Just after yesterday’s suggestion of using a forum or social community in order to help faciliate consumerism in an employee benefits plan, I run across a post by Jane Sarasohn-Kahn at www.healthpopuli.com that puts some more hard data behind the suggestion. (Would link directly to the post, but Health Populi doesn’t offer permalinks.  Scroll down to Wednesday, January 16 for the “People Who Need People Use Social Media” entry.)

 Jane references a December 2007 iCrossing study that finds that 34% of Americans turn to social media for health research.

 Furthermore, the study shows that these consumers are typically in decision-making mode, and that “someone else with the same condition” is the most important advisor, just behind the “health professional.”  And what’s more, 75% of these online health searchers say that the most compelling reason they use social media for health research is to “connect with other consumers to exchange information or get support.

A recently post on Health Plan Innovation highlighted an interesting concept in transparecy from Blue Cross Blue Shield of Minnesota — combining social networking and health care.

Actually, the concept is startlingly simple:  they’ve created a website called thehealthcarescoop.com and invited members to log on and post thoughts about their health care experiences and the care they’ve received from local providers.  Don’t like the price of your doctor’s routine physical?  Get the word.  Love your dentist?  Make a recommendation. Looking for a good chirocpractor, and wondering how much his time is worth?  Ask people who know first hand.

And why not?  Consumer feedback like this has essentially revolutionized traditional retail through the Amazon.com model of online shopping.  Putting healthcare through the same lens — where the consumer is in control of the most powerful form of persuasion (word of mouth) — helps force the best services and the best prices to the top of the pile.

So, why not apply this model to your consumer-directed healthplan in order to build a community of smarter consumers in your company?  There are plenty of free forum and community site solutions (the most popular, for starters, being phpBB) for startersout there, and the right guru at your company can set one up in a few minutes.  Put a Healthcare Forum on the company intranet, give your employees a place to ask questions of each other, make recommendations — with them in control of their healthcare dollar, you may be surprised at how eager they are to work together to stretch their savings further.

A recent study by Watson Wyatt shows that less the half of employees can define “co-pay” or “deductible”.  Less than 25% are comfortable describing “health savings account.”

Obviously, when implementing an employee-controlled HSA plan, someone needs to teach them how speak the language before they can be expected to adopt the change that lowers costs.

For example: EOBs. How many people really get the concept of EOBs?

Fontis Health offers a curriculum of videos like the one seen above. We teach the vocabulary, fill in the gray areas about using insurance and an HSA, and suggest ways to save more. And research shows that teaching employees to use healthcare properly is the first step in getting them to lower their (and the employer’s) costs.

Where are the American people on health care right now? An NBC-Wall Street Journal poll gives us an inkling:

By 49%-40%, Americans back conservative health-care solutions of tax credits and health-savings accounts over government coverage mandate backed by subsidies for the poor. But by 51%-42%, they back liberal idea of tax increases on the rich to expand coverage over continued tax cuts.

Of course, neither rich people nor the government ever tend to poll very well, so take it for what it’s worth.

I often read Slate’s Timothy Noah, mostly for amusement, since he’s rarely on target about much of anything, and when he’s off-target, well, he’s really off-target. When he’s not blogging the Phil Spector trial (which as far as I can tell only he seemed to care about) or worrying about whether he will continue as a Wikipedia entry (ditto), Noah delves into policy matters, and you’d be hard-pressed to find a more hackneyed perspective on public policy in a national publication.

Today he discusses John McCain’s health care plan. Here’s now he discusses McCain’s support for HSAs:

Market gimmicks: The main one is health savings accounts, which “put the family in charge of what they pay for, and should be expanded and encouraged.” Actually, health savings accounts are a roulette game that favors young, healthy people who don’t expect to get sick. If they get sick anyway, they’re screwed. If they don’t get sick, they’re screwing those who do by reducing funds available for the larger risk pool.

I’m sorry, but this is just a crock. Let’s take it apart:

1. “Actually, health savings accounts are a roulette game that favors young, healthy people who don’t expect to get sick.”

