back into health management plans is to encourage greater use of
health care—all while offering cost savings to the employer. PCPs through beneﬁt incentives and education.
These plans view health care not as a series of events on When employees or their dependants do have acute
which insurance companies bargain to get maximum health issues, the process they follow is often disjointed and
discounts from providers, but as a continuous process, from befuddled, resulting in unnecessary delays and duplication.
“healthy” to “acute sickness,” that can be managed By directly coordinating with patients, families, physicians,
proactively over time. While some factors cannot be ofﬁce staff, facilities and the employer’s HR department,
controlled, such as the aging of the population, the health care coordinators can avoid extra days in the hospital and
care process itself can be coordinated at the patient level, avoid redundant diagnostic procedures, while ensuring
leading to a decrease in health care costs. patients receive follow-up education after discharge.
Coordinated health care management plans should Incentives in a coordinated health care beneﬁt plan
consist of four features: encourage employees to identify and manage health risks
I Plan design that includes incentives to steer patients to and chronic conditions, and to follow a coordinated process
primary care coordination, preventive screening and of care. These incentives can be built into CDHP accounts,
management of chronic conditions; such as linking health reimbursement account contributions
I Patient advocacy that doesn’t leave consumers on their to an employee’s adherence to chronic condition care
own, provides direct guidance to patients and educates pathways.
them about how to better use health care; A coordinated health care plan can be used in conjunction
I Direct coordination with physicians and their ofﬁce staff; with any self-insured health plan, such as a CDHP.
and Employers utilizing these programs have held their average
I Continuous care management, integrating wellness, health care cost increase to 4.5 percent annually during the
disease management and acute care coordination. past ﬁve years, with no reduction in beneﬁts or cost-shifting
All of these elements must be tied together by a staff of to employees—less than half the national average. With a 92
care coordinators—nurses, social workers, patient service percent patient satisfaction rate, coordinated health care
representatives and provider support representatives with programs have proven their value for more than ﬁve years
whom all patient calls are routed. and represent a practical, effective solution for employers
In traditional health plans, calls are directed to at least and employees alike.
three (and often times many more) different service
centers, each of which has access to only partial information Headquartered in Columbus, Ohio, Quantum Health
operates an integrated health management program known
about the patient. Patients call around, asking fragmented as Coordinated Health/Care. Under Randall E. Gebhardt’s
questions and receiving piecemeal answers, often getting leadership, the company has won numerous awards for its
more confused. Combining everything into one integrated innovation and ability to generate results, including Ernst &
Young Entrepreneur of the Year and Most
customer service process eliminates confusion and Effective Benefit Design for Mid-Sized
frustration. Employers. To learn more, please visit
Primary care physicians (PCPs) must play a larger role in www.Quantum-Health.com.
their patients’ care process, including giving consumers
regular preventative screenings, helping them know their
health care risks and diagnosing tests. All health care events
42 September 2007 I CDHC Solutions™ I www.cdhcsolutionsmag.com