New TriZetto Cross-Constituent Survey Finds Surprising Agreements and Disagreements About Healthcare IT Solutions
June 19 2008 - 8:51AM
Business Wire
Results of a survey released today by The TriZetto Group Inc.
(NASDAQ: TZIX) show that patients, doctors and other healthcare
constituents agree that more shared information and aligned
incentive programs are key to helping solve the healthcare
affordability crisis and that health plans are best positioned to
coordinate these improvements. The findings of TriZetto�s 2008
Integrated Healthcare Management (IHM) Survey highlight a
disaggregated healthcare system in which employers, doctors and
consumers too often don�t have or don�t use the information they
need to optimize and coordinate individual health and treatment
decisions, consumer and provider incentives are misaligned, and in
some cases constituents lack agreement about the kind of technology
and tools needed to improve healthcare delivery. �To borrow a line
from the movie Cool Hand Luke, what we have here is a failure to
communicate,� said Dan Spirek, executive vice president, integrated
health solutions, and chief solutions officer at TriZetto.
�Consumers, providers, employers, brokers and payer organizations
are disconnected from one another and therefore have difficulty
coordinating healthcare decisions to drive better outcomes. The
good news is that the requisite data on health status, medical
procedures and much more resides largely in the administrative and
care management systems of health plans, so these organizations are
ideally positioned to share this information with all healthcare
constituents, improve the alignment of incentives and thereby
optimize the coordination of health benefits and care for the
consumer. We call this systemic approach Integrated Healthcare
Management,� Spirek said, �and we believe IHM can help fix what
ails the U.S. healthcare system.� Commissioned by TriZetto and
conducted by TNS Custom Research, a global market information firm
based in London, the IHM Survey is a cross-constituent study � of
senior-level health plan employees, employers, brokers, general
practitioners and specialists, and consumers � and will be
conducted annually, according to TriZetto. For the inaugural study
in late 2007, more than 1,700 individuals were queried online
regarding healthcare costs, cost management, incentive programs and
the availability of information and tools to make healthcare
decisions. AFFORDABILITY IS A CRITICAL CHALLENGE High costs in the
U.S. healthcare system impact all constituents as well as the
system itself. Survey results show that consumers, in particular,
have been touched by the challenge of healthcare costs. Eighty-one
percent of consumers surveyed by the TriZetto IHM study expressed
concern about their future healthcare costs, and only 8 percent
voiced a lack of concern. Similarly, 73 percent said they were
concerned about their current healthcare expenses, while 62 percent
expressed worry that their current health insurance plans would not
adequately control these costs. While the industry as a whole seeks
better cost management, �the first step in improving cost
management must be higher levels of basic awareness,� according to
the report, and awareness requires shared information. CONSTITUENTS
HAVE HIGH INTEREST IN SHARED INFORMATION Eighty-eight to 91 percent
of all constituents saw some value in a range of online information
tools that help anticipate healthcare costs, select benefit
packages and receive customer service. Examples of such tools are
estimators that consumers can use to determine how much they will
pay for treatments or online comparisons of physician and hospital
costs and quality. Three in four constituents (78 percent) said
they would like employers to offer online reward programs that
encourage healthy choices about diet, exercise and tobacco use.
Doctors, too, believed that additional online information would
benefit the healthcare system. Roughly 60 percent of providers said
that posting quality ratings would have a positive effect on
patient satisfaction and on their practices, and between 80 and 90
percent rated as very or extremely important that they have access
to patients� health information prior to appointments and access to
patient records of treatments and medications across all physicians
and hospitals. Four out of five providers, according to TriZetto�s
IHM Survey, believed pay-for-performance programs, a healthcare
industry trend, would be bolstered if payers �proactively shared
patient information to facilitate stronger care-giver interaction
and better care.� Significantly, two-thirds of providers surveyed
rated as very or extremely important the integration of health
insurance company information systems with those of physicians and
hospitals. CONSUMER, EMPLOYER AND PROVIDER INCENTIVES REQUIRE
ALIGNMENT More than 90 percent of both employers and payers in the
TriZetto IHM study considered wellness incentives at least somewhat
effective as a way to lower the healthcare costs of employees and
their families. And consumers appeared up for the challenge:
Between 50 and 60 percent said they would be interested in using a
range of incentives, if they were available, to take health risk
assessments and participate in wellness programs such as exercise.
