Managed Care

 

Meet the Consumer-Directed HMO

MANAGED CARE July 2007. © MediMedia USA
News and Commentary

Meet the Consumer-Directed HMO

MANAGED CARE July 2007. ©MediMedia USA

It took a while for a managed care company to combine a consumer-directed plan with a traditional HMO. Health Net of California, taking advantage of the strengths of California's managed care market, is launching a hybrid product called OptimizerHMO that "provides tools to help [members] make better health care decisions and incentives for demonstrating healthy behaviors," says Stephen Lynch, president of Health Net.

The hybrid includes a health reimbursement account (HRA) that employees can use to cover out-of-pocket medical expenses using a special debit card. Under the plan, employers deposit $500, $750, or $1,000 into the HRA earmarked for each participating employee. Employees can track their HRA balances and out-of-pocket expenses online. Sound familiar?

In addition, the product rewards healthy behavior by depositing $100 into a member's HRA if he completes a health risk questionnaire. Filling out the questionnaire provides access to information about health improvement and health topics of interest to the member. Another $100 is deposited if the member contacts a health coach within six months of a hospitalization.

Other tools include a treatment cost estimator, a medical group and hospital quality comparison report, and an encyclopedia of health information. At enrollment, members must choose a primary care physician to serve as a gatekeeper, as with a traditional HMO.

The product was rolled out in June and is open to employers with 51 or more employees. Health Net says the hybrid plan is priced at about 18 percent to 20 percent lower than the its traditional HMO products.

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014