Fall is the time of year when millions of Americans can decide to change their insurance — if they even have a choice. According to the National Business Group on Health’s annual survey of large employers, 84%of employers will offer their employees a consumer driven health plan this year. For more than one-third of these large employers, a CDHP is the only option their employees have. With healthcare costs rising this year yet again, it is a prudent strategy. After all, the research does tell us that high-deductible health plans help bend the cost curve by reducing spending on pharmaceuticals and outpatient care. And employers are rightfully concerned about the approaching Cadillac tax.
But research also tells us HDHPs often leave consumers alone in the wilderness of the healthcare landscape. Consumers are told to shop around, but they don’t know where to begin or how to do it. After all, they’ve never done it before.
HDHPs do little to help — and often hurt — consumers who have chronic illnesses such as diabetes or need extensive care. In some cases, these consumers quickly blow through their deductible and have little incentive to shop around, even though they will incur the highest expenses. Often they might get unneeded or inappropriate care. In other cases, they might skimp on needed care or choose to skip care all together. For the sickest consumers, such as patients with cancer, shopping around isn’t a concept that even begins to register.
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So how do we get consumers to behave, well, like consumers? How do we get them motivated so they shop around for their care, choosing options that are appropriate, high quality and affordable, even when they have a serious illness?
Transparency tools are not enough
For starters, we know the status quo is not the answer. Most employers bemoan transparency tools’ low engagement rates. Moreover, price transparency tools are really designed for consumers shopping within their deductible, and we know these are not our high-cost employees.
Giving consumers price and quality information is not enough. Most consumers don’t understand the difference between needed and unneeded care, nor do they understand that they often have a choice of treatment options. Many still think more expensive means higher quality care — that all doctors and hospitals are created equal. And forget interpreting quality metrics in healthcare unless you have a doctorate. However, measuring provider quality does improve the quality of care, and that sharing price information empowers consumers and improves the affordability of care by forcing providers to compete.
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Consumers need more than another app
The trick isn’t to just give consumers different price and quality data or a better app; rather, it’s to help them understand the information that’s already out there. Consumers need to understand what kind of care they need, that getting to the right provider is important due to the variability of care, and that price — also variable — has little relationship to quality. Often, consumers do best when we give them simple tools to pick the best value care. In healthcare, this could be a new online tool that wades through price and quality data to identify the best value providers for a given condition.
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If we are able to provide the right guidance, amazing things happen. First, consumers feel empowered. They are motivated and engaged because they made an informed decision to ensure they receive the right care. This helps their physicians, too, since it is easier to work with an engaged and informed patient. Second, employers win when their employees get the right care at the right price, rather than unneeded or inappropriate care or care from a low-quality, high-cost provider.
Moreover, having a guide doesn’t just help with initial treatment or diagnosis. It can help consumers through the entire care journey. For example, for the patient with a breast cancer diagnosis, she may need guidance getting through chemo, then surgery, then reconstructive surgery and recovery. At every step she will need support and help choosing appropriate, high-value care.
Plan now to bridge the benefit gap
So this open enrollment season, millions will choose a HDHP — often because they don’t have a choice — and will soon find themselves lost and confused. As we plan our benefit offerings for 2017 and 2018, it’s time to take a step back. We need to do more to support consumers if we want them to act like consumers. We need to give them a guide, something or someone that brings it all together for them. We have figured out plan designs that save money, and we know several guidance tools, programs and services exist. Now is the time to put it all together and give consumers what they actually need.
