High hopes invested in the power of transparency tools to transform the health benefits landscape remain at the hope stage for many employers, although progress toward achieving concrete results is ongoing. At the root of it is a broadening of the scope of transparency.
A member survey conducted earlier this year by the National Business Group on Health asked, among other questions, “Which of the following tools or programs will you have or offer employees?” Respondents answered as follows looking towards 2016:
- Price transparency tools, including those provided by the health plans themselves as well as third-party services: 71%
- Self-service decision support tools, e.g. online health content: 73%
- Medical decision support/second opinion services: 60%.
Even higher prevalence rates were reported for more health promotion and maintenance-oriented services such as nurse coaching for care/condition management, disease management, and nurse coaching for lifestyle management.
Also see: “Health care transparency measures moving beyond price.”
Meanwhile, employees on the receiving end are giving out mixed signals on their appetite for all of this support. For example, although rates are believed to have risen since 2013 when this earlier survey data was collected, utilization of price transparency, self-service and medical decision support tools were 16%, 27% and 13%, respectively.
Words vs. deeds
And in a survey published last year by HealthMine, a consumer health engagement company, 86% of consumers said “it’s important to compare costs before procedures,” but “despite the growing availability of health care comparative tools, 64% rarely or never price shop before choosing health care.”
Similarly, 83% reported wanting to have access to their health information, yet 68% do not know their basic biometric measurements.
Part of the problem seems to be the way information is presented. “A majority of consumers report difficulty interpreting their health information, or understanding what steps they need to take to maintain or improve their health,” according to HealthMine.
It has become evident that the original and tightly defined concept of “transparency” can only be helpful once employees have a more fundamental understanding of their own health and health care needs.
Also see: “Consumers demand health care transparency.”
“Just knowing the cost of back surgery doesn’t mean you need a back surgery,” notes Kristin Torres Mowat, VP of strategic alliance and data operations for Castlight Health.
Along similar lines, AHIP, the trade group for health plans, in a recent issue brief points to another dimension of the limits of price data. “Studies have shown that when consumers are presented only with price information, they believe higher cost translates to higher quality… However, presenting cost and quality information side by side in an easy-to-interpret format highlighting high-value options improved the likelihood that consumers would choose those options.”
Research cited by AHIP suggests that relatively few transparency services pair price and quality data.
And even when price, quality and relevant health information is available to employees, the job isn’t over. Prompting employees to get engaged with that information requires some heavy lifting by employers.
High deductible not critical?
In the early days of high-deductible, consumer-directed health plan adoption, the prevailing opinion was that financial incentives through plan design held the key to inspiring engagement. And while giving employees skin in the game helps, it’s not a panacea. As Mowat sees it, “There’s a lot you can do to advance consumerism without having a high deductible plan.”
Attracting employees to take advantage of transparency tools with incentives, such as the prospect of winning an award, is working “extremely well,” according to Shari Davidson, vice president of the NBGH. Prizes help overcome inertia, a key impediment to utilization. “Once they start using [the tools] they come back, and back,” she adds.
Bryce Williams, CEO of HealthMine, describes an incentive model in which employees earn points for taking recommended actions. The point value of each action is linked to its potential significance for the employee’s health, as well as its possible financial impact. Employees’ points are tallied at the end of the year, and they receive a proportional sum of cash.
The prospect of financial reward isn’t a cure-all, however. Often, over-scheduled employees simply need personalized timely reminders of tasks specific to their requirements. “Employees are saying, ‘remind me of what I need to be reminded, when I need to be reminded,’” says Alexander Domaszewicz, the head of health care consumerism for Mercer.
Such messages need not be limited simply to the generic, “It’s time to get your flu shot” health promotion category. For example, a transparency system that taps deeply into employee health claims data can generate a message like, “Now that you are entering the third trimester of your pregnancy, here are the things you need to be thinking about,” Domaszewicz suggests.
It might also tell an employee, “It’s time for your next blood test. I see you did that last time at the hospital. You will pay less if you have it done at a stand-alone lab.”
It’s also important, as Castlight’s Mowat puts it, “to meet employees where they are.” That might mean contacting the employee’s spouse, as a way to prompt action on the part of the employee. That was an effective strategy for a trucking company whose male drivers typically let their spouses manage decisions concerning the family’s health care. Letters sent to the spouses proved to be an effective way to facilitate engagement and action.
Some systems are even more sophisticated than those that generate personalized reminders, and try to anticipate a medical need even before it has been identified through the employee’s routine interactions with the health care system. That’s HealthMine’s goal. “Our technology is about first discovery,” Williams says.
When crunching data from multiple employee health sources of some 120,000 employees, HealthMine identified about 7,100 undetected pre-diabetes and diabetes cases. (Employees have to opt in to allow HealthMine to sift through their data.)
Armed with that knowledge, employees have the opportunity to begin addressing the condition before it becomes more acute, and use whatever transparency tools are at their disposal to determine where they can receive the treatment that meets their cost and quality criteria.
Also see: “Amex, DuPont prioritize mental health programs.”
The greater the heads-up, the greater the potential for employees to exploit transparency tools. A classic example is hip replacement surgery, which is typical scheduled months or even years after the need is identified. With time to weigh their options, employees can tap transparency tools to learn not just which surgeons charge most competitively for the procedure, but which hospitals where it is performed have the best track records, for example, in preventing infections that jeopardize patient health, add expense and time to the recuperation period.
But the more comprehensive an approach is taken to “transparency,” exploiting teachable moments to prepare for future choices, the better the outcome even when medical decisions – such as which hospital to be taken to – must be made quickly in an emergency situation.
“The goal of transparency isn’t just to educate, but to influence behavior,” says Mowat.
Transparency: the cost factor
Transparency around health care is often associated with the price tag. Price transparency came as a natural complement to high-deductible health plans. After all, what good does it do to incentivize employees to choose economical health care services if they lack the data to make appropriate choices? However, often things are not as simple as they appear.
Catalyst for Payment Reform, a nonprofit entity representing large employers and other health care purchasers, identifies the following as basic components of price transparency products (some of which reference “quality”):
- Information on in-network physicians and hospitals;
- Price information on basic procedures and diagnostic tests;
- Some price information for primary care, specialty are, labs and hospitals;
- Total cost of care and consumers’ share of cost;
- Quality information on hospitals and/or physicians;
- Cost and quality information across multiple providers, and
- Cost and quality information in a variety of plan designs.
Overreliance on price data at the expense of value measurements could backfire, warns AHIP, a trade group for health plans. While recognizing the importance of encouraging employee engagement in the process of picking the best health services to meet their needs, too much price transparency could actually lead to higher prices, not lower, AHIP predicts.
“Several states have proposed to structure price transparency initiatives based on dissemination of competitively sensitive information, such as specific negotiated rates between individual insurers and individual providers,” AHIP noted in an issue brief issued earlier this year.
Citing a Federal Trade Commission study, AHIP warned that the upshot of the prospect of the release of such competitive information would be to “chill competition by facilitating or increasing the likelihood of unlawful collusion” among health plans.
To avoid that scenario, AHIP urges that transparency initiatives “focus on the kinds of data that are most useful to consumers when selecting health care services and service providers.” That, according to AHIP includes:
- Out-of-pocket costs for specific services;
- Cost sharing obligations under the plan;
- Estimate costs associated with a likely ‘service bundle,’ rather than for an isolated service;
- Where consumers can find the health care service by local area and network; and
- The relative cost of receiving care at different providers.
Richard Stolz is a freelance writer based in Rockville, Maryland.
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