“A roulette game”? Huh? He doesn’t even explain what he means by this (and why not?–it’s not like the Internet has a word count) but I’m going to take a guess. What he means is that people who are generally healthy are more or less gambling that they won’t get sick. Yes, gambling. By carrying health insurance and funding a special account wholly owned by themselves to fund their health care. Somehow this is gambling. Right. And paying top dollar premums for health insurance that goes completely unused isn’t it;s own sort of wroulette wheel? How does that work?

2. “If they get sick anyway, they’re screwed.”

Really? Why? Again, no explanation. If you get sick and you have an HSA, you pay for your medical care from your HSA and you insurance plan. In fact, in may cases, you come out ahead with this sort of plan because you don;t get nicel-and-dimed on the back end like you often do with traditional insurance plans. Not that you would know that from Noah’s piece.

3. “If they don’t get sick, they’re screwing those who do by reducing funds available for the larger risk pool.”

Again, why exactly? They still pay premums to insurance companies. You have to have insurance to have an HSA. And isn’t it fascinating that from Noah’s perspective a person who is healthy is somehow “screwing” a sick person by being healthy? What sense does that make? Hey, I have an idea…let’s all get sick! That’ll improve the health care system!

Anyway, it’s certainly true that many times we just get sick through no fault of our own. But it’s also true that many people get sick because they engage in unhealthy behaviors. For example, I do not smoke cigarettes. Never have. Never will. Now, suppose another person in my “risk pool” smokes cigarettes and develops lung cancer. My rates go up accordingly. Isn’t that person kind of screwing me? Would Noah think so? Or is it the case that healthy people somehow screw sick people but not the other way around?

CDH is working, according to a Blue Cross Blue Shield Association study.

Key excerpt:

The BCBSA 2007 CDHP Member Experience Survey found that consumers eligible for health savings accounts (HSAs) were 17 percent more likely to participate in an exercise program than those enrolled in non-CDHP products. These consumers were also more likely to engage in the following wellness programs: smoking cessation (20 percent vs. 6 percent), stress management (22 percent vs. 8 percent), and nutrition and diet programs (27 percent vs. 12 percent). Furthermore, HSA-eligible consumers participating in these programs were more likely to see positive results.

Additionally, the survey found 63 percent of consumers eligible for an HSA, tracked their healthcare expenses and 47 percent are currently saving for future health expenses. In contrast, only 43 percent of non-CDHP consumers track healthcare expenses while 18 percent save for their future healthcare expenditures. HSA-eligible consumers also are more likely to seek information about insurance as well as about provider (doctor and hospital) costs and quality.

“These findings show us that CDHPs are beginning to deliver on their promise,” said Jennifer Vachon, executive director, marketing and consulting services group, BCBSA. “Our survey shows that CDHPs empower consumers and help them become more engaged in their healthcare decisions.”

It’s a slow evolution to be sure, but it appears that more and more doctors–especially primary caregivers–are pushing insurance companies out of the picture and entering inti one-on-one agreements with patients. The outcome: lower overhead costs and better patient care, at least from the standpoint of access and bedside manner.

An excerpt:

The key to his financial model, [Doctor Michael Stein] said, is that he doesn’t sign contracts with insurance companies, which means he’s not bound by their reimbursement rates and not subject to their rules. He can decide what tests to perform or drugs to prescribe without having to make phone calls or fill out forms. He also doesn’t have to worry about laws governing health insurance or Medicare fraud. Since he doesn’t bill the companies, he doesn’t have to follow their rules.

Part of Stein’s contract with patients is that he will be available at all times. Patients have his cell phone number and are welcome to call him at night or during the weekends if they’re having a problem.

“If something’s bothering me, I just dial him up on his cell phone,” said patient Mark Galvin. “If I don’t get him, I usually get a call back from him in five or ten minutes.”

