The relationship between healthcare professionals, their patients, and their families is critically important to the healthcare partnership in this post-reform era. With the help of the Internet, patients often arrive at the doctor’s office having made a self-diagnosis. The educated consumer with information at his or her fingertips may seem like a problem patient to a traditionalist physician who isn’t accustomed to answering questions.
Doctors must not think of this as a challenge to their authority, but rather as an opportunity to enlist the patient as a partner in his or her own medical care. The patient who understands what he or she is being told to do is more likely to follow through on the treatment plan, leading to better outcomes and a lower long-term cost of care.
For example, HealthIT.gov established a Consumer eHealth Program to empower Americans to improve their health and healthcare services. The program, which is part of the Office of the National Coordinator for Health IT (ONC), is “increasing individuals’ access to their own health information, helping families take action and gain control over their health, and shifting attitudes to encourage consumers to become full partners in their care with the support of e-health tools.” Ultimately, increased access to information and healthcare transparency of quality data is essential to assist consumers with making more informed decisions about their healthcare choices.
Learn more about enlisting patients as partners and download our e-book: Healthcare Consumerism 3D: Rise of the Consumer.
Today, more Americans are insured for catastrophic medical expenses. This is good news because it will surely mean fewer medical bankruptcies and fewer defaults on big hospital bills. But, more are paying for routine medical care—even care that is pricey compared to a weekly paycheck. This means providers may have a tough time with smaller connections. It also means that the consumer has a vested interest in getting good value for the healthcare dollar.
The emphasis on value from a consumer’s perspective has the potential to shake up the delivery of medical care. Why would a consumer choose to pay $3,500 for an MRI if he or she can get it for $1,600 at a radiology center? A hospital may feel that a state-of-the-art MRI machine that delivers the highest-quality diagnostic image is a better value, but the consumer will likely prefer a lower cost option if the image is “good enough.”
According to a Becker’s Hospital Review article from April 2014, “cost consciousness” is on the rise, with a clear majority (55 percent) of patients reporting they have been paying more attention to the details of their medical bills over the past year.” And this heightened sense of awareness is influencing consumers’ choice of providers, assessment on the quality of care received, and even the selection of insurance plans.
To learn about all three dimensions of this trend, download our free e-book: Healthcare Consumerism 3D: Rise of the Consumer.
In the new normal of post-reform, approximately 90% of employed, non-elderly, non-poor Americans receive healthcare benefits through their employers. Within this group, 20% subscribe to a High-Deductible Health Plan (HDHP) with a savings option—a triple tax-advantaged opportunity that can be used for any purpose and a great way to supplement a 401(k).
An unforeseen consequence of the Affordable Care Act was that employers realized they, too, could set up private insurance exchanges, enabling them to actively budget for healthcare premium expenses. Furthermore, according to HealthForum, employers such as Disney and big-box stores like Walmart are pursuing additional incentives:
- Increased HMO offerings
- Broad and narrow networks
- Limited PPO reference pricing
- Chronic disease management
- Intensive care management
- Wellness strategies
- Integrated care delivery
- Affordable primary care clinics
- Channeling the highest quality providers with systems and processes supporting efficient care
- Payment tied to outcomes
- Leveraging volume
In the end, healthcare expenses are on the rise. In order to economize on employee benefits, employers as payors are moving away from a defined benefits model, where they carried the financial weight and risk, to a defined contribution model.
To get an epic behind-the-scenes look into employers as payors in today’s post-reform era, download our e-book: Healthcare Consumerism 3D: Rise of the Consumer. We’re here to help you better understand and forecast your organization’s approach to succeed in the consumer-driven world.