Michael Heavener: Communications programs can make or break Consumer Directed Health Plans

If the communications about Consumer Directed Health Plans continues to fail to deliver, CDHP itself will fail. Analyst groups are divided over the ability of CDHP to produce the desired effects in health care management, especially the cost-containment component that CDHP presents to employers who offer it as a benefit choice. While traditional health care marketing communications can explain package benefits, there is a lack of adequate health maintenance information.

If consumers are to become responsible for their own health care, they need more than just program data: they need information about health, nutrition, causes of chronic illness, and prevention to make—in conjunction with their physicians—valid decisions about their long-term health. Intervention in the sickness-treatment cycle depends on quality information that consumers will follow and practice.

A project to deliver broad-based medical and health information to the subscribers of Health Insurance Company A and its CDHP offering is one way for the underwriter to provide added-value service to the employers who purchase the CDHP and the employees who use it—and can make or break the program through intelligent choices.

The health insurance industry is struggling to reinvent itself with new commercial products that meet the needs of increasingly divergent consumer audiences. One such product is Consumer Driven (or Consumer Directed) Health Plans (CDHP), a program that strives to make consumers responsible for not only immediate health care needs but long-term health management.

CDHP promises financial incentives for consumers who take an active role in their health care and for practitioners who encourage such consumer responsibility. It has an aggressive cost containment inducement for employers who have been concerned about double-digit medical insurance increases.

CDHP is a health care plan that offers medical care payments with a substantially higher deductible—itself a frightening prospect when lacking proper explanation—coupled with a tax-incentive savings plan that would pay for "catastrophic" medical needs. Employers are encouraged about CDHP's ability to reduce the record-inflationary increases in their premiums. Younger consumers, hip to new ways to keep money in their pockets, are pushing their employers to add such programs. However, as more consumers opt out of traditional health care benefit programs, those left will shoulder a greater burden of paying for those programs.

The goal is to convince as wide a population bases as possible, both in the aging Baby Boomer generation, and in their trendier offspring, to work together to make CDHP effective. The key is constructive communication about CDHP—but more about the value of long-term health care prevention and maintenance, so consumers are able to control their health and reduce the incidence of reactive health care. In other words, CDHP communications must focus on keeping consumers well, not on what happens after they get sick.

Because CDHP requires integrated communications and consumer education programs, it is at risk for failure if those programs are unable to convince consumers of the value of switching from traditional health care insurance products.

The communications must come from all quarters—brokers, employers, practitioners—but the bulk of the communications must be driven by the health insurance industry. The actuarial evidence, program components, planning processes and reasoning behind making the switch, even the specific details about the yield and savings, need to be driven toward consumers armed with data and information about illness treatment versus wellness and prevention.

The insurance industry as a whole is doing a poor job of meeting the communications needs for CDHP success. While they seem to understand the program, the level of communications can best be described as dense and at its worst incomprehensible. Even Mutual of Omaha, which built its reputation on educating consumers to manage their insurance portfolios, has a CDHP website that contains almost no usable information. It states "These components form a plan that meets the needs of both employers and employees" (Mutual of Omaha, 2006) but contains no explanation of how the plan meets the needs, nor what employees and employers must do to achieve the goal. On the employee page, the Mutual of Omaha website says it has "A wide variety of web-based support tools to help members make plan option and health care decisions" but offers no links to more detail. At bottom of each page, Mutual of Omaha encourages employees and employers—"For more information about Mutual of Omaha's Consumer-Driven Health Plan, contact your Mutual of Omaha Group Sales Representative."[1]

Even as reliance on sales managers and brokers is encouraged, employees are being sold on their ability to control their own health care programs and CDHP benefits. Yet the tools don't seem to match the expectations. Workforce Management magazine reported "Under these plans, employees should have a greater incentive to do more research on available treatment options, their efficacy, and potential costs. Whether sufficient information is available—in user-friendly format—to meet this demand is debatable in the current environment" (Workforce Management, 2006).

The federal government health benefit program for civilian employees provides a page on the Office of Personnel Management website that contains one of the best available descriptions of high deductible health plans. Yet plan holders are expected to tacitly understand "When you enroll, your health plan establishes for you either a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). The plan automatically deposits the monthly 'premium pass through' into your HSA. The plan credits an amount into the HRA" (OPM, undated).

The very component expected by Workforce Management magazine, "sufficient information is available—in user-friendly format—to meet this demand", is the key component for the success of any CDHP program. The entire health care insurance industry must shoulder responsibility to educate consumers/employees. Yet, it is possible for any one company, with enough vision, to become not only the leader in the CDHP communications process, but to cement for itself a substantial part of the business.

This is not about "dumbing down" the information for a complacent workforce to passively digest: it is all about packaging the best information, from a lot of seemingly divergent areas, to provide a realistic picture of what health care—and specifically CDHP—can provide for the cost.

Consultant Stephen Young, formerly the chief diversity office of JPMorgan Chase, was quoted in Time magazine: "It's not so much what I say, but what you hear" (Rawe, 2006). Telling employees that CDHP will certainly improve their care management, even if it's true, hardly makes them want to switch from traditional programs once they learn that it might potentially cost them more. One survey stated that such programs "give employees greater choice among benefits and providers but also expose them to greater financial risk" (Commonwealth Fund, 2006).

