By Tara Bishop
October 15, 2020
The pandemic has prompted many of us to become more engaged consumers of health care.
Nearly overnight, we have been forced to rethink where, how and when we get treatment. This level of consumer engagement is unlike anything I’ve experienced in my 20 years of practicing internal medicine. Consumer-driven health care has long been viewed as a powerful catalyst for system-wide change, but it never lived up to its promise. Just as we’d all but given up on it, COVID has given health care consumerism a new level of significance.
When people are willing and able to seek out the right kind of care, they can avoid receiving less effective treatments at more expensive sites of care that don’t always equate to better outcomes.
This is not only good news for consumers, but also for the system as a whole, including the employers who provide health insurance to anywhere from 40% to 50% of Americans. When people are better at buying health care, they have the opportunity to be healthier and to save themselves (and their employers) money.
Increased consumer motivation is a monumental step in the right direction toward reducing waste (i.e., unnecessary spending), improving quality and health outcomes and lowering the cost of health care in our country. But the health care industry must be willing to put the right infrastructure in place so people have the tools and personalized information they need to be better at buying health care. Here’s what that should look like.
Information at our fingertips
None of us could imagine shopping for groceries without knowing the cost or quality of our choices or tolerate a service where we learn of the price when we get the bill weeks later. Yet that’s what’s expected of us when we buy health care.
We deserve to be able to shop for our health care the same way we do for other items in our daily lives. We deserve to see the options that could solve our medical conditions, the ability to consider a list of providers that are best at treating each condition and the ability to have clear prices we can compare in real-time—all in the palm of our hand.
The data and technology needed to deliver a better health care shopping experience already exists. The onus is on health plans to build and offer it. Consumers should be able to simply search by condition and see the full range of treatment options, providers and prices. Being able to search by condition is important, because that’s how people think about their health-related issues. They need to know how to fix their high blood pressure, for example, not scroll through a list of providers or take the first available appointment at the local clinic because they don’t have visibility to other options. In the year 2020, the information needed to make informed health care choices should be easily accessible in real-time via smartphones and the web.
Incentives to shop smarter
Insurance design should be built on the concept that high-quality treatments and providers should cost less. This kind of smart pricing is intended to improve health and minimize waste. When quality and cost differences that expose value are presented side-by-side, people are more likely to choose less expensive sites of care and more affordable treatments.
Employers can reduce waste by lowering employee costs for treatments and incentivizing them to choose providers that demonstrate better outcomes. Clear, upfront pricing models can also lead to lower out-of-pocket costs for employees and more sustainable health insurance budgets for employers.
Since quality, cost certainty and prices that expose value are three key characteristics of a better health care shopping experience, deductibles must go away. When people aren’t sure how much treatment will cost, or they are faced with high deductibles, people may choose to skip or postpone care. I’ve seen it in my own patient population and it’s very unfortunate. Avoiding care and diagnoses for cancer, kidney disease, diabetes and other illnesses is extremely harmful and counterproductive.
A personalized pathway to our best health
Health plans can and should become highly personal and flex to consumers’ individual needs. With the right infrastructure and consumer involvement, employers can personalize insurance to address the unique needs of their employee population, which allows employees to make the best care decisions for them. This is where the hard work of laying the right foundation pays big dividends.
Employers can improve subsidization for things they know are important to their employees. This could include improving access to mental health screenings and therapy or making the cost of childbirth more affordable. Behavior and treatment history can also be used to take personalization further. This would make it possible to lower the consumer cost for treatments in those situations where clinical evidence suggests they’re effective for people experiencing a common condition. For instance, such a system could make insulin free or less costly for people with diabetes, since remaining current with their medication is good for their health and can be valuable in the long-term. It could also mean lowering the cost of treatments or medications known to be particularly effective in treating certain conditions within at-risk populations.
The ultimate potential of personalization is incredibly powerful. Imagine a future where a health plan can truly deliver a diverse and inclusive benefit—an experience that’s very hard to offer when plan design is one-size-fits-all. I believe that future starts today.
The time is now
It’s time to stand up and create a better framework for health care. People are ready to be smarter about how they buy health care and plans must rise to the occasion and meet those people where they’re standing. As an industry, we owe it to consumers to deliver a better, more affordable health plan experience. We owe it to everyone who’s ever been shocked by a surprise medical bill; everyone who’s avoided care due to fear, uncertainty or doubt; everyone who’s rationed medicine; and everyone who’s worked multiple jobs to afford a deductible. We also owe it to every employer who’s had to make the tough choice to shift more of the health care cost burden to their employees. There’s a lot at stake. It’s time to build better together.
The Bind personalized health plan makes health insurance easy to understand and use. Learn more about their impact—and what it could mean for you.
—
Tara Bishop, MD, MPH is the Chief Clinical Officer at Bind. She’s accountable for delivering value to Bind members and plan sponsors. When Tara began her career as an internal medicine physician almost 20 years ago, value-based care was in its infancy. The missing link was the patient. That’s why she joined Bind—she saw the opportunity to align patient need to a procedure’s value and cost.
The content is paid for and supplied by advertiser. The Washington Post newsroom was not involved in the creation of this content.
ncG1vNJzZmivp6x7uK3SoaCnn6Sku7G70q1lnKedZK%2Bzrc2dZKyspZm2sHvWqWZraGJlfHJ8jmpsaKCfrHq1tMRmp5qmlJq6qq%2BMnKaupJRiwLGt0aRkmmWemsRusdGaZKieXaWys7%2FOp5iloaqasW60xJqjraBdnru0wdGapZydXw%3D%3D