Consumer-Directed Care

Featured Health Business Daily Story March 17, 2008

Reprinted from INSIDE CONSUMER-DIRECTED CARE, a biweekly newsletter with timely news and insightful analysis of benefit design, contracts, market strategies and financial results.

By Bruce Goldfarb, Editor, (bgoldfarb@aispub.com)

Individualized personal health records (PHRs) — long a holy grail of medical informatics — are poised to serve a prominent role in consumer-directed health (CDH.)

Several large health plans have begun providing Web-based PHRs that give consumers powerful tools to manage their health. Coming soon, consumers will be able to keep tabs on the financial aspects of their medical care as well.

"We're seeing a lot of innovation in the marketplace right now," says Jeanette Thornton, director of health informatics at the America's Health Insurance Plans (AHIP) trade group. "A lot of plans are in the process of rolling out PHRs or have already done so. We're going to see more health plans offer really sophisticated tools to their membership."

Over the last two decades, health systems have worked to integrate components such as medical records, radiology and laboratory claims, and pharmacy claims into one seamless system. The PHR takes it to the next level by bringing the consumer into the picture, making the management of health care as convenient as buying a book at Amazon.com or a collectible at eBay. The development of PHRs can benefit CDH by engaging consumers more in the management of their health - and the costs of medical care.

Aetna, Inc. launched its new CareEngine PHR system in late 2006. WellPoint, Inc. and CIGNA Corp. provide a PHR to their members in collaboration with WebMD, Inc. UnitedHealth Group markets a PHR system through its subsidiary OptumHealth. Plans could not provide numbers for current active PHR users.

The PHR typically contains information such as insurance claims, doctors' visits and a member's prescribed medications. Moreover, members can add personal information about their health or family history, biometric data such as height and weight, or whether they take over-the-counter medications. The PHR — or portions of it — can be printed and shared directly with physicians and other health care professionals. As property of the consumer, the PHR is intended to be portable from one health plan to another.

PHRs usually also have some sort of health risk assessment component that helps consumers evaluate and modify lifestyle habits. "Consumers can develop a personalized self-care plan," explains Jandel Allen-Davis, M.D., Kaiser Permanente's associate medical director for external relations. "If I have a weight issue, I can get a personalized plan to help deal with that. That's pretty cool."

PHRs Add Financial Components

Several health plans — including CIGNA and UnitedHealth Group — are adding a financial component to their PHR with Intuit Inc.'s Quicken Health. Quicken Health allows consumers to organize and view medical expenses, insurance payments and service history from providers.

The Quicken Health module "will allow people to have greater insight into how they're spending on care and what they owe providers," explains Dan Carmody, CIGNA's vice president of information strategy and solutions. "It allows them to understand their health care from a financial perspective."

OptumHealth takes things a step further by using the PHR and health risk assessment as feedback for CDH incentives. With the "Rewards for Action" program, as members comply with therapy and engage in risk reduction, information from the PHR is fed back to the health plan for use in calculating premium reductions or other financial incentives. "We have mechanisms that become a very sophisticated incentive program that can be shared with an employer or payer," explains Harlan Levine, M.D., OptumHealth's chief medical officer.

Major Players Are Entering Field

Within the last two years, several prominent companies have made substantial moves into the PHR arena.

In December 2006, five major U.S. employers formed a consortium called Dossia to fund the development of a Web-based system to allow employees and retirees to access and maintain their personal health records. Founding members in the Dossia coalition include Wal-Mart Stores, Inc., Pitney Bowes Inc., British Petroleum America, Inc., Intel Corp. and Applied Materials, Inc.

Dossia developed its PHR in collaboration with Children's Hospital Boston. The PHR is based on a system called Indivo, created by Children's Hospital in 1998 for its own patients. Indivo in turn is based on pioneering work at Massachusetts Institute of Technology.

In January 2008, Dossia founder companies began rolling out the PHR to their employees. A beta group of about 20 Wal-Mart employees are testing the Dossia system, according to reports. When fully deployed, Dossia will maintain health information on 2.5 million employees and retirees of the sponsoring companies and their dependents.

Software behemoth Microsoft Corp. entered the PHR market in September 2007 with the introduction of HealthVault.

During the summer of 2007, Google Inc. briefly pulled the wraps off a "beta test" version of Google Health, which featured the essentials of a PHR. On Feb. 20, Google and Cleveland Clinic announced a pilot project to integrate the clinic's in-house PHR system with secure Google-based member profiles. Up to 10,000 Cleveland Clinic patients will be invited to participate in the pilot.

Observers suggest that wider adoption of PHRs will help educate consumers and give them greater control over their medical care. "If we are moving toward consumer-directed health and want to change consumer behavior, these kinds of tools are critically important," says Allen-Davis.

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