Consumer-directed health plans (CDHPs) have rapidly gained a foothold in the employer-sponsored health plan market. As more employers consider adding a CDHP, questions arise about which plans hold the best prospects for managing health care costs while offering quality care to members. In order to achieve their potential as a cost-effective, quality health plan, CDHPs rely on the consumer to make smart, informed health care decisions. This type of effective decision-making only occurs when plan members have the right information resources.
To help employers choose CDHPs that provide comprehensive information resources to employees, URAC has developed Consumer Education and Support (CES) accreditation standards. URAC is an independent, not-for-profit organization that helps employers evaluate health plans through its accreditation and certification programs. According to URAC, CES accreditation will help employers and employees identify those health plans that have the practices in place to provide important decision-making support to CDHP users, and will be especially helpful for employers seeking to compare and purchase CDHPs.
It is important to note that the CES standards focus solely on the consumer education and support features of a health plan. Any type of health plan-an HMO or a PPO, for example, can seek CES accreditation. Because consumers face much more decision-making responsibility in a CDHP than they do in traditional managed care plans, CES accreditation will be most useful in evaluating these newer types of plans. URAC says it likely will develop additional CDHP accreditation standards (beyond those that focus on consumer education and support) as these plans continue to mature.
CES accreditation focuses on assessing whether a health plan is ensuring that consumers get the information they need, when they need it. According to a URAC release on CES accreditation, the standards cover ten broad areas. The health plan organization should-
1. Ensure that the information it provides is understandable, is available in different formats and media, and is sensitive to the language differences and special needs (such as physical or cognitive impairment) of its consumers.
2. Clearly explain the costs of participating in the plan before enrollment.
3. Provide information about plan features and coverage before enrollment (e.g., benefits and coverage guidelines, consumer satisfaction ratings, provider directories, etc.)
4. Be proactive in providing all enrollees with access to prevention and wellness information.
5. Provide enrollees with access to a health risk assessment, and with feedback on the results and any suggested action for improvement.
6. Be proactive in providing enrollees with information about their responsibility for making health benefit decisions, including information that will assist them in their interactions with health care providers.
7. Be proactive in providing instructions on how to receive assistance from the plan (e-mail, telephone or in-person), and provide access on a 24-hour basis.
8. Provide, upon request, any available cost and quality information for choosing a provider.
9. Aid a member's decision-making on financial issues, by providing information on coverage gaps, any required managed care or review processes, and how to seek care once a member's personal health account has been exhausted.
10. Reach out to members with chronic health conditions to help them better manage their care.
More information about the CES accreditation standards and process is available through the URAC website, www.urac.org.