Bridge Out! Consumer-Driven Health Plans will Change How We Get Care

Bridge Out: A road sign you really never want to see.physician or facilities' billing rate for a service is
Its appearance in your path means that there hassignificantly different than a contracted rate. And a
been a failure and that you have to find a new waycontracted rate or allowable charge is significantly
of getting where you want to go. The rise ofdiffererent than the acutal amount paid for services
consumer-driven health plans indicates that the era ofby an insurer or other third party payer. So
managed care failed to control the increased costhealthcare consumers will need to understand all of
and demand for care and that many things about thethese to be able to make the appropriate choices.
way we receive healthcare in the US.In late AugustAlso healthcare providers will need to set up a
2006, Wellpoint, one of the nation's biggestsystem to be able to accurately inform the consumer
healthcare insurance providers, has gone on recordthe costs for a service. While this seems easy
stating that in 2007 they will the first insurer to haveenough, it becomes increasingly complex when one
consumer-driven health plans in all states and for allunderstands that every, single, solitary insurance plan
types of people (from major employers to smallis different in regards to deductible, copay,
groups to individual plans). "Our customers whocontracted rate and reimbursement rate.Second, in
choose these consumer-driven products will haveorder to be able to chose the cheapest, effective
new opportunities to lead healthier lives because oftreatment, healthcare consumers will have to know
this first-of-its-kind national offering," Wellpoint CEO,and understand their treatment options. This means
Larry GlassockThe press release also goes on tothat they will need to better understand the science
share: "we're empowering consumers through uniquebehind their illnesses as well as the science behind the
and robust online tools and incentives that encouragepossible treatments. This would be a whole lot easier
and reward them for choosing to live healthierif we went back to the old world model of having
lifestyles... Consumers who choose Lumenos will behealthcare providers that were able to develop
eligible for extensive preventive care and personalrapport and a trusting patient-provider relationship. In
health coaching, as well as smoking cessation andthe past, providers were given the time and
weight management programs. In addition, mostopportunity to really partner with individuals,
consumers will receive financial rewards forunderstand the complexities of care and develop a
completing various wellness programs." WOW! Thattruly individualzed treatment that best fit the patient
sounds great, right?!?!?! Well, I always read theseconsumer's need. However, in the days of the 15
things and think about what my parents and myminute visit, this becomes increasingly difficult to
in-laws know about healthcare/ health policy anddo.President Bush's recent executive order pushing
what they would think.So for those of you who arefor many things including transparency of pricing
not familiar with this new type of health plan, theirinformation is an attempt to address the issue of
implementation will produce significant changes in howunderstanding the financial aspects.However, how do
care is reimbursed. Consumer-driven health plans arewe make sure individuals have the information they
designed to shift some of the financialneed to be able to get the best treatment value? In
decision-making and responsibility to the individualsreality, physicians and healthcare providers, because
who consume healthcare services. Health savingsof their ability to understand and evaluate individual
accounts and high deductibles are key componentscases and circumstances, are the best resources for
to this new type of health plan. The thought behindhelping individuals make these decisions. However,
all of this is to allow patients to determine how bestthey will likely need to develop new ways of doing
to spend their healthcare dollars.If you buy intothis that are cost and time efficient. If healthcare
traditional economic theory as applicable to theproviders do not develop these new ways,
healthcare industry, this is not a bad way of trying toconsumers/patients will be left to fend for
control skyrocketing costs. Since the price ofthemselves.If consumers do not adequately educate
services has a direct impact on demand for services,themselves or access resources/advocates that will
in theory , this type of plan has the potential toassist them, then this plan too is doomed. Costs will
reduce duplication of services and unnecessarynot be contained, health will not be preserved and
utilization of higher levels (more expensive) of care.access to appropriate, effective care will continue to
In very simple terms, if patients are required to sharebe compromised.Carol is the Vice President of The
some of the financial responsiblity of their care, thenPromedica Research Center. She has a masters
they are more likely to choose the cheapest, mostdegree from Mercer University in Health Policy and
effective care.There are at least two very big 'rubs'Administration and currently teaches a master's level
to this plan. First, in order to to be able to makecourse on Health Care Organizations for the
appropriate choices, consumers will need to know theUniversity of Phoenix (Online), College of Health
cost of the care. While it seems easy enough, aSciences.