Though each insurance company has its own way of architecting the system, all of them follow a similar pattern. There are four basic pieces of CRM that CIOs are using as a framework for building the new insurance plans.

CUSTOMIZATION

Medical allowance plans will fail if health insurers don’t help consumers understand how big their allowance?which is usually stored in an interest-bearing savings account?should be. If the allowances are too high, consumers will set aside more money than they need to. Since the money can’t be used for anything but health care, that’s wasted money. If the account’s too small, consumers will have to pay additional cost out of pocket, and insurers will end up managing the care as they do now.

Under Goodman’s direction, Humana launched a limited digital health plan called Emphesys last October. Just last month, the company rolled out SmartSelect, a more advanced customized health plan for its more than 14,000 employees. That product will be sold to other employers this year.

With SmartSelect, employees go to a website and are asked a series of questions: How often do you use prescription drugs? How often do you visit a physician? Would you be willing to use generic drugs? Would you want to see a doctor at a teaching hospital? Do you have any chronic conditions? After answering dozens of questions, SmartSelect’s software builds several health plans with 42 possible combinations, each offering differing levels and areas of coverage. The program tells users what their yearly allowance should be so that they won’t put too much or too little aside. The CRM engine presents the employees with several options: They can choose any plan, but the tool is meant to help them understand which is the best fit based on their health-care needs.

INTERACTIVE CONSUMER TOOLS

Until now, consumers largely have been kept in the dark about health-care cost. These new plans bring them into the loop. "Ask anyone how much their prescriptions cost, and they’ll tell you $10," says Deborah Casurella, CIO of Definity Health, a St. Louis Park, Minn.-based startup that offers customization tools. "They have no idea the drugs cost hundreds of dollars or that a physical is $350."

To inform consumers, the CIOs have created interactive tools. In Casurella’s case, one of the most effective has been a prescription management tool that went live in January. In addition to letting consumers track their prescriptions on a calendar (how many drugs they’re using, when they fill them and so forth), the tool also helps them compare generics with brand-name drugs. "They can slice the data many ways. We’ve found it’s a very quick learning curve," Casurella explains. Goodman created a similar prescription tool now available to all of Humana’s members.