On the road to consumer-driven health care - Patient Financial Services

Healthcare Financial Management, Sept, 2003 by Bobette M. Gustafson

In most CDH Ps, when the savings account is depleted, the employee is responsible for a substantial deductible before the employer-provided catastrophic coverage is activated. Unlike traditional medical-spending account (MSA) surpluses, which are lost at year-end, HSA surpluses are rolled over into the next year's savings account.

CDHP members also enjoy greater choice and access to care, because most CDHPs do not require referrals or pre-authorization. Moreover, consumers gain a sense of greater financial control as they access plan-provided Internet sites with on-line calculator functions to determine what their costs will be under a benefit plan, based on the identified provider's charge for the service. In addition, many plans offer members bonus points for healthy behavior, such as a smoke-free lifestyle and participation in exercise programs.

On the downside, CDHP members often must pay greater out-of-pocket expenses than traditional indemnity or managed care plan members-including higher deductibles, copayments, and stop-loss limits. Also, to effectively manage their HSAs, CDHP members must keep a record of their claims and payments. Many consumers may find this requirement difficult or inconvenient, notwithstanding the Internet tools that many plans provide to assist them with such record-keeping.

AT A GLANCE

Under a consumer-driven health plan (CDHP), patients assume responsibility for designing their own healthcare coverage package.

* PFS professionals need to be prepared to respond to the new needs and concerns Of patients who become consumers of health care.

* Such consumers will require greater access to information on service cost and pricing as they "shop" for providers.

* CDHP members also will expect PFS professionals to be able to provide them with appropriate information on the health plan's adjudication and payment of claims.

LEARN ABOUT THE REDEFINED REVENUE CYCLE!

Attend HFMA's Revenue-Cycle Strategies, Fall 2003, the nation's premier revenue-cycle/patient financial services conference, October 19-21 in Las Vegas.

You'll Learn:

* Advanced and in-depth strategies for today's challenges

* How to conquer the revenue cycle from an integrated operational and strategic perspective

* Innovative and "best-in-class" solutions to current revenue-cycle challenges

* How to determine if your revenue cycle is performing at top level

* How to strengthen your financial management team by more fully integrating finance and PFS throughout the revenue cycle

For registration and other information, go to www.hfma.org/revenue.> Bobette M. Gustafson is president, Gustafson &. Associates, Inc., Port Washington, Wis., and a member of HFMA's Wisconsin Chapter. Her phone number is (262) 268-2916, and her e-mail address is solutions@gustassoc.com.