Years ago a colleague of mine had a desk plaque that read “The buck stops…over there.” For too long, this has been the mantra of the unwitting American healthcare consumer. Many Americans do not recognize themselves as consumers when utilizing the healthcare system. We are “patients” – often impatient, of course, but “patients,” nonetheless. We are people who, according to the definition of patients, “receive or are registered to receive medical treatment.” Therein lies the problem: patients “receive”, we are acted upon, we are passive participants in the healthcare process. We pass the buck.
Given all the changes now sweeping across the American healthcare system, this has to change. With the era of healthcare now superimposed on the age of immediate access to information, patients must become consumers. Consumers “purchase goods and services for personal use.” Consumers are active participants, they seek options, they arm themselves with data and they make informed decisions – most often based on value. It seems the U.S. healthcare system has been designed to discourage this typical consumer behavior often seen in other industries. Why don’t Americans purchase healthcare the same way we purchase vacations, vehicles and household appliances? New innovations brought about by both rising healthcare costs and healthcare reform should move the needle on this metric.
Insurance companies are creating innovations aimed at lowering cost, expanding coverage and shifting accountability. In addition to offering plans that comply with the Affordable Care Act, most insurance companies now (or will soon) offer solutions to increase healthy behaviors among consumers. Many also offer web-based tools to help consumers make informed purchasing decisions. For example, logging in to the member portals of some of the national insurance carriers gives consumers access to price comparison tools, provider directories featuring Zagat-style doctor ratings and education on how to prevent illness. These tools truly make it easier for patients to become consumers.
Employers have seen the light as well. For years, employers have played the role of health care purchaser for their workers. With increasing acceptance of defined contribution strategies, those where the employer providers a set dollar amount for employees to spend on benefits, as well as the prevalence of private exchange solutions, employers are forcing employees to become more engaged in their healthcare decisions.
Accountability, and the associated risk/reward model, are being applied to the provider community as well. Perhaps you’ve heard of Accountable Care Organizations (ACOs) and Patient-centered Medical Homes, industry innovations designed to improve care while reducing cost. These innovations are aimed at increasing efficiency in the healthcare system. The result: providers are being held more accountable for the health outcomes of people in their care. In these models, gone are the days of compensating doctors simply on the volume of services rendered; their services must actually work! When a patient shows up with multiple symptoms, doctors are expected not only to treat the symptoms but also to address the root cause. Failing to do so can lead to financial penalties for doctors and providers.
In the airline industry, travelers use sites like Expedia.com and Travelocity.com to find the best deals across multiple carriers. Now healthcare consumers can use the federal and state health marketplaces to find the best deals for insurance coverage. In the auto industry, buyers visit Edmunds.com and KBB.com for information and reviews on the models they are considering. Now healthcare consumers can visit Vitals.com and Healthgrades.com to read what others are saying about doctors in their areas. When a shopper needs a price on a new refrigerator, she may go to multiple retail websites to find the best price. Now when that same consumer needs a prescription filled, she can visit her insurance carrier’s website to get the price of the drug she needs at multiple pharmacies near her home.
The need is evident, the environment is ripe and the tools are available for American healthcare consumers to take charge. We must feel empowered to ask tough questions, seek alternatives and find solutions that make the most sense for our hearts, minds and our wallets. Rather than pass the buck, consumers must become the accountable party. And with the tools now available, there is no better time to embrace this evolving role.