SHPS. Inc.

Healthcare consumerism has evolved far beyond simple plan design. A successful program must take an integrated, strategic approach that incorporates financial motivation, behavioral change, administrative support, consumer advocacy and carrier management.

To make healthcare consumerism work, SHPS believes a comprehensive program must:

Address your entire workforce, regardless of income or health status;
Contain aspects of consumerism in all plan options;
Foster a sense of personal responsibility for the consumption and cost of health benefits;
Focus on strategies that influence behavioral change;
Rapidly identify individual health risks with lab testing and real-time pharmacy data;
Deploy condition management programs to ensure chronically ill consumers comply with evidence-based medical guidelines;
Provide wellness programs to teach and encourage healthy habits, while preventing future health issues;
Offer information, decision-support tools and incentives to change behavior;
Provide healthcare provider price and quality information directly to the consumer;
Integrate all programs that touch consumers, from enrollment to care management to spending decisions to retirement planning;
Include health networks with customized solutions for your population’s health profile;
Monitor health networks for performance and swap out poor performers; and
Link metrics to bottom-line financial and health outcomes, assessing the contribution of all program elements to the outcomes.

A successful healthcare consumerism program can reduce the annual incremental increase of total healthcare costs by 65 to 75 percent. In other words, best practice companies are achieving 2 or 3 percent increases in healthcare cost annually, consistent with inflation, compared to 9 percent increases across all employers.

To attain outcomes similar to those employers using consumerism best practices, you should establish a program that follows a framework similar to the one outlined below.

		Estimated Impact
Element	Solution	Behavioral	Financial
Health Plan Design & Individual Ownership	Spending Accounts FSAs HRAs HSAs	Creates a sense of personal responsibility through increased awareness of the cost of health services Encourages well-informed spending decisions	10-15% decrease in average health trend
Behavioral Change	Disease Management Case Management Utilization Management Wellness Programs Incentives Communications	Promote greater participation in wellness programs and compliance with evidence-based medical guidelines Results in improved health status and appropriate use of health benefits, which ultimately reduces healthcare costs	30% decrease in average health trend
Information Transparency	Health Portal Decision Support Tools	Delivers meaningful price and quality information to support well-informed decisions regarding personal health Provides a feedback loop to monitor spending account balances, incentives and progress in health and wellness programs	5 - 10% decrease in average health trend
Consumer Advocacy	Web and Telephonic Support Centers Clinical Administrative Financial	Enables employees and their families to navigate the healthcare system Provides personal assistance needed to select providers, evaluate treatments, medications and understand medical bills	10% decrease in average health trend
Benefits Administration	Eligibility & Enrollment COBRA / HIPAA Individual Billing Carrier Management	Manages the employee life cycle from enrollment to retirement or termination Provides employees cost control through effective data management and program metrics	10% decrease in average health trend

For more information on SHPS’ Framework for Healthcare Consumerism, we encourage you to sign up to receive the complete white paper. Pre-register now.