More Options for Consumers

Aetna has also experimented with establishing health-savings accounts designed to give consumers more control over their care and take more responsibility for health-care costs.

Similar to a plan promoted by President Bush during the 2004 election, the Aetna HealthFund plans allow participants and their employers to deposit funds into a health-savings account. Proponents of these plans say consumers can take ownership of the funds paid out for health care, which in turn should make them more cautious about their purchases of drugs and medical services. Once the fund is exhausted, an individual must pay medical bills out-of-pocket. The financial risk is limited to a few thousand dollars (the exact amount varies among plans of this type), with a high-deductible traditional insurance policy providing a safety net for catastrophic illness.

Brad Holmes, a Forrester Research health-care analyst, says Aetna's health-savings accounts represent "a necessary arrow in the quiver" to compete in the marketplace, but will only appeal to consumers who want to make their own health-care decisions. Still, Aetna made a serious investment by building this business internally, rather than hedging its bets by partnering with a specialist in medical savings plans as many of its competitors have done. The result is bound to be a more integrated service than one that relies on system-to-system integration, he says.

Rowe doesn't offer this type of a plan as a cure-all, noting that it tends to make the most sense for people who are relatively young and healthy. But he sees potential for consumer-directed plans, a category that includes both health-savings accounts and managed-care plans with tiered co-payments designed to make health-care consumers more cost conscious. In a study it commissioned, Aetna found that during 2003 HealthFund participants did a superior job of keeping a lid on medical costs, experiencing a 3.7% increase compared with 11% for a control group in a traditional health plan.

"Participants in the consumer-directed products turn out to be twice as likely to go online and find out what drugs cost, which represents a tremendous opportunity for them to save and their employers to save," Rowe says. Yet even as Aetna works to provide more medical data over the Web, Rowe admits to being concerned that consumers lack the "health literacy" to make the informed judgments required to manage their own care.

Overall, while Aetna itself is clearly much healthier today, Rowe gives most of the credit not to its systems but to the managers who have learned how to get the most from them: "Information was an infrastructure element here, and it was a core element, but it wasn't a strategy element."