Coordinated Health/Care + Consumer-Driven =
Recent years have seen the development of so-called "Consumer-Driven Healthcare Plans" (CDHPs).  These plans typically have a higher deductible, but provide "up-front" dollars through a consumer spending account such as an HRA or HSA.  This puts control and responsibility for healthcare decisions in the hands of the consumer, who in theory will spend more efficiently.

While CDHPs provide web-based decision support tools, most patients are not prepared today to understand and navigate the confusing process of healthcare, so the "consumer-driven" theory remains just that - a theory.

             ...A Winning Combinationination
We believe that one powerful solution is to combine a consumer-driven plan design with the hands-on assistance and guidance provided through the Coordinated Health/Care program.

Several plans incorporating Coordinated Health/Care also include an HRA. The program's targeted enhanced benefits are integrated into the HRA design. For instance, when a patient visits a PCP or specialist with referral, they not only receive the enhanced benefit but any plan payments are not deducted from the HRA.  By following the coordination process, patients conserve their HRA balance.

If you are considering an HSA, your plan will have to raise the deductible to about $2,000 for each family, leaving your employees with significant first-dollar exposure. They will need more help than ever.  By adding Coordinated Health/Care, you can provide your employees an added benefit of better guidance and assistance on how to spend their first dollars most efficiently. 

Ask us about combining Coordinated Health/Care with a consumer-driven plan design to create a truly effective healthcare plan. 

CDHPs by themselves are not enough
to significantly improve the process of healthcare.
Much of the emphasis in CDHPs is providing information on provider quality and pricing, so consumers can "shop around and determine the best value."  But with research showing that 50% of patients do not understand their physician's directions, and 60% of patients self-navigating to the wrong specialist, the problem goes deeper than quality and pricing information.  We believe consumer spending accounts and provider quality information do not equip patients to be effective consumers in all but the simplest healthcare situations.

Simply put, patients need help.  They need more information, hands-on guidance, education on how to efficiently use healthcare, and incentives that encourage specific healthcare behaviors.

In Coordinated Health/Care™, this assistance is provided through several program features: 

• Most importantly, the staff of Care Coordinators, who provide guidance and problem-solving on virtually all health plan issues.

• Single-point customer service that routes  all patient service calls through the Care Coordinators, in contrast to most health plans that "fragment" calls to different service points.

• Specialized incentives in the Plan Design, which have been refined and proven to encourage specific healthcare behaviors that otherwise lead to unnecessary duplication and delay. 

• Education on use of primary care physicians as a coordinating physician.

• Preventive screening for early detection of chronic conditions

• Disease management and case management of chronic and complex conditions.

• Direct coordination with and between a patient's physician(s) to direct care to the right setting, make appointments and make sure lab/diagnostic reports get to the right place at the right time. 

Quantum Health developed Coordinated Health/Care^T in response to what we have learned is the biggest source of inefficiency:
          lack of coordination in a complex system.

By understanding the sources of patient confusion and mis-direction, we have developed  "coordinated healthcare programs" that are focused on coordinating information and activities between patients, families, physicians, and their office staffs.  Patients receive better guidance and information, and health plans using this approach have seen significant savings by reducing unnecessary duplication and delays.