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consumer empowerment

For the longer term, consumer empowerment approaches show promise for decreasing the rate of health plan inflation. Consumer driven healthcare is an effort to change long-term health care purchasing behavior by giving consumers financial incentives to intelligently access and use healthcare services, and ultimately to make better choices affecting their health status.

Consumer empowerment includes several key concepts. First, it means incorporating economic consequences (“skin in the game”) for consumers. Second, it attempts to empower consumers by providing them with key data, including the cost and quality of provider services, as well as important health information for self-diagnosis and referral to healthcare providers. Finally, it attempts to preserve the best elements of earlier care models, including significant direct clinical support to consumers who suffer significant illnesses or injuries, use of provider fee schedules to ensure reasonable pricing for healthcare services, and best-in-class customer service and claims adjudication.

HealthSmart Benefit Solutions offers its clients a variety of Health and Wellness Programs that attempt to identify consumers who could benefit from long-term healthcare or lifestyle changes and to provide those consumers with the information and support they need to realize those benefits such as:

• Disease State Management programs
• Health Risk Appraisals
• Case Management
• Employee Assistance Programs
• Links to Health Information Websites
• Tiered co-pays that reward consumers for utilizing high-quality/low-cost providers
• Tiered networks that attempt to identify high-performing providers to consumers
• Variable benefits that reward consumers for taking health risk assessments, looking after their own health, and complying with care management instructions

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"Returning market power and decision making authority back to the individual-- consumer directed healthcare-- is critical to the creation of a 21st Century intelligent health and healthcare system that offers more choices and better quality at     lower cost."

Former Speaker Newt Gingrich
Center for Health Transformation



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