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"We've done a lot of research over the last two years trying to understand where consumers are in terms of being more informed consumers and being more involved in managing their healthcare," says Jim Slaba, vice president, e-business, CIGNA HealthCare. In fact, he adds, CIGNA undertook the study in part to validate the company's investment in a suite of decision support tools launched by the carrier this past January as part of its own consumer portal, myCIGNA.com.

Health insurance companies actually have taken a leadership role in fostering greater involvement of consumers in their own care, seeking greater efficiencies by putting incentive mechanisms in place that affect both quality and cost of healthcare services, according to Slaba. "We've done a lot of research into finding the right decision points for consumers, and we've sought to make the information we provide relevant to the individual" logging on to the carrier's myCIGNA.com member portal, Slaba relates. "The opportunity resides in trying to make a difference to the consumer while not overwhelming them with information."

Users of myCIGNA.com now can use a risk assessment tool that provides personalized information on members' health risks, along with recommendations for how to reduce them. The site provides access to the HealthWise (Boise, ID) knowledge base, a disease and conditions decision support tool. Customers also can compare hospitals' quality for more than 50 diagnoses and procedures using HealthShare's (Acton, MA) Select Quality Care tool, and they can compare drug treatment options through access to Subimo's (River Forest, IL) PharmAdviser application.

Although the consumers surveyed by CIGNA saw value in using the Internet to inform prospective visits to the doctor, the biggest concern they expressed about online information was that they would prefer to discuss issues with a live person. CIGNA offers such a "high-touch" complement to its "high-tech" functionality in two ways, Slaba reports. "There's the automated referral that will occur depending on how people answer assessment questions when it makes sense -- when they need an intervention 'now,'" he says. "And while we want people to use the Internet" for efficiency reasons, "we provide them with, 'While you're looking at this, you also have access to someone to speak to if you need further guidance or help interpreting the information.'"

Members can then be put in touch with a disease manager or case worker, based on health risk assessment answers, and they also can call a 24-hour, seven-day-a-week Nurse Information Line, through which they can address any concern with a registered nurse. Although consumers are encouraged to use online automated service, "we're actually looking to drive utilization of the Nurse Information Line higher," Slaba notes, "because we think that the more people speak to nurses and the more educated they get, ultimately it leads to higher quality, which in the long run leads to lower cost."

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