Bloom Health - a defined contribution company

Insurers invest a majority stake in Minneapolis-based Bloom Health to expand choice and flexibility of employers’ and employees’ insurance options

HEALTH CARE SERVICE CORPORATION, WELLPOINT AND BLUE CROSS BLUE SHIELD OF MICHIGAN COLLABORATE IN NATIONAL PRIVATE EXCHANGE AND DEFINED CONTRIBUTION SOLUTION FOR EMPLOYERS

MINNEAPOLIS, Minnesota (September 20, 2011) – Health Care Service Corporation (HCSC), WellPoint, Inc., and Blue Cross Blue Shield of Michigan (BCBSM) announced today a joint effort to offer a nationwide private exchange and defined contribution solution for employers to use in managing their health benefit offerings.

The three independent health insurers have invested equal stakes in Minneapolis-based Bloom Health, giving them majority ownership of the company. This is the first investment in Bloom by HCSC and WellPoint, while BCBSM is increasing its existing stake in the company. Each insurer will serve on Bloom Health’s Board of Directors, with Bloom remaining a separate company.

Bloom Health, established in 2009, provides employers and employees greater flexibility, access and choice of health care services by simplifying how they select and pay for health insurance. Through its platform, Bloom Health helps employers define and better manage their health benefits spending through a defined contribution model. The employer contributes a defined amount per employee toward the cost of employee health care benefits. Employees and individuals are presented with a wide selection of benefit plans through an online “marketplace” to best fit their individual needs.

“Currently, rising health care costs are top of mind for organizations of all sizes,” said Abir Sen, chief executive officer, Bloom Health. “Bloom Health is an important option that assists companies in responsibly managing the rising costs of health care, while at the same time making it simple, engaging and valuable to its employees.”

“HCSC is committed to making health care more accessible and affordable to all consumers. Adding a private exchange to our strong portfolio of health benefit options is essential to providing a broad array of solutions to meet consumer needs in this evolving marketplace,” said Marty Foster, executive vice president and president of plan operations, HCSC.

“We believe private exchanges will be an important solution as the rising costs of health care leave employers searching for more predictability in their health care spend,” said Ken Goulet, executive vice president, and president and CEO of WellPoint’s Commercial Business Unit.  “The combined leadership, technological capabilities, brand reputation and market presence make this a natural strategic fit to providing our customer base with the best value and their employees with convenience and choice.”

“By leveraging Bloom Health’s consumer expertise and leading-edge technology, we can offer employers a way to better manage risk all while preserving choice for their employees,” said Ken Dallafior, senior vice president of Group Business and Corporate Marketing, BCBSM. The company was the first to work with Bloom Health earlier this year to pilot a defined contribution health benefit solution to some Michigan employers during 2011, with an expanded rollout in 2012.

The Bloom solution will begin offering limited enrollment for groups renewing in 2012 and will be fully operational for all markets by 2013. For more information, visit www.gobloomhealth.com.

About Bloom Health

Bloom Health is a leader in the defined contribution health benefits marketplace, committed to assisting employers of all sizes move toward an employer-sponsored system that has effective cost predictability for employers and increased choice and personalization for employees. Bloom Health was founded in 2009 and is headquartered in Minneapolis. For more information, visit www.gobloomhealth.com.

About Health Care Service Corporation

Health Care Service Corporation is the country’s largest customer-owned health insurer and fourth largest health insurer overall, with more than 13 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross and Blue Shield Association. HCSC has a rating of AA- (Very Strong) from Standard and Poor’s, A1 (Good) from Moody’s and A+ (Superior) from A.M. Best Company. For more information, please visit www.HCSC.com or follow us at www.twitter.com/HCSC.

About Blue Cross Blue Shield of Michigan

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to more than 4.3 million members residing in Michigan, in addition to members of Michigan-headquartered groups who reside outside the state. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. For more company information, visit bcbsm.com.

About WellPoint, Inc.

