Commentary: When gas prices rise at the pump, consumers change their driving habits. They ride more strategically, putting off unnecessary outings and carefully planning out trips. Yet when health care prices rise and Americans must dig deeper into their own pockets, they put their own health at risk instead of becoming savvier consumers.
One in four Americans delay needed health care because they feel they can’t afford it. But is health care consumerism — driven by rising medical costs and mounting pressure on plan sponsors to lower health care spending — the consumer’s burden to bear alone? Or, do plan sponsors, including employers and carriers, have a responsibility to steer their members in this new era of health care?
Last year, 37% of insured consumers under age 65 were enrolled in a high-deductible plan — at least $1,250 for single coverage and $2,500 for family coverage — according to the National Center for Health Statistics. These plans have grown in popularity to help businesses manage escalating medical costs and avoid the pending 2018 Cadillac tax, which hits employers with a 40% tax on each plan that crosses the $10,200 threshold for individuals and $27,500 for families.
But for consumers, high-deductible plans require paying a substantial sum from their own wallets every year before insurance coverage kicks in. Since2009, the average deductible for insured workers has shot up 47%, according to the Kaiser Family Foundation and the Health Research & Educational Trust. That sticker shock is leaving many consumers to self-ration their health care — often avoiding needed medical attention until a health problem becomes a crisis.
Though they are expected to make better choices with fewer dollars, most insured consumers lack the knowledge they need to become smarter health care shoppers — not to mention smarter managers of their own health. Seventy five percent do not price shop for medical services before scheduling them. The majority don’t know their blood pressure, cholesterol level, BMI or blood sugar — key predictors of risk for chronic illness. Sadly, nearly half of Americans have a chronic health condition, and an alarming number go undetected.
Consumers have no health care compass. Navigating the health care market today is like driving with a blindfold on and no GPS; most will never get where they need to go without help. It’s up to plan sponsors to decide whether they will give their members a compass or cope with the crashes — presenteeism, low productivity, and chronic disease.
Here are three things plan sponsors can do to empower their plan members to become savvier health care consumers:
1. Arm them with knowledge to understand their health status and risk. This goes beyond implementing a wellness 1.0 program with a health risk assessment questionnaire. Fifty three percent of consumers feel it’s not so easy to understand their personal health information or what they need to do. Giving them access to personal clinical data — like their biometric measurements and an analysis of their historical medical and pharmacy usage — will shed light on their health needs, including necessary preventive care.
Also see: “How employers are controlling health care costs.”
2. Be transparent about health care costs. Even though the majority of consumers agree it’s a good idea to shop for the best deal before taking action on their health, most never follow through. Today, only 19% of wellness programs offer price comparison tools. Providing a way for members to look up doctors and procedures and compare quality and costs will facilitate follow-through. It will also help members save money.
3. Personalize health care programs to make them more meaningful and engaging. Innovative companies like Netflix are customizing their benefits programs to boost recruiting and retention — offering unlimited paid time off and up to a year of paid maternity leave, for example. Other employers and plans could take a page out of Netflix’s playbook by helping each member set personal health goals and providing tailored recommendations to get them there. They could up the ante on incentives and rewards for health by matching personal preferences with cash, gift cards, lowered premiums and more.
While plan sponsors are asking members to take on more of the cost burden for managing their health, they also have a responsibility to help their people navigate successfully through this new world of health care.
Bryce Williams is CEO and president at HealthMine. A leader and pioneer in health care consumerism, his extensive industry experience includes leading the largest private Medicare health insurance exchange at Towers Watson. Follow him on Twitter @brycewatch.
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