Health Care and Consumerism for 2009

Consumer Directed Health Care has been a big buzz in the health care community for the last few years. According to MCOL.com, Consumer Directed Healthcare can be defined as health benefit plans that put consumers and their providers at the center of health care decision-making, giving them greater discretion and power over benefit dollars and medical care choices. These plans often include increased cost-sharing wrapped around an HSA, decision support tools to evaluate choices, “health coaches” to encourage care management, and incentives to promote healthy lifestyles. Rather than shielding consumers, CDH plans engage them on a direct basis.

CDH, as reported by MCOL, is based on “patient centeredness” which, as defined by the Institute of Medicine, refers to health care that establishes a partnership among practitioners, patients and their families to ensure that decisions respect patients’ wants, needs and preferences; and ensure they have access to education and support to make decisions and participate in their own care. Consumer Directed Healthcare and patient centeredness has given rise to the next “hot trend” in healthcare - the medical home. A medical home is not a house, clinic or hospital, but rather an approach to providing comprehensive primary care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family-centric, compassionate, and culturally effective. A “whole person” orientation to healthcare delivery is at the core of the medical home. A personal physician is responsible for providing all the patient’s healthcare needs. Care is coordinated across all components of the patient’s healthcare community - hospitals, specialty physicians, pharmacists, social services, home health, nursing homes, and ancillary providers. And, it includes a vision of care for all stages of life, acute and chronic, wellness and prevention, and end-of-life.

According to the American Academy of Pediatrics, the basic tenets of the Patient Centered Medical Home include the following:
1.) Personal Relationship: Each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
2.) Team Approach: The personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing patient care.
3.) Comprehensive: The personal physician is responsible for providing for all the patient’s health care needs at all stages of life or taking responsibility for appropriately arranging care with other qualified professionals.
4.) Coordination: Care is coordinated and integrated across all domains of the health care system, facilitated by registries, information technology, and health information exchange to assure that patients get the indicated care when and where they want it.
5.) Quality and Safety: This includes using electronic medical records and technology to provide decision-support for evidence-based treatments.
6.) Expanded Access: Enhanced access to care available through systems such as open scheduling, expanded hours and new options for communication between patients and physicians.
7.) Added Value: Payment that appropriately recognizes the added value provided to patients who have a Patient-Centered Medical Home. The medical home is the next step toward true healthcare consumerism. With 45% of the U. S. population having a chronic medical condition accounting for $3 out of every $4 spent on healthcare, coordinated care delivery supported by a team-oriented medical management plan-of-action is a direction worth pursuing.

According to the National Business Group on Health (NBGH), Consumerism is a new concept that encourages employees to take a more active role in their health care by using innovative plan design and offering tools and resources. Similar to other consumer ideals, providing information on cost and quality of services will allow employees to make informed decisions, resulting in better health, a sense of empowerment, and reduced cost. Consumer-directed health care (CDHC) often pairs this philosophy with a health benefits design that allows employees to have greater control, choice, and flexibility with their care. This benefit design is typically a high deductible health plan with a health savings account. According to the 13th annual National Business Group on Health/Watson Wyatt survey, combining a CDHC strategy with other tactics — effective information, high-quality care, health and productivity programs, and metrics — can greatly lower cost trend. Employers with 50% or more employee enrollment in a Consumer-Directed Health Plan (CDHP), achieve a 3.6% median medical cost trend, compared to 7.0% for those companies without a CDHP offering.

The NBGH also reports consumerism and consumer-directed health care are both new initiatives that require careful consideration, communication, and support for employees. Employers can easily integrate elements of consumerism into any plan type:
--Offer "calculators" that help employees assess their annual medical costs.
--Hold informative sessions to educate employees on tactics to receive the best care.
--Provide flexible spending accounts (FSAs) so employees are exposed to the cost of care, and learn to plan for future health expenses.
--Use creative cost sharing strategies to encourage greater use of preventive services and preventive medications.
--Consider benefits like health coaching and health care navigators.

According to BenefitsLink.com, employee benefits consultants are optimistic that consumer-directed health (CDH) will continue to see steady growth in 2009 and could even become part of health reform efforts, according to the fourth annual survey conducted by Inside Consumer-Directed Care and ISCEBS. However, employers' and employees' limited understanding about the plans remains a key barrier to the acceptance of the plans. Despite these concerns, many respondents were optimistic that enrollment will continue to grow as employers become more comfortable with the price setting and employees gain a better understanding of the potential cost-saving benefits. Workforce Management reports that health insurers are aggressively marketing high-deductible insurance plans that allow patients to reduce their out-of-pocket costs by improving their health. But employers, concerned with legal issues and upsetting employees, have largely stayed away. However, a prolonged recession could change that.

At the moment, the question of whether consumerism is the wave of the future remains open, although some surveys suggest these plans have significant growth potential. So far, employers are still waiting for definitive evidence about cost savings as they weigh the criticism that these plans could have an adverse impact on worker health and morale according to the Wall Street Journal. Consumerism in health is effective. Patients definitely save money. There is much work to be done, though, to satisfy consumers, employers, and the health care community to make it work as designed.

Until next time. Let me know what you think.