Bedside Mannners.

Technological advances and insurers' renewed emphasis on the consumer are putting health-care decisions back in the hands of doctors and patients.

In the era of managed care, health insurance companies often found themselves in the middle of an emotionally explosive triangle, trying--and failing--to balance the sometimes-conflicting needs of patients for their care, physicians for professional autonomy, and employers for protection against escalating benefit costs. The distance between their expectations and insurers' delivery is a customer-service gap of sizable proportions.

Over the past decade, the health insurance industry assumed the nearly impossible role of mediating some of the most challenging personal decisions people ever have to make--who will care for them when they or their families are sick or injured and what kind of care they will receive. Physicians, who had been accustomed to a uniquely intimate relationship with their patients and a respectful position in society, suddenly found their judgment questioned and their role diminished. And people became frustrated when they did not feel free to choose their doctor or when a physician-recommended test was not covered by their health plan. Over time, the industry developed a reputation for obstruction rather than as the care facilitators they were expected to be.

At the same time, managed care did what employers expected it to do. It put a lid on premium increases and reduced the cost of providing insurance coverage to their employees. But it did so without fundamentally changing the relationship between the people and their health system. As a result, cost pressures have continued to build, and people have become increasingly dissatisfied.

The good news is that forward-thinking health plans have become aware of the dissatisfaction of consumers, physicians and employers, and they are working hard to pioneer new solutions that place patients' priorities first. And this comes at a time when new information-technology systems are smart enough and mature enough to serve as the foundation for a new era in consumer-focused care.

New Technologies

The health-care industry has been slow to adopt and effectively deploy information technology to increase its efficiency. This is partly because health care is highly fragmented and resistant to standardization, and partly because large organizations like hospitals and health-care networks operate with a patchwork of legacy systems that are too valuable to scrap and too expensive to replace.

Today, new database technologies, information-security technologies and the Internet offer opportunities to develop quick, efficient and seamless management of the business of health care. These technologies offer a way to deliver clinical information and insight that will improve health-care decision making and make the whole health system more effective. Here are just a few examples:

* Automation of enrollment, billing and electronic funds transfer is streamlining business processes and saving time and money. A lot of the frustration people feel about getting access to services and that physicians feel about slow payment will disappear. Some of these new systems--Web-based consumer personalization, credit-card transactions and online reporting--can offer consumers convenience as well as a new window on the cost of health care and their part in the process of paying for it.

* The Internet is an incomparable vehicle for capturing and delivering health education. Consumers can gather massive amounts of information online, including facts on health-care conditions and how to manage them, evidence-based practices and how to implement them, as well as the risks and benefits of treatment and how to weigh options. By collecting and tracking health-care use, the Internet can become a repository of a personal health record that can help patients track their health and health care. Insurers can set up protected, personalized records to store medical history and immunization records online, making the information accessible to consumers 24 hours a clay. With protected records, consumers can view their history, treatment program and medical options and can take an active role in their health care. Applying some clinical logic to this data, health plans can provide additional decision support, such as alerts and reminders, warnings about drug interactions and recommendations for diet and lif estyle.

* Integrated multichannel customer-relationship-management technologies are providing Web-based customer service with new, more effective voice-recognition and telephone systems that will dramatically reduce the time doctors, consumers and employers spend waiting for answers and make many of these resources available to people who are not active users of the Internet. Having more options allows consumers to make meaningful connections with doctors and health insurers to comfortably meet their personal needs.

* New database and networking technology is making possible the rise of much more sophisticated and personalized programs and services in disease management and complex case management to help the chronically ill coordinate their care and navigate our complex health system.

* Technology is making it possible for consumers to customize health solutions based on their own preferences. A new pharmacy benefit eliminates preauthorization in 99% of cases. In its place, the consumer, in consultation with his or her doctor, can choose among drugs with similar clinical effects but different copayments. In other words, consumers can begin to weigh for themselves the costs and benefits of their care.

* Finally, the Internet is a great vehicle for communication. Consumers can report on their care, and the results can be posted online. Rather than sharing opinions with their neighbors over backyard fences, they'll be able to find out how other people are dealing with diseases and rating their providers. The Internet also can be used to increase communication with providers, reducing the need for some office visits and supporting people who want to take more control over their care.

Consumer-Centric Health Care

In short, a new breed of consumer-centric health insurers are deploying technology to smooth and speed the business side of healthcare delivery while enabling physicians and patients to better manage the clinical side of the equation.

While different stakeholders have different priorities, they can agree on what they want from their health insurance partner:

* Effective, easy-to-understand processes;

* Flawless performance of the basics;

* More security and less hassle; and

* More help with health-care decisions, without trying to make choices for them.

The old paternalistic system of health care--from "Marcus Welby" 40 years ago through the managed-care era--is over. The new health system will have to be built on member empowerment where consumers--armed with new technology tools, innovative services and good information--share in both the rewards and the costs of their health decisions.

By supporting the patient-physician relationship rather than interfering with it, health insurers can restore the public's trust in the health system.

Dr. Jack Lord is the chief clinical strategy and innovation officer at Humana Inc., Louisville, Ky.