Health Savings Account Blog

Turpin was already on the road to recovery when English friends got him to move over to the relative luxury of the paying side of the system, but at least there his doctor — the same one from the ward — introduced himself and knew Turpin's name as well as his diagnosis. Of course, the bill for a short stay on the paying side was many times more than that for his longer stay among the national health patients.

Turpin has been with United Healthcare for about two years, and in Trumbull at the former Oxford Health Plans, which is now part of United Healthcare, for about a year. He spent more than 20 years as a health-care consultant to companies.

The reality of universal health care, Turpin said in a recent interview, brings with it a slew of questions, including how it will be financed and controlled.

In order to improve public health, he said, the state has to get beyond the issue of the uninsured and universal health coverage. Raising taxes to pay for coverage doesn't deal with the root cause for rising health-care costs.

"America's getting fatter, sicker, less accountable," he said, and in order to improve the health-care system, individuals need to take more responsibility for themselves. "I think obesity will be the next smoking," he said.

"You don't make a change in your lifestyle until you feel a pain in your chest or a pain in your wallet." The industry's coined a term for the new model — consumer-directed health care. It comes in a variety of forms, but the most popular is a Health Savings Account.

"The future of health care we're all moving out of the conventional HMO-model program," said Stephen Glick, administrator of the Orange-based Chamber Insurance Trust. This group manages the benefits programs for chambers of commerce in Connecticut and Western Massachusetts.

"The real solution is an incremental change," Glick said, starting with improving the Medicaid reimbursement rate and getting more kids insured.

At the individual level, insurance companies today, Glick said, are spending money and time to "reprogram plans," in order to reflect the change to consumer-directed health care. But the most important element is consumer education; here, Glick said, United Healthcare was an innovator.

According to Glick, companies such as Pitney Bowes, IBM and Xerox have created behavioral changes in their workers, using wellness programs to encourage healthier behavior, for example. This keeps their insurance rates from growing as quickly as those of other companies.

Tanya Court, director of public policy and programs for The Business Council of Fairfield County, said three-quarters of health-care spending is on chronic diseases, such as diabetes.

"That's largely preventable," she said.

Some companies are adding on-site fitness centers, or healthier foods in cafeterias, she said. Changing benefit plans to reward employees for healthy or frugal habits — such as no copay for an annual physical or reduced copays for generic drugs — is another possibility.

On the topic of universal health care, Court said, "You are already" bearing the burden of caring for the uninsured, through higher insurance costs. But the state and rest of the country have to get a handle on the costs of providing care and ridding the health-care system of inefficiencies.

"People have to have some skin in the game to take control of their health," Court said.

Turpin thinks his background in the middle between the health insurers and the companies buying their products makes him more of a pragmatist about the issue.

All the industry has been doing for the last six years is shifting costs to workers and eroding their wage base, he said.

Employers are looking for the lowest-cost plan, he said, adding some will leave a health-care company in order to save 1 or 2 percent.

Some doctors are dropping out of managed care entirely — seeing fewer patients and charging more but with less paperwork — while others are taking on higher-margin procedures that used to be done in hospitals. This, he added, means less income for the hospitals.

Patients and providers also need to pay more attention to outcomes, and getting the best quality care in the shortest period of time. The health-care system in the mid-1980s failed because all the companies did was to restrict access to care without enough focus on quality. Insurers could then reward the doctors who are following these guidelines, he said.

But legislating change would only create "guardrails" to keep people within the lines. This region is still lacking in the move toward consumer-directed care, but items such as Health Savings Accounts are starting to catch on. And smaller companies are waiting to see what happens at the bigger businesses going in this direction. Turpin is even hiring wellness specialists to work with his company's clients.

"Right now, our industry is in a sea of sameness," which will continue until someone sticks their chin out and makes real change, he said. "Everybody should have access to affordable care but the devil's in the details."

Find out more about what an HSA can do for you at: http://www.health--savings--accounts.com