Consumerism Still Not Living Up to the Name
With the federal government, state legislatures, aggressive business groups and corporate clients now breathing down their necks, vendors are scrambling to provide the information necessary to turn health-care users into informed consumers. But such tools are still years away.
By Fay Hansen
endors, employers and employees alike are now well aware that the "consumer-driven"
part of the consumer-driven health care label is largely a misnomer. Vendors launched
these plans with virtually no infrastructure in place to support the stated goal
of creating more informed consumers. With the federal government, state legislatures,
aggressive business groups and corporate clients now breathing down their necks,
vendors are scrambling to provide the missing data. The tools for real "consumer-driven"
plans, however, are still years away. Idaho Power remains thoroughly
frustrated in its effort to use its consumer-driven health plan to build savings
over time.
"There are no good tools out there for consumerism," says
Cindy Anderson, manager of health and disability benefits. "We have an extensive
communications program to help our employees dig down about costs with their providers,
and we’ve been pounding on our Blue Cross/ Blue Shield plan for the tools, but it
tells us that their contracts with their providers prohibit price transparency."
The only pricing data available at Idaho Power is from Medicare,
and the information is weak. "We are telling employees that providers will have
to supply the pricing information themselves," Anderson says. "This is a struggle.
It may take five years before we see the tools we need."
The TriZetto Group provides its employees with a benefits
estimator at the enrollment stage to help them decide if the company’s consumer-driven
plan is a good choice, and the vendor supplies a treatment cost estimator, pharmacy
cost estimators and access to wellness and prevention tools. Still missing, however,
are the price data and detailed quality comparisons that employees need to become
fully informed. "For the real tools that employees need, we’re two years out," says
Alan Heikkala, vice president of human capital management.
For now, most consumer-driven health plans cut costs only
through reduced utilization.
"This is a struggle. It may take
five years before we see the
tools we need."
—Cindy Anderson, Idaho Power
|
"Utilization is about half the total health care cost increase;
price inflation is the other half," says Blaine Bos, a Mercer partner. "The network
approach, which has been in place for decades, is supposed to address the price
inflation portion in contracts. The next frontier for this is transparency so we
can identify the most cost-efficient and highest-quality providers."
The missing element is a combined government and private-sector
effort to create a database that identifies the most efficient and highest-quality
policies and practices.
"We can expect to see public domain databases with this information
by about 2012," Bos predicts. "At that time, we should be able to measure most practitioners
in most metropolitan areas."
President Bush issued an executive order on August 22, 2006,
that directs federal agencies to increase pricing and quality transparency, and
30 states have passed or proposed legislation requiring steps toward transparency.
Some insurers are providing pricing for common procedures in specific locations,
but the data are uneven and incomplete.
In the meantime, some employers and experts now refer to consumer-driven
health plans as high-deductible health plans because the high deductible is really
the defining characteristic of these plans, and the driving force in reducing utilization.
Towers Perrin refers to them as account-based plans.
The nomenclature remains unstable, but dropping the "consumer-driven"
element may help lower expectations that cannot yet be met.
Workforce Management, April 7, 2008, p. 28
-- Subscribe Now!
Fay Hansen is a Workforce Management contributing editor based in Cresskill, New
Jersey. To comment, e-mail editors@workforce.com.
|