And Galvin has availed himself of Stein’s emergency services. When his daughter split open her eyebrow while the family was vacationing on Martha’s Vineyard, Galvin returned to New Hampshire to visit Stein’s office rather than use a local emergency room.

“It’s the best care I’ve ever gotten and my wife would not take my child anywhere else,” Galvin said.

Aetna has announced a major step toward real price transparency in health care with the development of an online tool for members to compare the prices for specific medical treatments and procedures.

In summary:

Aetna’s response to the growing need for physician and facility-specific price and clinical quality information encompasses three specific resources. These web-based resources, which continue to expand over time, include:

Medical Procedure by Facility Cost — Available in November 2007, this new tool will provide members with facility-specific costs for over 30 common medical procedures. Members can review a list of facilities in their area — such as hospitals, surgical centers and other free-standing facilities — that provide the service, along with cost ranges for the service from admission through discharge. At launch, the program will offer information for facilities in all or parts of 11 states and the District of Columbia.

Physician-specific Clinical Quality and Efficiency Transparency — Launched in August 2006, this program provides members with physician-specific indicators based on adverse events, 30 day hospital re-admit rates, overall efficiency in use of medical services, and volume of Aetna members treated.

Physician-specific Price Transparency — Launched in August 2005, this program offers access to physician-specific pricing for up to 30 of the most common services and procedures performed in the physician’s office, such as routine office visits, strep testing, or x-rays.

I know, I know…you can’t put a price on health care, right? Well, health care providers do it every day. They’re just not real keen on telling us what it is sometimes. Aetna’s little gizmo should help.

Catching up on some of the latest links out there:

1. It’s looking like benefit program designers across the country are finally waking up to the notion that health care plans should have a significant proactive element to them. In other words, health care is more than just taking care of things after they fall apart; it’s also about prevention and early detection.

A sample:

Here are some of the major trends that benefits experts at Watson Wyatt, which consults with large employers on their open enrollment programs, have identified for this year’s season:

– Incentives/penalties for healthy/unhealthy behaviors. Companies recognize that having a healthy workforce can help control rising health care costs and increase worker productivity. More companies are offering financial incentives to employees who have healthy lifestyle habits or who participate in wellness and fitness programs. A forthcoming survey by Watson Wyatt and the National Business Group on Health (NBGH) shows that 46 percent of employers currently offer economic incentives and another 26 percent plan to do so in 2008. A few companies take the opposite approach and penalize workers for unhealthy choices, such as smoking, by charging them higher premiums. Many companies give workers a financial incentive to complete a health risk assessment.

– Full coverage for preventive care benefits. More employers are covering preventive medical care and even preventive drugs at 100 percent and not subjecting these to a deductible. Often included in these fully paid benefits are vaccinations, exams and screenings for early diagnosis of and intervention in breast, colon and cervical cancer. Many employers also provide coverage or partial reimbursement for blood pressure and cholesterol checkups as well as flu shots.

– Health coaches/onsite health centers. A growing number of employers offer workers access to health coaches and advocates. These experts provide individualized advice to workers on personal health care needs and can educate workers about best care and what questions to ask their health care providers. Another survey by Watson Wyatt and NBGH shows that 44 percent of large employers offer health coaches and another 13 percent plan to offer them next year. Additionally, nearly one-fourth of employers have onsite health centers and another 6 percent plan to open them next year.

2. Employers are slowly but surely getting more comfortable with CDH plans.

3. Demonstrating (by implication) the importance (and opportunities) of marrying wellness programs with health savings accounts. Hmm, if only there were a company that helped employers do just that….

What, to your mind, is the best way to fight cancer?

A. Encourage cancer screenings early and often.
B. Stop smoking–or don’t start in the first place.
C. Use sunscreen if you’re out in the sun a great deal.
D. Have the federal government take over the health care system.

Did you pick A, B or C? Well then, you obviously don’t have what it takes. I think we can all agree that D is the best answer, no? Well, that’s what they think over at the American Cancer Society.

If you were planning to give money to the ACS ths year, you might want to rethink it.