No one knows what Republicans on Capitol Hill will ultimately propose to replace Obamacare, but healthcare consumerism will likely play a critical role.
The idea of healthcare consumerism started during the George W. Bush presidency as a free market solution to healthcare. Consumer-driven health plans were a popular health insurance plan design back then. The idea was to give patients “more skin in the game” in making their healthcare decisions.
These plans featured high deductibles and health savings accounts, which members could contribute to tax-free.
Once Democrats took control of Washington in 2009, consumer-driven plans and health savings accounts fell out of favor. But that doesn’t mean high deductibles ended.
Out of the ashes of consumer-driven plans came high-deductible health plans (HDHPs), which have become a popular choice for insurers and employers as they look to cut healthcare costs.
HDHPs have become so popular that Kaiser Family Foundation’s 2016 Employer Health Benefits Survey reported that 29 percent of all health plans are HDHPs, which is up from 21 percent in just two years. PPOs, which are still the most popular health plans in the US (48 percent), dropped by 10 percentage points in that same time period.
Americans are paying more for their healthcare services in HDHPs. By paying more for services, insurers and employers hope that individuals will make better healthcare decisions.
By giving individuals more cost and quality information, healthcare consumerism advocates say patients will become better consumers. The theory goes that educating patients on prices for medical services will lead to healthcare savings and reduce unnecessary tests and services. It will also open up choices for patients and may get doctors to compete for patients.
Consumerism is here; is healthcare ready for it?
Experts agree that healthcare consumerism is here. But a recent study found that health insurance companies, hospitals, and doctors aren’t providing the kind of information that patients need.
Kaufman Hall and Cadent Consulting Group surveyed executives from more than 100 U.S. hospitals and health systems. They released State of Consumerism in Healthcare report in November 2016, which found that most of health leaders “recognize the importance of consumerism,” but “most have not put consumerism into action.”
Health leaders surveyed found that healthcare consumerism is a “key to growth” and will be important “to succeeding in the face of competition,” according to the report.
Patient experience is both one of the most important and least understood areas of consumerism. There is resistance to change and a lack of urgency because of competing priorities. There is also a lack of clarity about how consumerism will fit into long-range plans and the lack of data and analytics, according to the report.
“At the end of the day, healthcare providers have to think: Who are my customers? What do they want? And how do I deliver on those needs better than anybody else?” Paul Crnkovich, managing director at Kaufman Hall, told MedCityNews. “It’s like any other business.”
Frank Hone, a healthcare engagement strategist who was the engagement officer for Healthx and Healthways, has been a leader in healthcare consumerism since the early days of the movement. In fact, he wrote a book on healthcare consumerism called “Why Heathcare Matters” in 2008.
“We’ve definitely seen a strong uptick in consumer interest to shop for various medical services. Price transparency was a foundational pillar of healthcare consumerism from the early days of the mid-2000s. Back then, the data weren’t available and consumer interest in price and quality comparisons was low,” he said.
Hone said “price transparency” has become more important with the explosion of high-deductible health plans, health insurers offering price comparison data, more price comparison vendors in the field and greater interest from the federal government and in the media.
“We’re definitely on a path toward broader availability of price information for consumers, and this is a big step forward for healthcare consumerism,” wrote Hone in his article, “Price Transparency Set to Unleash Market Forces in Healthcare.”
“Despite the market forces driving change, we’re still in the early days of this movement. Many have a misperception that higher cost equates to higher quality, which is generally not accurate. Many also have no real reason to shop if their insurance will reimburse all providers equally,” Hone told Fiorente Media.
Shopping for healthcare
Things have gotten better for healthcare consumerism, but there are still ways to go.
A barrier to greater healthcare consumerism is health literacy. Studies have shown a direct correlation between low health literacy and poorer outcomes and poorer healthcare decisions.
Another issue is that healthcare is not like buying a new car — no matter how appealing healthcare leaders try to make it. Few people joyfully research the cost of an MRI. Getting consumers to shop for something that doesn’t interest them can be difficult, especially for people who were not brought up on computers.
A HealthAffairs study found that the typical user of Aetna’s WellMatch price transparency tool is a “cost-conscious Millennial.” But the issue is how to get everyone else interested in researching the cost of a medical procedure or test.
McKinsey & Company surveyed more than 11,000 people about their healthcare wants and needs. What they found in Consumer Health Insights was that people want the same customer service from healthcare as any other non-healthcare company like Amazon.
More than half of those surveyed see “great customer service as important for non-healthcare and healthcare companies alike.”
