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For an industry confronting a chronic disease crisis and runaway costs, putting consumers in charge of their health care-financially and clinically-may seem like a last gasp effort. But many stakeholders believe consumerism is the best response to those challenges, and that the very absence of consumer involvement has helped drive up costs and led people to ignore their health.

On the financial side, consumer-directed health plans are here to stay, many experts say, and indeed, insurance plans are scrambling to provide their members tools to understand and utilize CDHP benefit packages. On the clinical side, consumer connectivity efforts-most notably online access to providers-also are growing apace. Both plans and providers hope that their I.T. strategies will result in a far more engaged population that appreciates costs, follows their treatment plans, and minimizes risky health behaviors.

Yet, when it comes to involving consumers in an integrated fashion, the divide between payer and provider remains gaping. The industry has a long ways to go before it can realistically provide consumers with accurate information on how consumer-directed health plans work and how service quality and price data can be analyzed to guide health decisions.

A CDHP, typically a low-premium, high-deductible arrangement with an adjoining reimbursement account, compels consumers to consider health care economics in ways they took for granted under traditional fee-for-service plans, says Mark Gaunya, principal of Borislow Insurance, an employee benefits consulting firm based in Methuen, Mass. He contends that, without a financial stake in health care services, consumers will have little incentive to shop for quality services and take preventive steps to sidestep costly illnesses. "Money drives behavior," he adds.

For consumer-directed care to work, access to information will be critical. And that's an area that even the staunchest proponents of CDHPs say the industry falls short. "On a scale of 1 to 10, with 10 being the highest, for access to information, the industry is a 2," says Gaunya, himself a CDHP participant for the last decade. "Health care is a Rubik's Cube. The more you twist it, the more difficult it is to solve."

A Source of Embarrassment

For many in the industry, the lack of consumer-friendly applications and content is a source of embarrassment. That especially applies to the financial statements generated by health care visits, says Ingrid Lindberg, chief experience officer at Philadelphia-based Cigna, which provides health insurance for about 11 million people in the U.S. and 46 million internationally. About 10 percent of Cigna's U.S. members are in a CDHP. "If you want people to change their behavior, you need to make it easy to understand what the claim is," says Lindberg. "And with consumer-directed plans, we need to communicate transactions much more clearly."

Like other payers, Cigna is revamping its online strategy to fill a "transparency gap" it acknowledges was substantial. "Insurance companies have not been transparent," explains Joe Mondy, Cigna spokesman. "The data we presented was completely incomprehensible to the individual. We can't simply scrape screens from data processing. We need to present information in an understandable way."

That's one reason Lindberg changed the look and content of the EOBs Cigna sends to members. The new EOBs, she explains, state "this is not a bill" in a 20-point typeface at the type, with a clear delineation of the claim, what was paid, what the health plan member owes, and any payment accounts involved. These may include tax-sheltered health savings accounts, or employer funded health reimbursement accounts, which typically accompany high-deductible plans. Cigna will offer electronic EOBs beginning this year, Lindberg adds.

Cigna has other online tools for its members as well. The insurance giant recently launched an online financial application, from Quicken, that enables members to track their claims transactions electronically. It works in conjunction with an online bill paying tool members can set up to tap health savings accounts automatically to fulfill their obligations as part of an office visit, adds Mondy. "The funds will be sent electronically to the physician," he says.

Not everyone in the industry shares the enthusiasm for high-deductible health plans. "Because they shift cost, they may cause people to consume less health care," says Matt Handley, M.D., associate medical director, quality and informatics, at Seattle-based Group Health, an integrated delivery system with its own health plan. "They also drive people to choose less important health care. Patients with diabetes or heart disease are less likely to use their medications that can prevent hospitalizations. People have to decide whether to fill their gas tank or refill their meds. The jury is still out on how dangerous the arrangements are."

The pitfalls of an overly dollar-oriented world view are not lost on the industry. Many health plans, while acknowledging that their high-deductible plans may cause consumers to rethink their purchasing decisions, understand that they must maintain a delicate balance with financial incentives. Insurers like Blue Cross Blue Shield of Louisiana are taking a multi-faceted approach in their online consumer strategies, offering a mix of financial and clinical information. Only a smattering of the Baton Rouge-based health plan's 1.3 million members is in a CDHP, says Laura Landry, vice president, I.T. customer engagement and planning. "They are mostly in individual plans, not group plans," she says. CDHP members, she adds, "may have more of a financial incentive, but that is only a piece of the puzzle. The more important piece is that consumers understand their health and risk situation."

Toward that end, BCBSLA offers an online health risk assessment and other disease management tools, primarily through partnerships with such vendors as WebMD and HealthMedia. To be effective, online tools need to be buttressed by personal contact, adds Landry. The insurer has had success with its own employees, after launching a wellness s campaign three years ago. Just over half participated when the program was launched, but now nearly all of the payer's approximately 1,500 employees do, Landry says. The program includes a risk assessment, which generates a wellness plan of action tailored to the individual. Being overweight was a common problem among the staff, Landry says. "In 2009, the company lost a total of 4,000 pounds and saw a 20 percent reduction in disability costs," she says.