“I feel this blanket of exhaustion settling on the nation,” says public health expert Dr. Elizabeth Coté, MD, MPH. We’re ten months into a global pandemic that has wreaked havoc not just on people’s health and wallets, but on their confidence in the healthcare system. People are fed up with an inconsistent and uncoordinated national response — one that’s allowed the virus to persist nearly unchecked, causing over 270 thousand deaths, thousands of closed businesses, and the myriad social concerns that go hand in hand with an economic downturn. This feeling of discontent is then magnified by continually rising healthcare costs and little transparency about where people’s money is going.
“People want more control over their healthcare spending, but there is more ambiguity than ever,” says Coté. “And this results in a natural human response of stress, overwhelming exhaustion, and then ultimately avoidance.”
By making it too difficult for people to understand and control their healthcare spending, especially right now, we’ve set them up to become disengaged. Instead of informed healthcare consumers, we’re creating disenfranchised healthcare users.
The consequences of this disenfranchisement are far reaching: one recent study showed that Americans overbuy on health insurance by $1,700 a year, which translates to less money for retirement and long-term savings. These lost savings are especially damaging this year. Aflac’s recent workplace study showed that 36 percent of employees reported a loss of income — and 40 percent said that if they have a copay over $500, they will need to finance it on a credit card.
All this to say: there’s never been a better time to empower healthcare users to become active, informed, healthcare consumers.
Step one: Increase transparency and clarity about healthcare costs
“When you purchase a car, you see a sticker telling you how much you’ll spend on gas; when you purchase a large appliance, you see how much you’ll spend on energy for the year. This is required by the federal government,” says Coté. “Yet when purchasing health insurance—where we spend more of our money—there is no approximation of what you’ll owe with the purchase.”
While healthcare expenses do vary from year to year, estimating yearly spending is possible. It just requires doing a lot of math. MyHealthMath uses over 10,000 data points to calculate a single healthcare consumer’s expected costs. This data comes from their employer’s health plan information as well as their expected medical usage—the latter captured through personal interviews and surveys. MyHealthMath then runs thousands of calculations to determine how much each health plan option will cost each employee. It’s unrealistic and unfair to imagine that individuals can do all that on their own.
Importantly, employees know that they need more help—and they’re asking for it. Aflac found that nearly 50 percent of employees would like to spend more time learning about and selecting their health plan because of COVID-19. Employees also expressed significant interest in using benefits spending resources, like decision support, to help them understand their benefits.
“The focus of cost transparency is permeating every part of the healthcare marketplace because people are being squeezed in ways they never have been before,” says Coté. “Solutions that offer more transparency, and actually give clear answers, will stand out most starkly and win the day.”
Step two: Focus on equity and inclusion
Empowering all healthcare consumers requires recognizing and addressing inherent inequities in the insurance landscape. The TIAA Institute found that lower wage earners have higher rates of overspending on health insurance, which then correlates strongly with lower retirement savings. At MyHealthMath we’ve seen similar trends among the employees with whom we work.
There are multiple ways employers can mitigate these inequities. For one, they can invest in decision support, which will often help lower wage earners who may have less time to devote to reviewing their benefits. Employers can also optimize their plan structure to give lower wage earners a boost towards choosing an optimal plan. For example, consumer-driven health plans (CDHPs) are often optimal, but lower wage earners may understandably shy away from the upfront risk of a high deductible. Adjusting employer HSA contributions so that lower wage earners receive more money, especially if they receive that money up front, can make HSAs a viable option for employees across income brackets.
“At this time in our history, we are seeing more than ever that it is important to focus on ensuring there are equal opportunities for everyone to have the best financial and health conditions that are possible for them,” says Coté.
Step three: Integrating healthcare leaders
Empowering consumers requires that leaders across the healthcare spectrum—employers, physicians, insurance carriers—work together to put the consumer first. Employers have led the push to consumer driven, value-based health care for nearly two decades, forming purchasing coalitions and calling for accountability and quality measures. More recently physicians are forming innovative care delivery models that center on the patient integrating their care. Health insurance carriers, too, are changing the way they do business to better empower consumers. A major New England health carrier has already taken great strides by working with MyHealthMath and their employer partners to give members health plan decision support.
“Leaders that make decisions where the rubber meets the road—whether it’s a doctor or an employer—will be the ones with the responsibility for shaping the future,” says Coté. “Ultimately, through increased transparency and this integration of players, we’re going to move to more engagement and empowerment for the consumer.”
Interested in learning more about the future of healthcare benefits and the consumer experience? Much of this blog was taken from a recent BenefitsPRO podcast featuring, Elizabeth Coté, and Harvard Pilgrim Health Care’s Beth Roberts