News The out-of-pocket thresholds of high-deductible health plans are leading consumers to ask questions about their care, demanding higher quality and lower cost.
Born out of necessity, a new breed of health care consumers is demanding transparency about the true price of office visits, lab tests, procedures, prescriptions and hospitalizations. Clinicians and billing staff should be paying close attention to this trend and working with patients who are balancing the cost of care with its effectiveness.
One-third of Americans
It’s been a slow move from indemnity plans with minimal deductibles before generous copays kicked in, but nearly one-third of American workers are now covered by a high-deductible health plan (HDHP) of some sort, according to 2016 data from the Kaiser Family Foundation. Nineteen percent of American workers have an HDHP with a Health Saving Account and another nine percent have an HDHP with a more restrictive Health Reimbursement Arrangement.
With a high-deductible plan, consumers pay the insurance-adjusted rate of a visit, test or procedure out of pocket until the deductible kicks in. This means most routine care will be paid by the patient, leaving insurance for more intensive illnesses and injuries. It also means patients are asking more questions about the true cost of care and the value of a particular test or scan and the information it can give a clinician versus the cost of knowing.
“Channeling patients to high-quality, low-cost providers saves money, which the plan or the company can share with the patient.”
With only three out of ten workers and their families covered by HDHPs, clinicians might be lulled into believing the transparency issue can be put off for future discussion. But health plans and companies with self-insured plans already are looking closely at the cost and quality of the care they are paying for. Claims data provides a wealth of information about care episodes, the total cost and the outcomes.
Understanding the new consumerism
Narrow network plans incentivize patients to use particular providers, often with price and quality as common selection criteria. Even among wider provider networks, patients are increasingly receiving higher reimbursements or co-pays to use certain providers or provider/facility combinations for such procedures as hip replacements or cardiac procedures where a total common cost can be calculated. Channeling patients to high-quality, low-cost providers saves money, which the plan or the company can share with the patient.
Clinicians must be aware of the cost of the care they are providing, as well as such associated costs as support staff, billing and technology. Increasingly, providers are helping patients who have high-deductible plans by taking less payment than the full retail price of that visit. The new consumerism means that registration and collections staff must do more on the front end to collect money from the patient at the time care is given. And it also means providers are being asked more questions about generic medications, the need for a lab test or scan and alternative treatment plans that respect costs and individual preferences.
Consumerism hasn’t reached the mainstream — yet — but the tide is turning toward greater transparency in the pricing of medical visits and procedures. Consumerism represents a paradigm shift in the doctor and patient dynamic, and providers ignore this trend at their own peril.