The Commonwealth Fund survey also said "the majority [of benefit managers] also believe that the plans will not improve the quality of care or prove popular with employees, and that the plans will attract only healthier employees." For an employer like Microsoft, which provides funding and access to a variety of traditional and contemporary health care benefit programs, such a readily published damnation of CDHP could harm the program's ability to build converts and reduce corporate health car sponsorship expenses.

Even when an industry consortium like the HSA Coalition points out fallacies in the Commonwealth Fund rationale, the lack of adequate communication from health care providers—insurance underwriters, medical professionals, and human resources and benefit administrators—leaves employees wondering if they really will get their money's worth from the 20, 30, 40 percent they contribute to their managed care. They become unwilling to trust the communications that exists.

One solution is to explain CDHP in more understandable lay terms. This has worked well for many churches as mainstream congregations shrink and alternative worship institutions step into the gap. These hip, young churches build their communities by renaming—say, the narthex, as "the lobby"—which it is but which conventional churches reject as threatening. What the recalcitrant churches don't seem to understand is that the new terminology is not the threat, it reflects the audience's desire to hear the message in new ways attached to new paradigms. Anything less consigns the ministry to an increasingly aged population with less money and deep unwillingness to do outreach. "People want to hear what they already know; XYZ is just like ABC, only healthier, cheaper, cooler." (Weltner, 2003).[2]

The same can be said for health care programs. Traditional programs are able to address less and less of the needs of an aging employee constituency, expecting more and more of the programs, driving costs higher for the past 20 years, if not longer. Explaining the new offerings would certainly be an advantage to reaching the younger generations of workers who begin to understand their parents' health plans don't work but who aren't able to articulate why.

But the parents, those still in the work force, are threatened by messages that appeal to the lifestyles of their children. They often don't approve and have resigned themselves to avoiding confrontations. Any health plan that seeks to bridge this communications barrier must offer information that is valuable to both population groups.

The kind of information most valuable to the Baby Boomers and their Generation X/Gen-Y co-workers is about the effects of health management itself. Both groups want to know what they can do to stay healthier and consume less medical care. What they really seek is information that they can use day-to-day to care for themselves. The California Health Decisions website lists one such program by a member organization "which provides benefits for 1.3 million members, developed a video on What You Should Know About Prescription Drugs ... the tools have been incorporated into employee education programs and corporate intranet sites, translated into several languages, and shared with physicians and other healthcare providers" (CHD, 2003).

The CHD program is not the only way to communicate program benefits, but it demonstrates that non-program information, including answers to health care questions, may be far more valuable to consumers than explanations about CDHP itself. If the health care industry can work together to demystify it—if common procedures can be couched in lay terms—all programs will benefit, not just CDHP.

These differences can be explained by better communications about drug effects and costs, treatment regimens, treatment alternatives, healthier behavior, and the value of annual check-ups. Under traditional health care management programs, these are the exclusive bailiwick of physicians and providers, to be shared with consumers only when necessary—and often only when used to ensure grudging compliance by consumers.

I offer as an example my own management program for diabetes. When I was diagnosed in 2001 as Type 2 diabetic, the only treatment offered was daily insulin injections, to which I have a deep-seated panic of needles, if not a philosophic objection.

When pressed, the nurse practitioner reluctantly admitted there might be other control methods: "But they're harder," she warned me. She finally admitted I might be able to control my illness through diet alone. With the help of some very encouraging friends and co-workers, as well as a sympathetic family physician, but against the advice of the diabetes specialist, I embarked on a self-management program. It reduced my carbohydrate intake drastically, added an exercise component (walking two miles a day at least four days each week), and led me to eat foods (salads and vegetables) that were more healthy. I lost 40 pounds, my eyesight improved, and my blood pressure dropped to normal ranges. More significantly, it eliminated an asthmatic tendency which gave me bronchitis every three months and two bouts of pneumonia for the previous five years.

Now, I understand the trade-off value of the carbohydrate units I eat. I know if I want to splurge on an ice cream cone once a month, I must plan ahead. I know that the enemy is not the tablespoon of sugar (12 grams carbohydrate) I put on the half cup of oatmeal (27 grams) I cook every morning, it's the two pieces of white bread (30 grams) I was slathering with a knifeful of peanut butter (7 grams) and jelly (14 grams). And more important, I know the seven grams of healthy fiber from the oatmeal is helping to reduce my LDL cholesterol levels.

The point of this example is that I learned health management and a healthier behavior myself, through studious research on the internet and by cross-referencing publications from a number of resources including but not limited to the American Diabetes Association. If my health plan had published this information, or if I had been offered membership in a health care program that gathered and published this information for my use, I would have been encouraged to join. More important—if such a communications/information program had been offered to me at a younger age, rather than the traditional "do as you're told" practice, I would have made the necessary changes to my lifestyle earlier, before the onset of diabetes. I wouldn't have waited until my blood sugar levels threatened my eyesight and heart.

