WASHINGTON — Although consumer-driven health care puts much more decision making in the hands of consumers, there is still a role for employers and insurers, several speakers said at a meeting on health care competition sponsored by Health Affairs journal and the Center for Studying Health System Change.
Employers will have a role because “as there's labor competition for offering health benefits, we have to offer health plans,” said Dr. Robert Galvin, director of corporate health care programs for General Electric. “You're going to see much more [emphasis] on financial incentives for employees staying healthy and making [good] choices on doctors and hospitals and health plans.”
Another role for employers—although it gets denigrated a bit—is providing access to meaningful, usable, and accurate information “as long as the market isn't working on its own, and it certainly isn't today,” Dr. Galvin said. “This is a responsibility of ours to keep driving at.”
He noted that within GE, officials believe “if information is not readable, it isn't going to be read.” In light of that philosophy, the company has come up with a “health index” that tells employees things such as how healthy they are, compared with how healthy they want to be; how much money is in their wellness account; and when it's time to schedule their children's physicals.
Although employers can act as intermediaries, insurers also have a role, said Dr. Samuel Nussbaum, executive vice president and chief medical officer at WellPoint Inc., a multistate Blue Cross and Blue Shield company based in Indianapolis. One of their roles is to make consumers more aware of how much their choices are costing them.
“Most Americans consider health care an entitlement, not a consumer product,” Dr. Nussbaum said. “And consumers are insulated from the true costs of health care services and products. So a prerequisite for health care competition is to have accurate, usable information about cost and quality.”
Insurers also can help steer patients to higher-quality providers, and that means making sure the networks they are in are of high quality, he continued. “It's not effective enough to have 20% high-quality providers because [consumers] can't all get to those high-quality providers … [or] travel around the country for care.”
In addition to helping consumers with purchasing decisions, WellPoint also tries to help consumers decide on treatments by making evidence available on its Web site. “We do this with academic physicians and specialty societies,” Dr. Nussbaum said.
Health plans also can make it beneficial to consumers to get more information, he said. For example, in one of WellPoint's consumer-driven health plans that uses a health reimbursement account, “we pay consumers more to take health risk assessments, we pay them more to enroll in personal health coaching programs in disease and care management, and we pay them more to graduate.”
And the early results are promising. “You can see the reduction in pharmacy costs of 15% and an increase in preventive care spending; 5% of total medical expenses are going to preventive services rather than only 2% or 3%,” he said.
WellPoint also has a database patients can consult when they are about to undergo a procedure. “You can go online and learn about a condition and compare hospital quality, so if you are in Los Angeles and require bypass graft surgery, you can find out whether it should be done at UCLA Medical Center or Cedars-Sinai, how many procedures they do, and what their outcomes are,” Dr. Nussbaum said.
To be the consumers' trusted choice as an intermediary in consumer-driven health care, “we need consistent standards of measurement and transparency in cost and quality,” he concluded.