In recent years, there has been an incredible transformation in the health care industry, especially in the role of consumers. A decade ago, health plans worked with employers to manage almost all health benefit decisions, leaving consumers relatively unaware of the costs associated with their health care needs.
Today, employers and consumers are more frequently choosing plans with higher deductibles; more than 15.5 million Americans are enrolled in such plans, according to America’s Health Insurance Plans. That has encouraged consumers to become more aware of their health care costs, as they now have a greater, more direct financial obligation for their care.
This rise of consumerism in health care has presented unique opportunities and challenges for health plans. As a result, more effectively engaging with consumers has become a high priority for health plans to remain competitive and maintain customer satisfaction.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
Three Areas of Focus to Address Health Care Consumerism
To meet these new challenges, health plans and industry stakeholders should focus on three key aspects of health care consumerism: education, administrative and financial. As an industry, we have made significant progress toward improving the educational and administrative resources available to consumers, especially through new programs, websites and even gaming. To improve the financial side, organizations need to think beyond traditional industry standards and collaborate with health care providers and new partners to improve how consumers manage and pay their medical bills.
EDUCATION
To help improve the decision-making process, consumers need educational materials and resources to help them make more informed decisions around when and where to access care. Through online directories and mobile apps, consumers can now more easily select high-value care providers. Some of these initiatives use national standards to evaluate care providers for quality and local market benchmarks for cost efficiency, including family practice, internal medicine, pediatrics and cardiology.
Health plans are also taking steps with care providers to better engage consumers, including the creation of patient-centered medical homes and accountable care organizations that link care provider reimbursement to quality and efficiency measures. This collaboration puts the patient at the center of the health care experience, providing resources and support to help prevent disease and better manage chronic conditions. Already hundreds of billions of dollars in reimbursements to hospitals, physicians and ancillary care providers are paid through contracts that link a portion of the reimbursement to quality and cost efficiency. These reimbursement structures will become more common as additional care providers join the transition to accountable care contracts that reward quality and value-based health care.
Worksite wellness programs are another way to help improve the health of consumers and reduce medical costs. The Wellness Council of America states that workplace wellness programs are a wise investment to help address rising health care costs and improve employees’ health and well-being.
New technologies, such as activity trackers, are making it easier and more interactive for employees to participate in these wellness programs and take charge of their health. For instance, some companies have created voluntary walking challenges and provided free acivity trackers, as well as enabling employees with Fitbits or other wearable devices to synch their steps to an online platform that allowed wireless tracking of daily steps.
The adoption of wearable devices is part of the growing use of corporate wellness incentives, which have doubled in value to $594 per employee since 2009, according to a recent study from the National Business Group on Health. By providing employees wearable devices and other resources, employers are able to encourage more active and healthier lifestyles and track the actual activity levels of program participants.
ADMINISTRATIVE
Many health plans offer member portals to help meet consumers’ administrative needs by providing access to personally relevant plan, benefit and network information. These resources also offer information to help health plan participants understand how their benefits were applied to their claims with simple, consumer-friendly explanations of health care and insurance terms. Some health plans are even using game play and game mechanics to help engage consumers, helping them to better understand and use their health benefits.
In addition, there are various mobile applications, including Health4Me for iPhone and Android devices, which put crucial health and plan information, and decision support, at consumers’ fingertips, including the ability to comparison shop for health care services based on both quality and cost. A recent UnitedHealthcare study showed that price transparency services, which can include quality information in addition to cost estimates, enabled people to more frequently select quality health care providers across all specialties, including primary care physicians (7 percent more likely) and orthopedists (9 percent more likely).
FINANCIAL
Improving resources that help consumers understand their health benefits is another crucial step, especially to help address questions about claims, explanation of benefits (EOBs), deductibles and more. Although consumers can view benefit and claim information through member portals and mobile apps, health plans can do more to make it easier for consumers to understand, manage and pay their health care bills. New systems are enabling consumers to clearly identify their claim and financial obligations, as well as pay their medical bills with their credit card, debit card, health savings account (HSA) or bank account. These services add convenience for consumers while helping health care providers get paid more quickly.
These are just several examples of how the health care industry is changing, with more efforts to come to simplify the health care system and engage consumers. By making it easier for consumers to understand and navigate the health care system, and enabling people to more easily handle their health care financial obligations, health plans and other industry stakeholders are helping to improve and modernize the nation’s health care system.
Photo: Flickr user David Spinks