Further, there was agreement among consumers, employers and payers
in the TriZetto study that participation in workplace health and
productivity management programs could be encouraged most by cash
incentives, co-pay or premium reductions, and lower co-insurance
levels. However, in an example of where incentive alignment could
be improved, consumers found few opportunities to sign up for
wellness programs, with only 6 to 18 percent reporting
participation in a range of such incented programs. Further,
according to TriZetto�s IHM Survey, most employers � 60 percent �
reported that they had no information systems with which to mange
incentive-based programs. And only 28 percent of employer, broker
and payer respondents said they were very or extremely likely to
build incentives into health benefit plan contracts, with 44
percent unlikely to include such contractual commitments in the
near term. Among providers, some 60 percent of general
practitioners and specialists surveyed by TriZetto thought that
incentives to coordinate care across facilities would improve
outcomes and reduce costs. Half believed that pay-for-performance
programs could be an effective way to reduce cost and improve
quality. But, in another example of an opportunity for better
incentive alignment, only about a fourth of surveyed providers
reported participation in payer-sponsored pay-for-performance
programs. PAYERS ARE BEST POSITIONED TO LEAD THE WAY, BUT MUST
CHANGE ROLE When asked who might best lead the coordination of
health benefits and care for the healthcare consumer, payers were
most frequently named by all constituent groups. Health plans were
preferred by 26 percent of respondents overall, according to
TriZetto�s IHM Survey, versus 18 percent for consumers, 17 percent
for government and 14 percent for physicians and hospitals.
�However, to lead the coordination of health benefits and care,
payers must evolve from their historically transactional
orientation to a broader role as health and wellness advisor,�
according to Spirek. �Laudable are the initial efforts of national
players, which are driving awareness. But regional players may be
best positioned to deliver real results that enhance information
exchange and close information gaps between healthcare
constituents.� INFORMATION AND AWARENESS GAPS ACROSS CONSTITUENCIES
Exemplifying these information gaps was the finding by the TriZetto
IHM Survey that consumers were unaware of how much employers paid
toward their insurance premiums. Only one in 10 consumers knew that
the employer share was greater than $1,000 per year per individual
and more than $5,000 per year per family. Four in 10 consumers had
no idea what employers paid, and in fact, five in 10 believed
employers paid considerably less than what they paid toward
employee premiums. In 2007, employers� monthly premium payments
were more than $3,600 per individual and $7,400 to $9,400 per
family.(a) Regarding their own outlays, nearly two-thirds of
consumers admitted in the TriZetto IHM study that, at best, they
were only somewhat aware of their healthcare expenditures. Yet, in
contrast, most consumers expressed concern about their future
healthcare costs. While cost awareness was an issue for
individuals, cost management revealed an information gap among
providers. Nearly half of the surveyed providers reported increases
in accounts receivable and bad debt. However, only some providers
were actively assessing patient liability, with 68 percent saying
that they infrequently or never estimated the amounts patients owed
prior to providing care. But the TriZetto survey also showed that
the number of providers who estimate patient liability would grow
by 70 percent if online tools were available for them to do so.
Other online tools can help consumers track their medical expenses,
get estimates for procedures, compare provider costs and quality,
and manage personal health information. Eighty-seven to 92 percent
of surveyed consumers claimed that they had an interest in using a
range of such tools. But there was evidence of an information gap
because 43 percent of consumers simply did not know if online tools
were available to them. LACK OF AGREEMENT CONCERNING THE
INFORMATION CONSTITUENTS SEEK To some degree, payers and providers
were not in agreement about the information that would be required
to improve the coordination of benefits and care for consumers. For
example, the TriZetto IHM Survey revealed that providers would like
to have access to patient records across all providers. However,
only a minority of payers (29 percent), according to the survey,
reported that providers requested this kind of access. And while
two-thirds (67 percent) of providers said that integration of
insurance with provider and hospital management systems would be
important, only a third (33 percent) of payers acknowledged that
providers sought this integration. The TriZetto IHM Survey revealed
a similar disconnect between employers, brokers and payers. While
more than half of surveyed employers and almost 75 percent of
brokers favored information tools that would help determine the
plan options that best fit an employee�s benefit management goals,
only about 40 percent of payers perceived this need. Sixty-five
percent of brokers and 48 percent of employers favored applications
that would ease the management of employee incentives, but only 42
percent of payers acknowledged this sentiment. �Again, payers have
all the benefit plan, cost and treatment information on Americans
with health insurance,� Spirek said. �Payers can close these
information gaps, bridge these disconnects and drive IHM by
leveraging the wealth of health benefits and care information in
their systems to engage constituents and align incentives, helping
to solve the affordability crisis.� A full report on the findings
of TriZetto�s 2008 IHM Survey is available on the home page of
www.trizetto.com or from the contacts listed below. About TriZetto
TriZetto is Powering Integrated Healthcare Management�. With its
technology touching nearly half of the U.S. insured population,
TriZetto is uniquely positioned to drive the convergence of health
benefit administration, care management and constituent engagement.
The company provides premier information technology solutions that
enable payers and other constituents in the healthcare supply chain
to improve the coordination of benefits and care for healthcare
consumers. Healthcare payers include national and regional health
insurance plans, and benefits administrators that provide
transaction services to self-insured employer groups. The company�s
payer-focused information technology offerings include enterprise
and component software, hosting and business process outsourcing
services, and consulting. Headquartered in Newport Beach, Calif.,
TriZetto can be reached at 949-719-2200 or at www.trizetto.com. (a)
Kaiser Family Foundation and Health Research and Educational Trust,
�Employer Health Benefits, 2007 Annual Report�
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