Meet the Consumer-Directed HMO


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.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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