The communications program I propose would gather the best research from all sources, collecting it into useable

and other mechanisms for explaining the choices between working for health or ignoring warning signs. Such a body of material developed in conjunction with the best expertise the industry offers, presented without charge, would benefit the entire health care industry. Any company offering such a pilot communications program could brand itself as an industry leader.

This program would, by necessity, need to have consensus and approval from the sources of the information and regulatory agencies. The biggest element of creating the body of data would be how it should be sliced into quickly digestible bits with extensive attribution to other resources.

I was never told, during my years of traditional employer-paid health insurance and health care management, that I was putting myself at risk for diabetes—through bad diet, lack of exercise, and over-indulgence in sweets and carbonated beverages. "Before people develop type 2 diabetes, they almost always have "pre-diabetes"—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 41 million people in the United States, ages 40 to 74, who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes" (ADA, undated). I look back and wonder how my life might be improved had more information been made available through my health care avenues, rather than waiting for me to discover it through my own research.

Any company willing to devote the communications resources to a comprehensive information program will gain the attention, if not the loyalty, of people seeking to control their own health. I based my diabetes control on dietary information about carbohydrates, fat, and the nutritional components of the food I eat—information I found or was given. My reliance on health insurance has not only been reduced, but the care I am able to get is much more informed and effective. I still see the doctor regularly but now it is for wellness maintenance items like hemoglobin A1C tests, rather than remedial treatment for lingering bouts of bronchitis and pneumonia. Instead, my doctor and I can focus on making sure I never suffer a heart attack of the sort that killed my father.

Humana published a brochure about the three-year results of their consumer solution programs, which found: "Health insurance is no longer merely a vehicle by which claims get paid. Health insurance is many things, including providing guidance for the consumer" (Humana, 2005).

Information-based communications does not eliminate the need for traditional marketing communications used by health insurance sales teams, brokers, and employers to determine the validity of programs before engaging the employees, or consumers, in choosing between programs. Comparison data of the kind in the Humana report will continue to provide valuable insight into selecting programs for inclusion in employee benefit packages. But these traditional programs need to be enhanced with as much current, cogent data as possible about responsible management of his or her own health care.

If consumers want to have the same educational discussions with their health care providers, especially the practitioners, they will want to be armed with as much information as they can find. Forrester Research reported "80% of online consumers find common healthcare decisions complex, and most cite personal discussions with their healthcare professional or family as most useful in helping them make health-related decisions" (Bishop, 2006).

A second Forrester Research report states: "To win the loyalty of individual consumers, health insurers must operate as advocates, taking their hands as they navigate the foggy landscape of the healthcare marketplace" (Holmes, 2006). The Kaiser Family Foundation also lists consumer education as critical to reducing potential disagreements over the services that will be provided or paid for by health plans.

Because CDHP has been endorsed by the Bush administration as the most viable national health care policy, organizations which sell such plans are faced with providing information and facts about not only the plans themselves but about health care in general and the impact of consumer decision-making. "Bush's approach would empower patients—allowing them to reap the benefits and bear the costs of the decisions they make … the net result will be a more level playing field between individual and group insurance" (Goodman, 2004).

Even the American Academy of Family Physicians recognizes the need for CDHP and the educational component that's been missing from health care. "Those who believe in consumer-driven health care say it puts the focus where the focus has been lacking: on patients, who are currently disconnected from the cost of their care yet whose lifestyle choices contribute to medical inflation and poor health outcomes" (White, 2006).

It is clear that the health insurance landscape has changed. Employers, perhaps panicked by double-digit increases in health care premiums for their employee groups, want to put their employees in the driver's seat to make practical, economically-efficient medical choices. Whether CDHP is the program selected or more traditional plans are continued, human resource managers and benefit administrators are seeking ways to contain expenses.

Any program that offers, as an integrated component, a communications program for distilling and disseminating the best health care and health maintenance information and data, should have a better chance for success in the benefits environment. Once consumers are trained to use the information, and once the body of knowledge has accrued to a critical mass, employees—consumers—can take charge of their health care and work closely with their physicians and providers to alleviate reactive care management. They will be able to substitute pro-active care management systems that focus on long-term wellness, rather than on short-term treatment.

This is the type of information-based communications profile I propose for the Consumer Directed Health Plan of Health Insurance Company A, as a strategic component in the program's sales and marketing communications programs.

[1] The Mutual of Omaha website's glossary of terms does not even contain the terms CDHP or Consumer Driven Health Plan.

[2] "People like what they know, and want what they like. " Weltner's axiom, as developed and articulated by my close friend Jerry Weltner from career marketing software tools to consumers and other developers. "This is NOT a formula for inertia. Rather, it is a strategy for marketing where you must recognize that even new, excitingly different ideas/products/etc. must first start where the customer is comfortable, and move forward from there. XYZ is just like ABC, only faster/slower, smaller/bigger, more efficient/cheaper, or whatever.' "

Michael Quin Heavener

Communications programs can make or break Consumer Directed Health Plans

Communications programs can make
or break Consumer Directed Health Plans