HealthWorks 103: Being a Wise Health Care Consumer

Welcome to the latest HealthWorks University course. Today’s subject is one you may have heard in the news lately because it’s one of the hot topics in health care: health care consumerism.

Our course will go over what being a wise health care consumer is, why it’s important, and strategies for becoming the best health care consumer you can be.

Slide 2: Who Is a Health Care Consumer?

Who is a health care consumer? Well, you are. In fact, everyone who goes (or doesn't go) to the doctor, exercises (or doesn't exercise) regularly, and takes (or skips) their prescribed medication is a consumer of health care. Everyone "consumes" health care; the key is to be a good health care consumer.

Generally, we think of health care as something we need but have limited control over. In a medical emergency, we don't have a lot of time to weigh our choices. Sometimes we're overwhelmed by complex information, or we may be too timid to ask questions of our doctors or pharmacists. Of course, there are medical issues that are beyond our control, but wise consumerism is about making good decisions when good decisions can be made. The truth is, the more we seek out information, gain understanding of our choices and make wise health care decisions, the more control we have over what's most important – our health.

Armed with information, you can become a more savvy consumer at three critical points in making health care decisions:

When You Choose a Health Plan: The truth is, the more we seek out information, gain understanding of our choices and make wise health care decisions, the more control we have over what's most important – our health.

When you choose a health plan: Buy well. Choose the right plan for you and your family, taking into account your true needs and their overall costs.

When you need treatment: Use your medical plan wisely. Understand and make the most of your benefits.

Day to day : When you decide not to reach for that extra doughnut. Or to take a walk rather than a cigarette break. Be well. Take advantage of the growing number of resources available to McClatchy employees to address your health risks and improve your well being.

Slide 3: Being a Better Health Care Consumer Health care consumerism is making the news because rising health care costs keep making headlines. Employers across the country are enlisting employees in the effort to manage soaring costs by providing education and tools on how to best choose and use their health benefits.

Let’s return to those three critical decision points when you can take the consumer skills you flex elsewhere into the health care marketplace.

Buy well — During annual Open Enrollment, choose the right health plan for you and your family.

Use well — When accessing health care, understand and make the most of your benefits.

Be well — Every day, take advantage of opportunities to address health risks and improve your well-being.

Slide 4: Annual Enrollment – Questions to Ask Each year you're given the opportunity to make changes to your benefits during Open Enrollment. You may add coverage, drop coverage or change plans. It may be tempting just to stick with the same type of plan you're in or go for the lest expensive plan available, but a wise consumer will take the time to do a little research. Use the plan comparison chart and the eValuator tool to make your job easier.

When it's time to enroll, here are some things to consider:

* How often does my family usually need health care? *Do any of us have chronic conditions or illnesses that require frequent treatment? *Do I anticipate a major health event – like a pregnancy – in the next year? * Is my doctor (or my family's doctor "in-network"? Would I mind switching doctors? * Would I rather have higher monthly payments and low copays ¬– or the other way around?

You don’t have a crystal ball, so you can’t know for certain what your health outlook will be for the next year. But by weighing your anticipated needs, your history, your preferences and health care budget, you can select the plan that’s likely to be the best fit for you.

Slide 5: Annual Enrollment – Finding the Answers

As you can see, you’ve got a lot to consider when it comes to selecting your health care plan. Luckily, you’ve got some help: the eValuator.

eValuator is an interactive online tool designed to help you estimate your health care budget and choose the plan that best can help you manage your health and your money. And in addition to helping with plan selection, eValuator can help you determine how much to save in your Health Care Flexible Spending Account.

Here’s how it works — after you provide some information about your covered family members and anticipated benefit use, eValuator calculates potential out-of-pocket costs for your situation based on the medical plans available to you. You can change the scenarios you enter to account for the potential of adding or dropping a dependent. You can play with variables such as trips to the emergency room or a switch to generic medications to treat a chronic condition. The eValuator draws on a national database of costs for specific, common treatments and procedures, and can also show how much you’d pay on your own if you didn’t have health insurance.

