Consumer-Directed Health Care
Consumer-directed health care (CDHC) is a movement in the healthcare industry designed to empower members, reduce employer costs and change consumer healthcare purchasing behavior. CDHC provides the member with additional information to make informed and appropriate healthcare decisions through the use of member support tools, provider and network information, and financial incentives. CDHC includes many different benefit plans and services including consumer-directed health plans (CDHP), high deductible health plans and the option to use debit cards for payment. In conjunction with these plans, members may have a health reimbursement account (HRA), health savings account (HSA) or flexible spending-account (FSA).
When the consumer is paying more of the bill, you may need to devote resources to conducting preservice work with patients. Consumers on a high deductible health plan may require more specialized service work due to the questions on cost and options.
• Seeks education about choices
• Selects health plan
• Selects network/ providers
• Seeks information
• Estimates costs to compare providers and treatment options
• Seeks quality information about providers
• Knows what they owe
• Can apply payment from a variety of sources, including access to credit
• Seeks help with next steps of treatment plan
- Health information/ coaching
- Efficient sources
• Promotion to consumers
• Performance information for consumers
• Determines member eligibility and benefits
• May estimate member responsibility for upcoming service
• May inform member of estimate in advance
• Determines eligibility, benefits and specific member responsibility
• Collects correct amount from the source selected by the member
• Provides feedback on performance
• Seeks improvements
Consumer Directed Health Plans
High-deductible health plans (HDHPs) partnered with member personal savings accounts (PSAs), such as an HSA, an HRA, or a FSA, form a CDHP. The type of account used in these arrangements has strong implications to the administration of the CDHP, as the IRS regulations governing these tax-favored PSAs vary significantly.
Once members have met their deductible, covered expenses are paid based on the member’s benefit plan. As a participating provider, you should treat these members just as you would any other Blue Cross member:
• You should accept the Blue Cross reimbursement amount/allowable charge (up to the member’s deductible amount) and any co-insurance amount, if applicable, as payment in full.
• If you collect billed charges up front, you must refund the member the difference between your charge and the Blue Cross reimbursement amount/allowable charge within 30 days.
BlueCard members whose plan includes a debit card can pay for out-of-pocket expenses by swiping the card through any debit card swipe terminal. These cards are used just like any other debit card. The funds will be deducted automatically from the member’s appropriate HRA, HSA or FSA account. If your office currently accepts credit card payments, there is no additional cost or equipment necessary. The cost to you is the same as the current cost you pay to accept any other signature debit card.
Combining a health insurance ID card with a source of payment is an added convenience to members and providers. Members can use their debit cards to pay outstanding balances on billing statements.
They can also use their cards via phone in order to process payments. In addition, members are more likely to carry their current ID cards, because of the payment capabilities.