In the world of today's health care, the term "consumerism" is being used in many contexts and with many meanings. However, the term can best be defined as "a model of shared responsibility for health and cost management among all stakeholders." The stakeholders who share this responsibility are a) the health care provider; b) the employee; c) the employer; and d) the health plan. The following describes the primary responsibilities that must be assumed by each stakeholder group to achieve a successful model of consumerism.

Health Care Provider

The health-care-provider stakeholders include any entity that delivers health care, including physicians, hospitals, and ancillary services. For consumerism to be successful, providers must adopt transparency by participating in efforts to share information about quality and cost. They must also be willing to introduce and participate in reengineering of processes to improve cost and efficiency. An example of this is to train a doctor's office staff on a triage model that allows certain decisions to be made by receptionists and more-complex decisions to be made by nurses. That would increase the efficiency of the physician by reducing time and energy spent on routine decisions.

Another key responsibility for the provider community is to promote health management. This includes partnering with health plans and health management vendors to identify health risk factors within their patient population. In addition, the providers must encourage and support their patients in seeking and participating in health risk identification, in risk reduction programs and in utilizing tools to modify behavior and mitigate risk.

Employee

In consumerism, one major responsibility of the employee is to manage health. Health management addresses each employee across the spectrum—from the well, to those with excessive health and lifestyle risk, through those with chronic diseases. For the well, the responsibility is to remain well by participating in health promotion programs, undergoing appropriate health screenings and maintaining a healthy lifestyle. For those with excessive risk, the responsibility is to identify and understand their risks and potential consequences and then participate in behavior modification (such as quitting smoking) and risk reduction programs (joining weight-loss classes, for example). Those individuals with chronic diseases have a responsibility to understand their diseases and treatment and to follow recommended treatment and monitoring. At the same time, they should understand and reduce risks that may lead to a worsening of their condition or the development of another chronic disease. A diabetic, for instance, could limit the damage of the disease—and the potential for heart trouble or other serious problems—by consistently monitoring blood sugar levels and by altering his or her diet.

Under the consumerism model, another major responsibility of the employee is to manage cost. This entails identifying and seeking care from providers with the highest quality and efficiency. For an employee to do this, however, providers and health plans must work together to, respectively, provide transparency and serve as the vehicle for this information. Managing cost also means minimizing unnecessary procedures and provider visits. Again, this requires access to appropriate information regarding tests and treatment.

Employer

The employer has three major responsibilities. First, the employer must provide decision support. Decision support would include such things as providing a Web site with health support information and tools; creating a workplace environment that supports health and health strategies (healthy choices in vending machines or discounted fitness memberships, for example); and providing health management tools such as personal health assessments, health fairs, lifestyle risk reduction programs and disease management opportunities.

Second, the employer needs to drive engagement. This can be accomplished through "branding" and internal marketing of the health program; providing year-round communications and campaigns; and designing appropriate and meaningful incentives to encourage and reward participation. By creating an internal "brand" for all health-related activities, it can most effectively create culture change within the organization. For example, creating a program called "Healthy Connections" and then labeling all associated health-related activities—such as health promotion, employer-financed health reimbursement arrangements, disease management and healthy vending machine choices—as a component of the "Healthy Connections" program increases employee awareness of the entire program. Incentives and communication then become a part of this focus.

It is equally important for plan design to be constructed so as to be in alignment with the health management strategy. The implementation of high-deductible HSA plans, for instance, may encourage more price and quality sensitivity on the part of the employee. Other examples would be reducing or eliminating copays for maintenance medications for chronic conditions and providing full first-dollar coverage for appropriate health-screening procedures.

Many insurance carriers and third-party administrators provide wellness and disease management services, often through partnerships with specialized vendors. For smaller companies, this may be the best avenue for obtaining an integrated solution. In addition to wellness and disease management, carriers frequently also offer 24/7 nurse lines and health content Internet portals, which can enhance and support a health management strategy.

Health Plan

Health plans have a responsibility to provide technological infrastructure that serves as the basis for the employee's access to information such as high-performance providers. In addition, the technology should provide decision support tools around plan design that help guide a patient through the pros and cons—and costs—of treatment choices and also provide an exceptional customer experience.

Another responsibility of health plans is to provide outreach and encourage engagement. Since the health plan is a repository of all claims data, one example would be to monitor health-screening activities (mammograms, Pap exams, prostate cancer tests, cholesterol-level checks, etc.), match them against current medical recommendations and then autogenerate mailed notices to employees who are not conforming to those standards. Plans also have a responsibility to provide educational and self-management tools and information that members can easily understand. Engagement can be improved if health claims data is analyzed to identify those individuals who could most benefit from a health management program, whether through health risk reduction or better management of a chronic condition.

If each stakeholder makes good on its responsibilities, the results for the "consumer" are improved information coupled with economic incentives leading to behavior change that results in informed choice and value-based health care for all stakeholders. In many ways, though, employers are first among equals—responsible for ensuring that all other stakeholders assume and address their responsibilities in the consumerism model. More than any stakeholder, in fact, employers can drive the adoption of this strategy through their selection of plans and by taking the lead in promoting the model with their health insurers, provider networks and employees.

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