Armed with the estimates from eValuator, you’ll be able to make an informed decision during Open Enrollment.

Slide 7: Everyday Decisions

Besides genes, the biggest influence on your level of health is your lifestyle. And generally speaking, that’s something you have a lot of control over. Are you a smoker? Do you exercise regularly? Do you eat a well-balanced diet? Are you under too much stress? Take some time to assess the daily choices you make. Consider these questions too:

* Do you know your family’s medical history? Are you monitoring your own health for any hereditary illnesses?

*Do you perform recommended self-examinations (e.g., breast self exam)?

*If you’re living with a chronic condition, do you know the latest research on that condition? Do you know what treatments are available?

As you’re about to see, there are a lot of tools and resources available to help you be a wise health care consumer in your everyday life.

Slide 8: Tools and Resources

Being a wise health care consumer requires a lot of information. To help employees be good consumers, companies are now offering a wide variety of tools and resources.

First there are online tools available at health-oriented sites, such as WebMD, as well as through Aetna’s Web site. A great place to start is a health risk assessment (HRA). An HRA is an interactive questionnaire designed to help you determine some of your health needs. If you complete Aetna’s HRA, you will received tailored Health Reports and a one-page Health Summary report you may share with your health care provider.

If you participate in Aetna’s Simple Steps to a Healthier Life program, you will also receive a personalized Action Plan after you complete the HRA. The Action Plan proposes guidance and support for making positive health changes. Other online tools are available to help you with your Plan such as the Fitness Planner and the Diet Manager. Information on diseases, treatments, drugs, tests and medical terms is available and easy to find on Aetna’s Simple Steps to Healthier Living Web site (www.simplestepslife.com).

If you are anticipating a hospital procedure or are looking for advice on what to do about a rash or who to see for a specific health care issue, Aetna has several ways to assist members and their families with these situations.

The Informed Health Line is a 24-hour nurse line, which can be called toll-free at anytime and is generally used to answer simple questions, give you guidance on a particular health issue or to direct you to the appropriate level of care.

The Health Advocates are more involved with your total health. They may become involved to help you manage a chronic illness, assist you with hospital pre-admission counseling as well as discharge planning and follow-up on your health risk assessment survey or on the 24-hour nurse line calls. Their job is to proactively educate, inform and assist members in getting the most efficient care through the benefit plans.

Aetna uses experienced nurses to man the 24-hour Nurse Line and to act as Health Advocates. Because both these programs use the same database, the nurses are able to see a more complete picture of your health status and are able to give you better assistance and guidance.

What if you’re already dealing with a chronic condition? Well, there are tools and resources available to help you manage that, too.

Aetna offers the Healthy Outlook Program, an outreach program for members at risk or dealing with chronic conditions such as diabetes, coronary artery disease and congestive heart failure. The program helps coordinate education, counseling, self-care and physician support for chronic condition sufferers.

Those who might benefit from the care management program are identified by Aetna staff and invited to participate, but Aetna members can also enroll themselves or be referred by their doctors. Once enrolled, participants can receive educational information, individualized assessments and counseling. Nurses manage the cases and make follow-up calls to provide support to participants.

Increased awareness about a chronic condition and its treatment can be the key to improving the quality of your life.

We will continue to seek out the best tools and resources and make them available to you so that you can become a wiser health care consumer. Some programs that you’ll see beginning in the Fall of 2005, include:

eValuator — compare health care plans and see which choice is right for you and your family.

Aetna Navigator — track your claims, request ID cards, compare hospitals on the self-service Web site for Aetna members.

The Moms-to-Babies Maternity Management Program — offers services and educational materials to help moms-to-be through their pregnancies.

Conclusion Slide: This concludes the health care consumerism course. Now that you know what one is, we hope you’ll take advantage of the many ways McClatchy can help you become a wise health care consumer.