WellPoint works to simplify the connection between Health, Care and Value. We help to improve the health of our members and our communities, and provide greater value to our customers and shareholders. WellPoint is the nation’s largest health benefits company in terms of medical membership, with 34 million members in its affiliated health plans, and a total of more than 69 million individuals served through its subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia, Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas). WellPoint also serves customers throughout the country as UniCare. Additional information about WellPoint is available at http://www.wellpoint.com/

Bloom Private Exchange Platform™ Enables Health Plans to Personalize Group Benefit Offerings Through Defined Contribution Solution

MINNEAPOLIS – July 6, 2011 — Bloom Health announced today that two health plans have begun to sell and market health benefits to employers through the company’s newly-launched private exchange. The private exchange is currently available through the largest insurer in Michigan and through Medica, a Minnesota-based health plan.

The Bloom Private Exchange Platform™ is a turnkey solution that allows health plans to offer their employer clients a defined contribution solution to predict health care costs and provide personalized benefits in a group market setting. This new offering geared toward health plans further enhances Bloom Health’s suite of products, tools and services that help employers responsibly engage their workforces in making their own health benefit purchasing decisions.

“We’ve heard from health plans that they need a way to offer more customized, individually-tailored benefits to their employer clients who are looking for more choice in a tough economy,” says Abir Sen, CEO of Bloom Health. “As the insurance marketplace transforms over the next few years, health plans are increasingly looking for ways to ensure that they are offering employers value and choice they can’t get elsewhere. The Bloom Private Exchange Platform™ does just that.”

A leader in defined contribution health benefits, Bloom Health works with employers of all sizes to move the employer-sponsored system toward better cost predictability for employers and increased choice and personalization for employees. The company currently works with nearly 50 employers, representing more than 25,000 members. The Bloom Private Exchange Platform™ is the company’s first health plan-specific defined contribution solution.

The Bloom Private Exchange Platform™ aggregates on one platform the various insurance products and services that employers can make available to their workforces. Within the private exchange, employers can set an amount they are willing to contribute to the coverage, and employees then select the coverage that is best for them according to their health, financial situation and appetite for risk. The private exchange also offers health plans an existing platform from which to sell medical, dental, wellness and other ancillary products and services.

In addition to facilitating the selection and sale of health coverage, the Bloom Private Exchange Platform™ also offers health plans an end-to-end solution that eases burdens associated with other sales channels. Specifically, the exchange platform includes customized branding capabilities and a comprehensive communication toolset – including sales, employer, and employee support; sales training plan and materials; employer on-boarding process and step-by-step implementation guide; and enrollment, eligibility, billing, and recordkeeping functions.

“Employers want their benefits programs to truly help attract, motivate and retain the best workforce possible,” said Simeon Schindelman, Medica senior vice president of commercial markets. “Bloom’s Private Exchange Platform™ gives us the opportunity to do this for employers with our new defined contribution product, distributed by appointed and credentialed agents, brokers and consultants.”

The Bloom Private Exchange Platform™ also includes:

• A full employee website experience, including a recommendations engine and exchange marketplace
• An employer portal to self-initiate and manage on-boarding, reporting, and ongoing life events
• A reporting package with enrollment, payroll, customer service, and satisfaction statistics
• A comprehensive “t-minus” project plan and template for operational readiness
• A dedicated project team and subject matter experts to ensure successful launch and implementation

Learn more about the Bloom Private Exchange Platform™

Future of employer-sponsored health benefits focus of “Defined Contribution: Powering the Private Exchange” roundtable event

Future of employer-sponsored health benefits focus of “Defined Contribution:
Powering the Private Exchange” roundtable event

MINNEAPOLIS – June 28, 2011 — Today Bloom Health hosted “Defined Contribution: Powering the Private Exchange,” a novel roundtable discussion about the changing landscape and future of health benefits since passage of the Patient Protection and Affordable Care Act (PPACA).

In partnership with the event sponsors Medica and Mercer, the event brought together more than 120 business leaders, policymakers and health brokers from the Midwest to analyze the new era of health benefits quickly approaching and to share real world best practices.

