Consumer-Driven Needs a Driven Consumer
Richard D. Quinn
Views & Vents * March 2005 –Employee Benefit News

Will a consumer-driven health plan save company money? Of course it will, just like raising deductible or office visit co-pay save money. It’s called cost shifting. The trick, of course, is sustained cost savings and, more importantly, changed behaviors. Here is where the jury is still out, and will be for a long time.

The problem in part is that we have the cart before the horse. In today’s environment, a consumer-driven plan will at best cause a patient to defer or delay mostly primary care, but is unlikely to impact specialist care (because that is typically perceived as potentially serious care) or inpatient care and the like. I am not sure that we know what we want consumer-driven health care to be and that, more often than not, we hide behind a high-deductible plan and HSA while we simply ask the employee to pay more. Isn’t it ironic that large companies "can’t afford health care," while shifting premiums and out-of-pocket costs to workers, even low-paid workers, is merely accepted as a business norm.

Many of today’s benefit professionals were not in the business when health plans always included deductibles, applied reasonable and customary fees (with the excess fee all the patient’s responsibility) and all outpatient services, including prescription drugs were reimbursed at 80%. Before 1975 or so, the typical employee had considerable skin in the game as we like to say, and yet, it did little to control health care costs. I suspect the same will hold true for the consumer-driven movement after the initial cost-shifting impact.

Now, as some would point out, consumer-driven plans are not about high deductibles and HSAs, but rather the educated consumer who will question the need for care, for tests and will seek the best care at the best price. And how will they do that with little, if any, real quality information available or for that matter even a well-defined definition of "quality?"

Don’t get me wrong; I’m not saying we should give up, just be realistic and not get caught up in the hype of a new plan design. It’s happened before. Clearly, there is great value in working toward an involved, educated consumer armed with facts and figures and able to identify the health care system that works best. But if we allow ourselves to be seduced by the HSA and high-deductible plan as the panacea; we will lose focus where the value truly may lie. Right now, the patient is bounced around the health care system like a pinball and having them take the first $1,500 in bills out of their pocket doesn’t give them control over the flippers.

Modest progress is being made in measuring quality care, but we have a very long way to go. Employers would do well to place their resources in this effort rather than investing in yet another change in the benefits plan. Let’s aim for the day when the best hospital for each procedure is routine information and the normal topic of discussion between patient and physician. Let’ s expect that when you enter a physician’s office, you see a list of fees and have already evaluated how he or she follows standard protocols and how well patients are monitored. Let’s demand that information about the best drug come not from the last representative who walked through the door, but from objective sources used by the doctor. Then we may have consumers driven to demand more for not only their dollar, but for their health.

R.D. Quinn