Managed Care - August 2008 - (Page 29) was the hot issue in the 1996 survey. Today it’s all turn? Many people believe that the way is to inabout consumer-directed health plans. Issues crease participation, but incentives do not appear that were important in one decade are often not to be working. Employers are now asking even visible in the next. whether they should be looking at reimbursing people at a lower level rather than paying them MC: What will the hot issues be in 2018? to take care of themselves. BOS: They are probably going to be issues that are just barely being discussed today, such as the MC: Employers might stop offering employees inmedical home concept and how a health plan will centives to take health risk appraisals? support that. That’s something that primary care BOS: Yes. Many employers who have been using physicians have become very interested in, and it incentives for five or six years are disappointed by may very well be one of the issues that we’re the fact that to improve participation they end up having to pay employees more and looking at 10 years from now. We might ask, how effective is the The basics of the survey more, as opposed to having employees and their dependents naturally medical home? Can we measure a stay the same: How gravitate toward these programs return on investment on this con- much are you paying based on word of mouth. Historically, cept? for health care, what when different health plan designs are MC: We’re hearing a lot about the addoes your average plan offered, word of mouth drives growth vanced medical home. Will it take in enrollment. That happened with 10 years for it to become wide- design look like, and what are you charging HMOs, and it is happening with conspread? sumer-directed health plans. But we BOS: Right now employers are curi- your employees for don’t see it happening in this case. ous, but they have not embraced health care? Employers have become frustrated the concept. If they do embrace the concept, in 10 years we are going to want to with the lack of appropriate participation in dismeasure the effectiveness of what has been put ease management and wellness programs, so they in place. That’s where we are today with disease are changing their strategy. Instead of saying, management. We have been talking about disease “We’ll pay you $50 to complete a health risk quesmanagement for several years, but the issue right tionnaire annually,” they are saying, “If you don’t now is how to measure ROI uniformly. How can do the HRQ, you are not going to get full benewe determine the effectiveness of a disease manfits, or you are going to have a higher deductible. agement program and how can we standardize And if you are identified as having a chronic conreporting so that it doesn’t matter what vendor dition or being at risk for developing a chronic we’re using? It’s a cycle: An idea comes about, it condition and you refuse to participate in a disbecomes embraced because it’s philosophically ease management or wellness program, you will correct, and then the CFO starts saying, “We are also have to pay more.” spending an awful lot of money on this. Prove to MC: That’s pretty tough. Are companies doing this me that in fact this is something that is effective.” already? Then we turn to measurement evaluation, reBOS: Some companies are looking at it. Some will porting, and those kinds of issues. be introducing it in the next plan year. MC: So the business community believes that disMC: Do consultants like you drive all of this, or do ease management’s cost effectiveness has been you implement and elaborate on ideas that come demonstrated? to you from the business community? BOS: Disease management has been embraced, and BOS: It’s a combination of both. Sometimes a client there is general agreement that it is having a posis looking for the consultant to offer new ideas, itive impact on the health and well being of peoand in other cases the client looks to the conple who have chronic conditions. The questions sultant for help in implementing a program now are: How can we measure that to be sure we smoothly. are getting the best return on investment for MC: What else can health plans learn from the anthese programs, and how do we improve our renual employer survey? AUGUST 2008 / MANAGED CARE 29
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