A recent survey of Americans who have high-deductible health plans (HDHPs) suggests strategies that should be considered by health plans, employers, and health systems if they want to increase engagement and consumerist behaviors among people with these plans.
Understanding the Challenges of Engagement and Adherence
The popularity of HDHP enrollment has created significant challenges for patients, providers, and healthcare systems in the United States. More than 40 percent of Americans enrolled in HDHPs are at risk for extensive out-of-pocket spending. Moreover, consumers’ exposure to high deductibles could get worse if plans are modified by potential changes to the Affordable Care Act that would result in fewer cost-sharing reductions or lower actuarial values.
With concerns over potential skyrocketing out-of-pocket costs, many healthcare consumers do not seek necessary care, even when services are exempt from cost-sharing. Consumers with chronic health conditions or lower incomes are even less likely to get the care they need. Providers and health systems face challenges related to patient adherence (the extent to which a patient complies by taking medication, following a diet, etc.) and an increase in costs of non-reimbursable services. The question is how to get healthcare consumers to engage and seek the care they need while also getting the best price possible for the best quality care, just like they would shop for any other consumer good.
Patients as Consumers
Theoretically, consumers with HDHPs would become more discerning healthcare consumers in order to get the most value for their out-of-pocket expenditures. For example, a consumer would plan ahead for future services that are subject to deductibles and save up for them. An engaged consumer would use price transparency information or speak with a provider about the cost of a procedure. The consumer would then negotiate what they would pay for that service and budget accordingly.
Evidence also suggests that when consumers use price transparency tools, there are substantial savings. One example was a study done with magnetic resonance image (MRI) tests and patients who engaged in consumer behaviors such as price shopping: they saved an average of $220 per test.
Unfortunately, even with the increasing availability of healthcare price transparency tools, few of the Americans surveyed engaged in the types of consumer behaviors that would help save them money and get the care they needed.
Broad Conclusions About American Healthcare Consumers
In one study, five consumer behaviors were used to examine healthcare consumer engagement:
- Saving for future healthcare services
- Discussing costs with a provider
- Comparing prices
- Comparing quality
- Trying to negotiate a price
The results demonstrate that most Americans in HDHPs, even those who are highly engaged in healthcare decisions or tend to comparison shop, do not engage in these consumer behaviors with their healthcare.
However, the study results did suggest opportunities for new strategies that employers, health plans, and health systems should consider to encourage greater engagement. Some of the suggested strategies specific to people with HDHPs include:
- Employers could promote saving for healthcare by providing and contributing to Health Savings Accounts with HDHPs.
- Employers could offer more health insurance literacy and financial literacy programs.
- Health plans could develop solutions for employers to offer – such as programs to help HDHP enrollees communicate effectively with providers about the costs of services and how to negotiate prices.
Other suggestions included deploying mobile technologies to leverage data on a consumers’ health needs and then reaching out to the plan member when they were seeking care with a series of prompts to help them engage in consumer behaviors. Ultimately, though, health plans, health systems, employers, and even employees must work together to understand and benefit from consumer behaviors and engagement.
Your Role as a Broker in Healthcare Consumerism
Your clients rely on you to help control their healthcare costs. And one of the best ways to do that is by helping to convert their employees into educated healthcare consumers. Studies demonstrate that there is a correlation between low health literacy and higher expenses. So, as a broker, you can help your clients by empowering their employees to make more cost-conscious healthcare choices. For example, you can:
- Provide information to ensure your clients’ employees understand and enroll in their benefits.
- Increase employee participation in a preferred health plan with engagement services.
- Compare cost and quality among plans, and explain savings opportunities by educating your clients’ employees about care options.
Ironically, in America, healthcare is different from every other aspect of the consumer experience. No one would leave a broken car with a mechanic before getting a cost estimate for repairs, yet healthcare consumers schedule procedures and physician visits without having a clue what they’ll be asked to pay. By advocating for patient empowerment, brokers can gain a significant competitive advantage over everyone who is doing business as usual.
The Canopy Health Difference
At Canopy Health, our alliance partners offer a different healthcare experience with added value to members, patients, and physicians. Through productive health plan partnerships, best-in-class care management, an engaged provider network, and competitive unit pricing, we’re making high-quality healthcare more accessible and affordable. As an alliance, we also moderate pricing to pass savings on to members through affordable premiums.
With healthcare costs growing by roughly five percent every year, many businesses could quickly price out of their current benefit plans. As a broker, you have an opportunity to bring change to the healthcare industry by educating your clients about innovative healthcare solutions like Canopy Health that are offering decreased costs of healthcare while maintaining or improving the quality of care. Quality healthcare options offered through Canopy Health’s carrier partners emphasize accountability, coordinated care, and transparency — all of which can make a difference for you as a broker and for your clients.
Kullgren, J. T., Cliff, B. Q., Krenz, C. D., Levy, H., West, B., Fendrick, A. M.,… Fagerlin, A. (2019, March). A survey of Americans with high-deductible health plans identifies opportunities to enhance consumer behaviors. Health Affairs 38(3). Retrieved from https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05018
Livingston, S., & Castelluci, M. (2017, September 2). Is the price right? Solving healthcare’s transparency problem. Retrieved from https://www.modernhealthcare.com/reports/achieving-transparency-in-healthcare/#!/