Employers are beginning to recognize the importance and value of customization with their employee health insurance plans.  To both promote employee interest in health insurance, and their choosing of employer-sponsored health insurance plans, employers are finding that different employees want different coverage.  Moreover, by offering choice, itself, employers promote happier employees and higher retention rates among them. [H. Wachdorf “Local CEOs Describe Their Fantasy Health Plan” New Mexico Business Weekly July 13, 2007 (Albuquerque.bizjournals.com)]

In such cases, “customization” is usually merely offering a set of different health plans for different demographic segments among employees.  Plans of coverage specially suited to younger singles, married couples, then parents, those with young children, and finally, empty nesters, often with more chronic conditions due to age, may be all the different plans needed to please most/all segments.  Of course, plans that cover segments differently will cost differently as well, and that is often the major reason behind segments’ having different preferences.

Customization can easily go beyond insurance plan options, however.  When it comes to sickness care, for example, providers generally empower patients and family members to play a significant role in developing the “care plan” for each patient.  Planetree hospitals, for example, champion the practice of including patients and families in creating a care plan for every patient within 24-48 hours of admission.  This tends to promote patient and family satisfaction with the inpatient experience, and participation in post-discharge care, thereby enhancing both clinical and service quality.

Customization to individuals, rather than merely segments, is also possible and practiced among at least some of the many proactive health management (PHM) providers.  Providers who employ phone coaching, for example, such as Healthways, Inc., customize their coaching sessions through the normal nurse/patient interactions of every session.  Providers who employ automated computer-generated analysis of employee and member health risk assessments, such as HealthMedia, Inc. can customize feedback and online coaching to each individual through the idiosyncratic patterns of answers to HRA questions.

But consumers are increasingly showing their desires not to merely have choices, but to participate in the design, development, and implementation of the products and services they buy.  This tendency, when coupled with the advantages that customized PHM interventions have shown with regard to impact on participation and engagement in such interventions, make customization by as well as for individuals desirable.

When customization is done through automated computer-generated analysis, the feedback and coaching communications can at least be personalized by labeling the feedback HRA report and recommendations with the name of each individual.  Online and mail communications can also be personalized with individual greetings by name, and beginning sentences with the participant’s name.  This may be accepted as total individualization by participants, even if they do not participate in the design to the full extent as Planetree patients.

But there are at least some employees (and dependents as well), who participate actively in the design and implementation of PHM interventions.  It is a cooperative participation, rather than full autonomy, however.  Participants in the Duke Prospective Health Program get advice and guidance when they select their own health goals to pursue.  And Duke University Health, itself, can choose which types and levels of intensity for the support they offer participants, based on the risk/reward potential of the health status and goals of individual participants.

It has been shown in many cases that individualized PHM interventions, including those where customization is achieved by computer analysis, delivers what appear to be the most benefits to both participants and payors.  What we need now is some research into the relative advantages and costs of empowering individuals to participate in the design and implementation of PHM interventions, themselves, as in the Duke example.

Far too many of the rigorous studies of different PHM interventions have suffered from serious limitations, by focusing on:

•     Limited areas of PHM, primarily chronic disease management
•     Limited participants, primarily Medicare and Medicaid participants in CMS authorized reviews
•     Limited dimensions of success, primarily just reductions in sickness care costs compared to PHM costs added

And almost all such studies have involved PHM interventions that were designed entirely by PHM providers, with little or no involvement in participants except those who choose to enroll in what are often customized only to disease or risk condition/behavior, not to individuals.  Moreover, one of the major limitations of the studies, themselves, has been the limited proportions of people targeted for intervention that have chosen to enroll therein.

Customization has proven to be a major attraction in getting people to enroll in PHM interventions, and in keeping them participating throughout the intervention, rather than dropping out or lacking enthusiasm once enrolled.  While it may cost a bit more to customize completely for individuals, and a good deal more to customize by individuals, it should certainly be worth a comparative study of different approaches to customization to see which is most cost effective.