Health Insurance Daily

How to Design Consumer-Directed Plans for High-Cost Members

While critics of consumer-directed health (CDH) plans often argue the plans are designed primarily for healthy and affluent individuals, some health plan executives say it's possible to design CDH plans for high-cost members if proper incentives are in place.

If CDH plans are going to attract people who have a high utilization of health care and those with chronic diseases, they need to do four things, says Michael Parkinson, M.D., chief health and medical officer of CDH firm Lumenos, Inc., a subsidiary of WellPoint, Inc. The four elements are:

1) Pay 100% of preventive care services, including tobacco cessation, weight management, and desired physical activities programs.

(2) Ensure the CDH-plan accounts are "clinically credible." The question that patients will ask is, "Can I manage my family's health with that amount of money," Parkinson says.

3) Make sure that the out-of-pocket "bridge," which represents the amount the employee must pay before full coverage kicks in, is a "speed bump" and not a "Jersey barrier."

(4) Address the out-of-pocket issue first, and demonstrate clearly how it matches or is better than what the employee pays in his or her existing PPO or HMO.

To read this article in its entirety click on CDH.

posted by Mike @ 7:40 AM