“Our state has long been an incubator for innovative health care companies generating new ideas, products and services,” said Abir Sen, founder and CEO of Bloom Health and host of today’s event. “The focus of this event was to create a platform for that same pioneering thought leadership and to foster discussion on ways to redefine the model for employer-sponsored health benefits. We want employers to have a voice in developing effective models for increasing choice and personalization in employee benefits.”

The morning’s keynote speaker, Regina Herzlinger, is a Nancy R. McPherson Professor of Business Administration at the Harvard Business School and one of the nation’s most respected health care analysts. Herzlinger addressed the business leaders with a high-level overview of the evolution of health care benefits, the future of health care and how companies of all sizes can prepare for the changing health care environment.

“Important changes are coming to health care and there’s a greater demand for more consumer-focused options in the marketplace,” Herzlinger remarked during her presentation. “Health care of the future will be more transparent, including sharing outcomes so consumers can decide which doctor or hospital provides the highest quality of service.”

In addition to Herzlinger’s keynote address, a panel of local and national industry leaders from Bloom Health, Medica, Mercer, Orion Corporation and U.S. Bank, discussed current challenges to employer-sponsored health benefits, as well as evolving models such as defined contribution and private exchanges, which aim to help employers responsibly predict and plan for health coverage expenses.

“This event encouraged an open dialog on the evolution of health benefits that is starting to unfold under the new health law,” said event panelist Patrick Boughey, the principal consultant for Mercer’s Health and Benefits practice located in the Twin Cities. “This is exactly the dialog that is needed to uncover what employees and employers truly need and how our industry can work together to provide it.”

Blue Cross Blue Shield of Michigan partnership with Bloom Health will help employers successfully structure health benefits to control costs

First-to-market solution helps employers plan future health care expenses, while preserving choice and security for employees

MINNEAPOLIS – Feb. 23, 2011 — Blue Cross Blue Shield of Michigan today announced that it will partner with Bloom Health to offer employers a new defined contribution health benefit solution that will help them better manage changes brought on by national health reform and offer employers a more sustainable path forward in health care.

The new solution – known as GlidePathSM – will offer employers and consumers greater control over health care spending. Employers will see more predictable management of their health benefit costs and simplified administration, while employees get help choosing a plan that best fits their health and budget needs.

The Blues plan to pilot GlidePath to employers with active employees during the second half of 2011, with expanded rollout to the market planned in 2012.

GlidePath will be powered by Bloom Health, which was formed in 2009 to help employers use defined contribution health benefits to better manage their health care costs and to offer employees greater choice in selecting the benefits that best meet their needs.

GlidePath will enable employers to determine how much they want to spend on employee health benefits and then allocate pre-tax dollars on behalf of each employee’s health accounts. Employees then complete Bloom Health’s user-friendly health, financial and personality survey. The results instantly generate a customized list of recommended health plans and other related services that match each employee’s specific needs. Employees can then use funds from their health account to purchase the health plan of their choice.

“With health care costs climbing, employers face difficult decisions around providing health care benefits. Also, as new health reform requirements loom on the horizon, we wanted to create an innovative solution to deliver and help manage health care benefits for active and retired employees,” said Ken Dallafior, senior vice president of Group Sales and Corporate Marketing for the Michigan Blues. “By leveraging Bloom Health’s consumer expertise and leading-edge technology, we can offer employers a way to better manage risk all while preserving choice for their employees.”

With this new defined contribution solution, Blue Cross Blue Shield of Michigan becomes the first health insurance partner of Bloom Health in the country.

About BCBSM

Blue Cross Blue Shield of Michigan, a nonprofit organization, provides and administers health benefits to 4.4 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association and is a limited partner of the Blue Cross Blue Shield Venture Partners, L.P., a corporate venture fund that has a minority ownership interest in Bloom Health. For more company information, visit http://www.bcbsm.com.

Member data shows a strong shift toward employees purchasing consumer-driven health plans

MINNEAPOLIS – Feb. 14, 2011 — With employers’ annual health care costs projected to rise to $10,730 per employee in 2011, many businesses faced difficult decisions when paying for their employees’ health insurance benefits this past year. But for nearly 25 employers, 2010 marked the end of out-of-control health care costs and one-size-fits-all decisions thanks to Bloom Health’s unique defined contribution approach to health benefits management.

