Sharing the Wealth -- of Information

For reform to work, McCallister suggested, doctors and hospitals also have to modernize. Despite all the medical technology that fills U.S. hospitals and doctors' offices, both suffer from a surprising lack of information technology. "Only 14% of doctors use electronic medical records." Even as hospitals move to implement electronic systems, their approach may be very insular. If patient care is to be better coordinated and waste eliminated, patient information needs to flow from doctor to doctor, from hospital to hospital, even from one insurer to another. "As payers, we have incredible databases. We have to be able to connect all this."

He cited the success of a joint project by Humana and Blue Cross/Blue Shield of Florida that created a Web-based information exchange system that offers a full look at a patient's medical history by pooling insurance claims information such as doctor visits, hospital stays, lab tests and prescriptions. The stated goal is to improve the quality of care, eliminate duplication of services and enhance patient safety by allowing providers to see what other care the patient has received. Patients often don't tell their doctors that they are seeing another doctor or taking pills that another doctor prescribed, or they may simply forget when a previous illness unfolded or what medication they took and at what dose.

Humana, like some other health insurers, is making the most of the fact that consumers have become comfortable with using the Internet to comparison shop and sort through all kinds of purchasing decisions. McCallister said his company is trying to help its members get smarter right from the start about what level of coverage works best for them by providing easy-to-understand Internet tools, including a "Family Health Budget" tool that predicts their health costs for the year. After selecting a plan, members can then register on a Web site and do a personal health assessment. If a particular problem is noted, a Humana nurse is alerted, who contacts the patient to talk about seeing a doctor. Members can go online to look up quality information on doctors and hospitals in the Humana network, and even use a Humana-issued debit card to tap into a health savings account and pay their portion of the bill when they go to see a doctor. All the pieces related to cost and quality are tied into one Internet site.

Much of the information consumers get from their insurance companies is incomprehensible and does nothing to encourage them to make better choices, McCallister stated. The complicated "E-O-Bs" (explanation of benefits) that people routinely get in the mail from their insurance companies are "C-R-A-P," he added. He tosses his in the trash. "We're going to have to step up and make things simple, clear, easy to understand. The power has to be in the hands of the individual consumer."