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The Four Stages of Digital Health

A discussion of the stages of self-enrollment.

January 31, 2001
Related Topics: Health and Wellness
The first generationof eHealth simply replacesexisting communication functions originally performed on printed material. Thisis illustrated by a recent WorldatWork e-mail survey of 387 employers that usethe Internet for the following functions:

Provider Directories65%
Company Newsletters61%
Links to OtherResources57%
Summary PlanDescriptions45%
Online Open Enrollment26%
Online PrescriptionDrug Services23%
Employer or InsuranceCarriers Accept E-signatures16%
Employer or InsuranceCarriers Track Major Life Events11%

    Therate of provider directories, at 65 percent, is the highest-use e-healthfunction, highlighting the Internet’s strength at disseminating frequentlyupdated information. It also illustrates the growth potential for onlineself-enrollment, currently at only 26 percent.

    Ina typical self-enrollment, employees use the Internet and/or phone call centersto research competing health plans, evaluate their options and record theirselection. This greatly eliminates manual processing chores for the benefitsstaff, making it possible for employers to offer a broader selection of healthplans and providers.

    Whatcan an employer expect from self-enrollment? In the WorldatWork survey, 74percent of employers who had chosen online self-enrollment reported increasedemployee satisfaction. Although 81 percent reported improved administrativeefficiency, only 39 percent reported lower costs. This could result from severalcauses: 

  • Theparticular service used might not have a clear cost-reduction strategy

  • Reducingbenefits staff was not yet appropriate, and staff hours re-assigned to otherHR needs might not have been recorded as “savings.” 

  • Employeesinitially needed extensive telephone or staff support to enroll due toliteracy problems, lack of Internet access, or difficulties in learning Webnavigation

    Evenin high-tech companies, 100 percent employee use of online enrollment may nothappen. In Sageo’s early experience providing self-enrollment services, about70 percent are using the Internet to enroll, with 30 percent relying primarilyon telephone support, said Tom Beauregard, chief strategist of Minneapolis-basedSageo.

    Forhigh-tech employers, Internet use might go as high as 98 percent, and formanufacturers where lack of access or literacy might be a problem, Internet usecould go as low as 55 percent, Beauregard says.

    Turningopen enrollment from a paperwork nightmare to an Internet self-service functioncan also reduce employees’ dissatisfaction with shortcomings in customerservice. These advantages make it easy to forget that Web sites must alsoservice the individual client’s healthcare decisions after enrollment.According to Catherine Cather, a total health management consultant with HRconsulting firm Towers Perrin, employees can go through four stages during andafter self-enrollment:

Drivenby purchasing concerns: price, convenience, accessibility of benefit andease of administration.Drivenby illness concerns:  Breadthof coverage, appropriate treatment, timely access to preferred providersand patient support groups.
Drivenby membership concerns: rapid turnaround on requests by phone or e-mail,timely documentation of provider changes.Drivenby needs of family member: Breadth of coverage, appropriate treatment,timely access to preferred providers and caregiver support groups.

    A Web site that focuses exclusively onenrollment (the upper left quadrant) gains only the immediate cost savingsavailable from efficient enrollment administration. A Web site that supportsemployees through all four quadrants helps realize the full cost savingsavailable from a consumer-driven healthcare system.

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