“Bloom Health brought an end to increasing premium hikes for our company and inadequate health insurance plan options for our employees,” said Amy Habedank, Human Resources Manager at Pinnacle Services. “With Bloom, our employees have been able to select health insurance plans that meet their families’ needs, and in some cases, they have even had additional money left over for other medical expenses. Instead of anguishing over the enrollment process, we can now take comfort in a defined and predictable health care spend and focus our attention on company growth.”

Bloom Health first helps employers determine an appropriate amount to spend on employee health benefits, taking into consideration a target health care budget and employee needs. Employers then allocate pre-tax dollars on behalf of each employee into individual Bloom Health accounts. Next, employees complete Bloom Health’s user-friendly health, financial and personality survey – the results instantly generate a custom list of recommended health insurance plans, wellness programs and other related services that match the employee’s specific needs. Then, employees can purchase the plan of their choice using funds from their Bloom Health account.

“Picking a health insurance plan was a refreshing change this year with Bloom,” said Kari Harrisville, an employee at Digineer. “It was nice to have multiple insurance plans to pick from that were tailored to the needs of my family versus the company as a whole. The process was easy, and there was a live person available to answer my questions before I picked my insurance plan. Buying my own plan was actually rewarding, something I never thought I’d say about health insurance.”

Upon surveying its members, Bloom Health earned a Net Promoter Score (NPS) that is 26 points higher than the industry average. An established benchmark of consumer satisfaction, NPS is calculated by asking members to rate products, services and brands on an 11-point scale in order to determine the percentage of brand promoters versus brand detractors. The company’s high NPS within the industry is a result of its focus on creating an experience that resolves common open enrollment confusion and engages consumers by providing customized advice and best-fit health insurance plan options.
Transparency and Trends

Based on data from Bloom Health members’ purchasing decisions in 2010 and 2011, there’s a strong shift toward consumer-driven health plans. Sixty-five percent of members purchased a Health Savings Account (HSA) plan; two percent purchased a high-deductible plan, and 33 percent purchased a standard co-pay plan. Additionally, Bloom Health’s website provides real-time data on members’ health plan selection by carrier preference.

“All health insurance plans are not created equal – something many consumers are discovering for the first time as they’re able to take more control over their health care decisions and dollars,” said Jill Prevost, head of customer experience at Bloom Health. “We’re glad we can be an independent resource to help simplify a complicated process. We’re equally as excited about how many employers have quickly resonated with our defined contribution approach to health benefits management. It’s been a whirlwind six months since our solution went live, and 2011 is shaping up to be an equally great year.”

John Vlajkovic, Manny Menendez Bring Decades of Experience in Helping Employers with Benefit Strategies

MINNEAPOLIS — February 7, 2011 — Bloom Health announced today that it has appointed John Vlajkovic and Manny Menendez to key leadership positions on the Bloom Health sales team, adding a depth of industry expertise that puts Bloom at the forefront of the defined contribution health benefit space.

Vlajkovic joins the company from Aon Hewitt, where he advised corporate officers on the development of innovative benefit designs. A former hospital administrator, Vlajkovic is a nationally-recognized expert in employer benefit strategies.

Menendez most recently was the Chicago Health Management Market Manager at Aon Hewitt, where he advised national employers on health care plan selection, budget rate development, and measurement. An expert in consumer-driven health care strategies, Menendez has helped employers understand and respond to the implications of health care reform.

Vlajkovic and Menendez will report to Kevin Kickhaefer, who recently joined Bloom as head of sales and market development. Kickhaefer also brings extensive experience in the health benefits space. He previously served as vice president for national accounts at Cigna Healthcare.

“John and Manny bring tremendous experience and industry-leading insights to Bloom Health,” says Abir Sen, CEO at Bloom Health. “For decades now, employers have looked to John and Manny to guide them through the health benefit maze, and we are thrilled to have them join Kevin’s team as Bloom works to help employers across the nation transition to a defined contribution strategy.”

