Consumer Health Advisory Services offered by CHA are designed to closely parallel consumer financial advisory services. Financial advisory services have proliferated as increased responsibility for long range financial planning has been placed on the individual under defined contribution retirement plans such as 401(k). In these services, an independent third party adviser tailors the selection of financial products to the specific life situation, risk tolerance and retirement objectives of the consumer. The financial adviser operates on the basis of full objective information about the financial status of the consumer as well as a variety of subjective information about habits, attitudes, and behaviors collected from the consumer on a voluntary basis.
Our consumer health advisory services similarly tailor the selection of health-related products and services to the specific health conditions, health finance status, and wellness objectives of the consumer. Full information on the health status, health utilization and medical conditions of the consumer, captured and presented within the CHDC platform, is integrated with a variety of subjective information about habits, attitudes and behaviors collected from the consumer on a voluntary basis. The consumer health adviser operates as a third party independent of any specific health insurer, benefit plan, or health services provider.
Advisory services offered by Consumer Health Advisers LLC will be selected and paid for by the consumer at his/her discretion. Specific types of advisory services offered by the enterprise are organized in four groupings:
Employers and government are offering many new choices of health plan benefit design, ranging from a variety of HSA and HRA structures in the private commercial world to Medicare Part D options in the public sector. Even among the more “traditional” PPO, HMO, and POS benefit plans, there are critical new design variations that can have a substantial impact on a family’s financial risk exposure. Recent policy proposals for change in the taxable treatment of health benefit plan premiums add a new dimension of complexity to the selection of health insurance plans. Decisions on plan selection thus have financial and clinical implications that can only be fully evaluated with knowledge of the family unit’s medical history and risk factors as well as financial status and risk tolerance
Healthcare is now such a major part of the average family’s overall financial security that longer range planning is a necessity. The precariousness of Medicaid and its complex spend-down rules lend urgency to consideration of LTC insurance as part of an overall financial plan. The carryover feature of HSA plans makes the healthcare nest egg a key feature of retirement planning along with 401k, IRA, and other defined contribution pension provisions. The cost of major surgical and diagnostic procedures under high deductible plans is a major budget consideration for many families.
The new era of enhanced consumer financial responsibility under defined contribution plans places a premium on well informed selection of healthcare services and providers. The defined contribution model is premised on the ideal type of a rational, knowledgeable consumer who can weed out medical necessity and the quality/value of treatments and diagnostics. However, the reality is that consumers have a very limited experience base with decisions of this type. We believe that consumers need access to experienced advisers to assist with decisions ranging from second opinions to cost of procedures to evaluation of provider and facility quality.
Efficacy of the new defined contribution health plans depends on the premise that consumers will be motivated and capable of improving their overall health and wellness. The real cost savings will be derived from a decline in the prevalence of “avoidable” medical conditions (and associated utilization) that come from obesity, inactivity, smoking, alcohol use and so on. Toward this end, many private employers are already providing general wellness education programs, discounts on exercise club memberships, and the like. But more intensive personalized planning and intervention efforts have heretofore been highly limited. We believe that consumers need access to more personalized planning and counseling on diet, exercise, family risk factors, and other lifestyle considerations.
In today’s climate of increased consumer financial responsibility, absolute accuracy in processing of healthcare claims is a necessity. All too often, claims adjudication is ridden with errors and inaccuracies that leave the consumer exposed to inappropriate co-pays, deductibles and balance bills. We offer a comprehensive Medical Bill Review service which allows the consumer to audit the adjudication of healthcare claims against the details of insurance benefits. Our trained claims professionals have decades of experience in claims management. If an error is found, our advisers seek correction and remuneration from the payer with the permission of the consumer.