Bridge Out: A road sign you unmistakably never want to see. Its appearance in your path means that there has been a failure and that you have to find a new way of getting where you want to go. The rise of consumer-driven health plans indicates that the era of managed care failed to control the increased cost and interrogate for care and that many things about the way we receive healthcare in the Us.
In late August 2006, Wellpoint, one of the nation’s biggest healthcare insurance providers, has gone on description stating that in 2007 they will the first insurer to have consumer-driven health plans in all states and for all types of population (from major employers to small groups to personel plans).
“Our customers who select these consumer-driven products will have new opportunities to lead healthier lives because of this first-of-its-kind national offering,” Wellpoint Ceo, Larry Glassock
The press publish also goes on to share:
“we’re empowering consumers through unique and robust online tools and incentives that encourage and bonus them for selecting to live healthier lifestyles… Consumers who select Lumenos will be eligible for allembracing preventive care and personal health coaching, as well as smoking cessation and weight management programs. In addition, most consumers will receive financial rewards for completing assorted wellness programs.”
Wow! That sounds great, right?!?!?! Well, I always read these things and think about what my parents and my in-laws know about healthcare/ health policy and what they would think.
So for those of you who are not well-known with this new type of health plan, their implementation will furnish requisite changes in how care is reimbursed. Consumer-driven health plans are designed to shift some of the financial decision-making and accountability to the individuals who consume healthcare services. health savings accounts and high deductibles are key components to this new type of health plan. The understanding behind all of this is to allow patients to rule how best to spend their healthcare dollars.
If you buy into traditional economic theory as applicable to the healthcare industry, this is not a bad way of trying to control skyrocketing costs. Since the price of services has a direct impact on interrogate for services, in theory , this type of plan has the inherent to sell out duplication of services and unnecessary utilization of higher levels (more expensive) of care. In very straightforward terms, if patients are required to share some of the financial responsiblity of their care, then they are more likely to select the cheapest, most productive care.
There are at least two very big ‘rubs’ to this plan. First, in order to to be able to make appropriate choices, consumers will need to know the cost of the care. While it seems easy enough, a physician or facilities’ billing rate for a aid is significantly different than a contracted rate. And a contracted rate or permissible fee is significantly differerent than the acutal amount paid for services by an insurer or other third party payer. So healthcare consumers will need to understand all of these to be able to make the appropriate choices. Also healthcare providers will need to set up a theory to be able to accurately apprise the consumer the costs for a service. While this seems easy enough, it becomes increasingly involved when one understands that every, single, solitary insurance plan is different in regards to deductible, copay, contracted rate and repayment rate.
Second, in order to be able to chose the cheapest, productive treatment, healthcare consumers will have to know and understand their medicine options. This means that they will need to great understand the science behind their illnesses as well as the science behind the inherent treatments. This would be a whole lot easier if we went back to the old world model of having healthcare providers that were able to organize rapport and a trusting patient-provider relationship. In the past, providers were given the time and opportunity to unmistakably partner with individuals, understand the complexities of care and organize a truly individualzed medicine that best fit the patient/consumer’s need. However, in the days of the 15 limited visit, this becomes increasingly difficult to do.
President Bush’s new menagerial order [http://www.whitehouse.gov/news/releases/2006/08/20060822-2.html] pushing for many things along with transparency of pricing data is an exertion to address the issue of comprehension the financial aspects.
However, how do we make sure individuals have the data they need to be able to get the best medicine value? In reality, physicians and healthcare providers, because of their potential to understand and evaluate personel cases and circumstances, are the best resources for helping individuals make these decisions. However, they will likely need to organize new ways of doing this that are cost and time efficient. If healthcare providers do not organize these new ways, consumers/patients will be left to fend for themselves.
If consumers do not adequately educate themselves or entrance resources/advocates that will help them, then this plan too is doomed. Costs will not be contained, health will not be preserved and entrance to appropriate, productive care will continue to be compromised.
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