“Employers are facing a new day in health benefits, and the defined contribution approach that Bloom Health is spearheading will change the face of employer-sponsored health care,” says Vlajkovic. “This is an incredibly exciting time to be part of this company.”

Menendez says that employers are increasingly looking for the kind of customized benefit strategies that Bloom Health provides. “The old way of offering benefits isn’t working. Employers understand that they need more predictability in health care expenses and that their employees want more of a say in their own care,” Menendez says.

MINNEAPOLIS — December 2, 2010 — Bloom Health is pleased to announce the hiring of Kevin Kickhaefer as its head of sales and market development. Kickhaefer joins the team with more than two decades of health care and sales and marketing experience. In his new role, he will drive adoption of the company’s defined contribution health benefits management solution.

Before joining Bloom Health, Kickhaefer led national sales and new business initiatives for several Fortune 500 companies. Most recently, he successfully developed and managed new business relationships as vice president of national accounts at CIGNA HealthCare. Prior to CIGNA, Kickhaefer was sales director at Aetna in Chicago where he built and expanded its mid-size and large employer markets. He has been recognized nationally for leading the country in sales for both companies.

“Traditional models of health benefits financing and selection don’t meet employer or employee needs anymore,” said Abir Sen, chief executive officer of Bloom Health. “Kevin has seen this reality first hand and is ready to bring his skills to Bloom Health where we are pushing boundaries and helping employers and employees get more from their health benefits and save money.”

“It’s not a question of if, but when. Defined contribution models are where the industry is heading,” said Kickhaefer. “Bloom Health is leading the initial charge, and it’s professionally invigorating to apply my experiences and knowledge to such an innovative offering during a pivotal time in the industry.”

Kickhaefer holds a Bachelor of Science in finance and accounting from Kansas State University.

A Breath of Fresh Air: Bloom Health Partners With American Lung Association to Offer Freedom From Smoking Program

Freedom From Smoking Program now available as part of Bloom Health’s Virtual Shelf of health insurance plans and other services

MINNEAPOLIS — October 22, 2010 — Bloom Health today announced a partnership with the American Lung Association. Starting early 2011, Bloom Health will offer free and premium versions of the Lung Association’s Freedom From Smoking® program through its Virtual Shelf™, an online marketplace where employers use a defined contribution approach to help fund their employee’s health insurance plans and related services that are tailored to each individual’s unique needs.

The Freedom From Smoking program leverages evidence-based lessons, modules and tools to positively support consumers in their efforts to quit smoking. It is available as a group clinic as well as online and has helped more than a million people quit smoking over the past 30 years.

“Unhealthy behaviors, including smoking, are a driving force behind employers’ skyrocketing health care costs,” said Abir Sen, CEO of Bloom Health. “Smoking related diseases kill 443,000 people every year and cost $193 billion in indirect and direct health care expenditures. The American Lung Association’s Freedom From Smoking program has a proven track record and just flat out works. We’re proud to offer them as a solution for cost-conscious employers and for employees struggling with nicotine addiction.”

Bloom Health first helps employers determine an appropriate amount to spend on employee health benefits, taking into consideration their upcoming health care budget and their employees needs. Employers then deposit pre-tax dollars on behalf of each employee into a Bloom Health account. Next, employees complete Bloom Health’s user-friendly health, financial and risk survey, the results of which generate a custom list of recommended health insurance plans, wellness programs and other related services that match the employee’s specific needs. Freedom From Smoking will be offered as an optional wellness program.

“Partnering with Bloom allows the Lung Association to reach more people with our effective Freedom From Smoking program, and to do so in a way that empowers consumers to make the choice on their own,” said Bill Blatt, Director of Tobacco Programs at the American Lung Association. “This program is designed to help smokers conquer their addiction and emphasizes the comprehensive benefits of quitting smoking.”
About American Lung Association

Now in its second century, the American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease. With your generous support, the American Lung Association is “Fighting for Air” through research, education and advocacy. For more information about the American Lung Association or to support the work it does, call 1-800-LUNG-USA (1-800-586-4872) or visit www.LungUSA.org.