McKinsey & Company found that healthcare consumers are not making “research-based decisions.” In fact, a minority of healthcare consumer are researching provider costs or researching information for their health plan choices.
Hone said lack of engagement is the biggest issues with healthcare consumerism — just like any other health behavior change initiative.
“Consumers need to be nudged toward action in this area. Better promotion can drive awareness and begin movement in the right direction, but it’s been hard to get traction early,” he said.
Much like every other new movement in healthcare the ultimate driver could be incentives. Hone offered one example — Vitals SmartShopper, which now offers payments to individuals who choose selected lower-cost providers for their medical services or lab tests.
As healthcare consumerism becomes more common, peer influence and patient testimonials will become important, he said.
“It’s taken a long time for healthcare prices to get as complex and opaque as they are today, and it will still take time to unravel the mystery and achieve real price transparency,” said Hone.
Patients care most about sound medical care
Tufts Medical Center in Boston is a 415-bed academic medical center based near Chinatown and the Theater District that serves a wide cross-section of the Boston area. Tufts patients include a large population of low-income, non-English speakers, homeless patients, and immigrants, which are groups that health leaders will need to engage if healthcare consumerism is to become popular for everyone.
Dr. Saul Weingart, MD, PhD, chief medical officer at Tufts Medical Center, said what’s most important for Tufts Medical Center patients is “sound medical care.” Though costs have become increasingly an issue because of high co-pays and deductibles, Weingart said patients aren’t looking as much for quality data.
Weingart told Fiorente Media that Tufts Medical Center provides estimates of costs of services when requested, but patients rarely request the information. The hospital posts quality information online and it’s also available on the federal government’s Hospital Compare and from the Massachusetts Center for Health Information and Analysis.
“It is uncommon for us to be asked about quality data, in part because the data is readily available and in part because patients assume that our quality is excellent based on their previous experience, word of mouth and reputation,” he said.
Cathy Feleppa-Camenga, MS, RN, CHCQM, director of quality and patient safety at Tufts Medical Center, said high-deductible plans are driving more consumerism. Patients are interested in cost data and may delay treatments because of high deductibles. They may also choose a low-cost option that will actually cost more in the long run.
For instance, a patient may call a Patient Financial Services staff member and ask about an MRI, but may not look at what is really cost effective.
“They will ask for how much each view costs. They may decide to go with limited views only to find that additional views are needed to make a diagnosis. In the end, this is not cost effective for the patient,” she said.
Patients have become more concerned about the cost of healthcare, but “concerns often surface after the bill comes in rather than in advance of needed care,” said Weingart.
Health insurers hop on consumerism
Health insurance companies are now providing its members with cost and quality data. One example is Blue Cross Blue Shield of Massachusetts with its “Find a Doctor & Estimate Costs” tool.
Beyond searching for a doctor by location, the tool includes cost estimates for procedures, the amount members would have to pay and quality data if it’s available for that provider.
Members can search by primary care, specialist, and behavioral care.
There is also a portion of the site that allows members to write and read doctor reviews — and members can compare doctors side-by-side. The tool provides prices for more than 1,600 procedures.
Deborah Devaux, chief operating officer at Blue Cross, said in a statement, “We are trying to make the healthcare experience easy, convenient and affordable. It’s all about putting our members first.”
For BCBS of MA, the tool is taking a page from consumer sites like Yelp, in which members play a critical part in rating and reviewing services.
“We know our members use information and reviews on sites like Yelp and Hotels.com to compare options and choose where they eat or stay. Our tool offers a similar experience to help them find the doctor or therapist that’s right for them,” said Devaux.
How may Trumpcare affect consumerism?
At this point, we don’t know what will replace Obamacare (aka the Affordable Care Act). But with Republicans in charge of both houses of Congress and the White House, healthcare consumerism will be a part of it. Republicans support the ideas behind consumerism — competition, the free market and putting more emphasis on the consumer.
“I’d expect that any revisions or replacements of the current ACA will support consumerism as Republicans favor smaller government and more market-based competition,” said Hone.
Hone said the consumerism trend has been percolating for more than a decade and it’s ready to explode.
“It’s taken awhile to align HDHPs, price and quality data, consumer engagement, and employers willing to move beyond their paternalistic view of health insurance benefits. The wellness trend has gotten many more employees to take actions to improve their health behaviors and to recognize their own role and responsibilities. The individual health insurance marketplace will also likely grow as more people buy their plans independent of a corporate sponsor, which may lead to a lessening of the traditional role of employer-sponsored health benefits,” said Hone.