Insurers Customize Health CoverageInsurers Customize Health Coverage

Health-care providers aren't the only ones building personalized patient systems. Health plans and insurance companies, which are treasure troves for patient data, are also getting in on the action.

When patients are armed with comprehensive information about their own health conditions and risks, they're better prepared to transition to consumer-driven health plans that let individuals choose coverage based on what services they need most. "The health-care industry is in the midst of a fundamental change in how health care is delivered, and technology is at the core of this," says Eric Consolazio, CIO at Cigna Healthcare, a division of Cigna Corp. Cigna is building an IT-based "toolbox" that can help consumers choose their health plans based on individual health-risk assessments, past conditions, preventative-care options, cost, and other factors.

These sorts of consumer-minded principles are also on the radar at UPMC Health Plan, the division of UPMC Health System that provides health coverage to the 35,000 employees at the University of Pittsburgh Medical Center, as well as more than 300,000 other members in western Pennsylvania. During open enrollment for UPMC's employees this year, the medical center will begin testing a new consumer-driven plan with a pilot group. The My Health plan will offer incentives--for instance, smaller deductions or co-payments--to patients who take proactive measures to stay well or improve their health. Although details of the My Health program are still being worked out, in general, UPMC, as an employer, health provider, and insurance company, will manage the plan using data from multiple sources, including claims data, risk-assessment analysis, and biometric data such as patient lab results, UPMC Health Plan's CIO, Ed McCallister, says.

The My Health program is aimed at helping patients avoid illness and take better control of chronic health problems. A smoker who attends a cessation program might be eligible for reduced deductions in premiums as long as he doesn't smoke. UPMC might require those patients to take periodic lung tests with a device that measures carbon dioxide in the lungs to make sure the habit has indeed been broken. That's the kind of biometric data that might be looked at for such consumer-oriented plans, McCallister says.

As UPMC develops its My Health plan, it conducts focus groups on how the program might work best. McCallister admits that some patients become uncomfortable when asked questions such as whether they smoke, knowing that the information might get stored somewhere. If such questions make some people uneasy, the issue of how much and what kind of patient health data is collected for personalized health-care offerings in general could become thornier, especially as sensitive information, including DNA traits, becomes available.

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