MINNEAPOLIS — October 13, 2010 — Bloom Health is excited to announce the addition of 277 new individual health insurance products to its Virtual Shelf and available for purchase to Bloom members. On September 23rd, 2010 Medica and Blue Cross Blue Shield announced suites of new products that would be available for purchase to individuals. Bloom Health immediately began adding these innovative and affordable options to its Virtual Shelf.

All of the new plans feature benefits outlined by health reform laws, including preventive care covered at 100 percent. Some of the new plans offered to Bloom members include features such as discounts at gyms/fitness clubs and access to retail clinics. In addition, Blue Cross Blue Shield announced that for both Personal Blue plan and Options Blue plan the maternity waiting period has been reduced from 18 months to 90 days.

“We’re committed to making sure each of our members has access to these new plans as soon as possible – most health insurance companies are adding great features that their other customers have been requesting for years. Our members now have instant access at their fingertips through the Bloom portal” said Bloom’s Head of Product, Jill Prevost.

As health insurance companies roll out new individual insurance plans in the future and as health reform laws continue to become reality, Bloom Health is staying ahead of the curve by continuing to offer these new products to its members as soon as they’re available.

Solution controls health care costs and delivers employees tailored health plans.

MINNEAPOLIS — August 24, 2010Bloom Health today announced five Twin Cities-based companies have deployed its health benefits administration solution — taking the worry and hassle out of open enrollment for the coming benefit year.

Clients that have successfully implemented the Bloom Health solution include Anderson Companies, Orion Corporation of Minnesota, Echobit, Refactr and Wellclicks. Several more companies plan to launch Bloom Health before the end of the year.

"We set out with one goal for 2010: to simplify how employers and their employees select and pay for health insurance," said Abir Sen, chief executive officer of Bloom Health. "We’re off to a great start with our first client implementations, and the positive feedback from employers and employees is validation that our unique approach to health benefits administration has immediate application and value. It’s especially rewarding to see how quickly an entire company’s outlook on managing health benefits can change from frustration to one of pride and comfort."

The company’s solution is well suited for businesses of all sizes and industries. First, Bloom Health works with employers to determine a reasonable and affordable amount to spend on employee health benefits. Then, employers deposit pre-tax dollars on behalf of each employee into a Bloom Health account.

Employees participate via Bloom Health’s user-friendly health, financial and risk survey, which generates a custom list of recommended health insurance plans that match the employee’s specific needs. Employees then choose a health plan and any related services based on desired cost, coverage and features, and pay for insurance and other programs directly from their Bloom Health accounts. This process empowers employees by meeting each individual’s needs.

Scott Sloan, an employee of Wellclicks adds, "Going through the Bloom Health process took the complexity and confusion out of choosing health insurance. The online questions guiding me through health plan options were effective and simple, and at the end, I had a list of benefit choices. Bloom Health did all the heavy lifting for me. I purchased a health plan well suited for my needs, not the needs of all my co-workers. And, I get to interact with the health care system just as I did before, only now I know my health plan dollars are being well spent."

The Bloom Health solution helps employees and employers alike. Its innovative approach empowers businesses to control costs, while offering customized benefit plans to their employees.

"I had to find a better health benefits option after facing yet another cost increase to our high-deductible health plan, which also resulted in inadequate coverage for many of our employees," said Mike Sarafolean, President of Orion. "Bloom Health has completely released us from the limitations of traditional health benefits administration while bringing greater employer and employee accountability to the table. For the first time, I feel ahead of the game when it comes to managing open enrollment and controlling health care costs into the future."

"Bloom Health is a smart solution for bringing cost certainty to employers and customized benefits to employees, all within the confines of today’s health care system," said Peter Hayes, a veteran health and benefits consultant. "As the provisions of health care reform are implemented in the coming years, things such as individual and employer coverage mandates, Bloom Health-like models will become commonplace — driving efficiency in the system and empowering the next wave of health care consumerism."