FREE Health Data Management Site Registration

Sign up today and access the leading source of Health Care I.T. information on the Web.

Your FREE site registration entitles you to:

Free Health Data Management e-newsletter
 
Search more than 12,000 articles
 
Access Web Seminars on a host of I.T. topics
 
White Papers and Industry Research that provide valuable insights on a variety of technologies and implementation issues
 
Podcasts, updates on industry events, and much more!

 
   

Payers Get Personal With Online Records


By Zack Martin, Managing Editor February 2007
Many of the nation's biggest managed care companies, including United-Health Group, Wellpoint Inc. and large Blue Cross/Blue Shield plans, are pushing their members to use personal health records. Aetna Inc. has taken the extra step of purchasing a company that offers PHRs to its members and others.

Meanwhile, some of the nation's largest self-insured employers, including Wal-Mart, Intel Corp., Pitney Bowes and BP America are pushing PHRs too.

Why are these major players taking this step? Because they believe that giving consumers access to more information about their health care will help them stay healthier, ultimately reducing costs.

PHRs = better health awareness

Managed care plans and self-insured employers hope that as more consumers rely on PHRs, they will be more likely to get tests done on time, follow up on disease prevention, get their children immunized and take other steps that will keep them healthier. Ultimately, that could lead to fewer cases of serious illnesses, fewer hospitalizations and lower costs. And if that happens, insurers might see bigger profits and consumers might see lower premiums.

Simply put, a personal health record is a patient's view of their medical record. It's different than the "official" electronic medical record because the patient can add or remove information from it and can control who views the information.

A wide variety of PHRs are available, including some created entirely by patients. But managed care plans pushing PHRs are building them by posting medical claims data, pharmacy benefits information and lab results from multiple sources to an online record that members can access.

Members can then add a medical history, take a health risk assessment and find information about their specific health conditions. In most cases, payers are enabling their members to share the PHR with their physicians.

Managed care plans believe they are in a perfect position to offer PHRs because they gather information from multiple providers. In contrast, a primary care physician's electronic medical record for a patient might not include the medication records from a specialist who also is treating the patient.

"PHRs can help connect a fragmented health care system," says Archelle Georgiou, M.D., executive vice president of strategic relations at UnitedHealth Group, Minnetonka, Minn. "People see multiple doctors from multiple offices and have multiple medications, and the PHR enables that information to be housed in one single place."

During the two years or so that major payers have been offering PHRs, the biggest challenge they've faced is persuading their members to use them. Some doctors have proven reluctant to get on the bandwagon as well.

Managed care companies want patients to check health records the same way they might check their bank account. But so far, the rate of adoption has been somewhat disappointing, prompting a few payers to offer cash incentives to members who sign up.

Privacy is paramount

Perhaps the No. 1 concern that consumers have expressed, payers say, is whether sensitive medical information that's accessible online will remain truly private. To help address that issue, payers are enabling members to limit who can see the information and what data is populated in the record.

In addition, some physicians and others have expressed serious concerns that PHRs may do more harm than good.

Because many payer-initiated PHRs offer consumers the option of hiding certain information from physicians, this could lead to a misdiagnosis or harmful drug interactions, some opponents contend. Some physicians also point out that the information gleaned from claims may not accurately reflect all the complex details of a clinical diagnosis.

As a result of the slow adoption rate, the jury's still out on whether PHRs will achieve payers' cost-cutting goals.

So far, the rate of PHR adoption has been higher among those enrolled in consumer-driven health plans, high-deductible insurance plans in which the member is responsible for much of the upfront costs.

More Feature Articles

Hospitals Archive
Group Practices Archive
Payers Archive

Marketplace