How to help employees become true medical consumers
In this new age of medical consumerism, individuals and families are tasked with navigating the rough and unfamiliar waters of a fragmented health care system. Gone are the days of just going to any physician, following whichever treatment plan he or she prescribes, and paying whatever it cost to do so, no questions asked.
Today, not only are providers and payers sharing in the risk of providing high-quality care at a reduced cost, patients are now charged with better understanding such things as physician quality, centers of excellence, treatment decisions, and high-deductible health plans.
Meanwhile, benefits professionals have put a colossal amount of effort into deciding which of these benefits strategies and combination of approaches will deliver the best value care. Unfortunately, that sometimes means we don’t have enough time left over to really think about the tools we are giving our employees to navigate these vast and choppy seas. It is no wonder a recent survey found that 30 percent of employees said they didn’t think they had the information necessary to make a major medical decision.
The good news is that employees can learn how to become true medical consumers, and there are some relatively easy steps we can take to help them. Not unlike consumerism in other areas of our lives, the education, tools, and experience necessary to select the highest quality medical goods and services, at the lowest price, are best acquired over time. With any luck, we will even receive guidance along the way to both shorten the learning process and develop consistency in our personal approach.
When we consider the changes to the simple things in our lives like buying a car or television, growing consumer savvy is evident. It is no longer sufficient to stand before a massive wall of flat screens, all tuned to the same channel, and point to the one we want the salesperson to retrieve from the backroom. Instead, we go to store websites and those of online retailers. We wade through dozens of reviews and articles, and consider such details as “initial quality,” “warranties,” and “technical specifications.” Only then will we walk into the store with confidence and make a purchase. Active consumerism has led us down a path of thoughtful consideration of what details separate one offering from another.
Unfortunately, consuming health care industry is not as simple as buying a TVs or car – it is more complicated, and much more stressful, especially in the face of a life-altering diagnosis. And there are fewer reliable resources to walk patients through the tasks of finding the highest quality physician or locating the best hospital in which to have a surgical procedure. In these situations, a lack of guidance and support can exacerbate the difficulties a patient and their family already face, and it often starts with how to address the most basic of healthcare questions: “What do I have?” “What do I need?” “Who do I see?” “Where do I go?” And, “How will I cope?”
For this reason, the first significant role we can play as benefits professionals is an educator. We must begin by teaching our employees that quality matters and that it varies. We can point them to the handful of reliable resources out there that can help them. For example, the Pacific Business Group on Health (PBGH) has recently teamed up with Consumer Reports to share information from the Choosing Wisely campaign on a microsite. The content helps consumers understand —in plain English—when specific services and treatments may be necessary and when they aren’t, assisting consumers to answer the question, “What do I need?”
A recent study shared by my organization aimed to teach consumers that not all physician review sites are created equal – select the highest ranked doctor on Yelp and you may be in for a surprise since there is little correlation between Yelp stars and actual measures of physician quality. Thankfully many employers successfully partner with Leapfrog to educate employees that quality matters and that it varies, helping them to answer the questions, “Who do I see” and “Where do I go?”
Of course, even the best of resources can often be overwhelming, especially in the face of an employee dealing with something like a cancer diagnosis. So it is no surprise the NBGH annual survey of employee benefits revealed that 36 percent plan to offer their employees high touch concierge services this year. The most comprehensive of these offerings will help consumers answer all five of these critical questions over the course of their health care journey, so they don’t have to address them piecemeal.
And finally, whether health care is ongoing or treatment is finished, there are always the bills to deal with in this era of consumer cost sharing. The financial side of healthcare decision making is also an area of considerable confusion, and patients find themselves lost when facing uncertain insurance coverage, billing questions, and complicated explanation of benefits statements.
Employers can follow their own model of promoting financial literacy, as many are already doing in the area of employee retirement. There is an important role they can play helping consumers understand their benefits, and also accessing assistance when needed. Claims advocacy plays a crucial role in supporting patients and their families throughout their journey, as a deep understanding statement accuracy, and the process of claims resolution are new requirements for many. No wonder a growing number of employers are offering the service to employees.
What patients are asking for is assistance. They recognize change within the healthcare community and across the healthcare landscape. They just want help navigating through it. What we can provide is the insight into the most fundamental questions and issues they face, with the maximum benefit being offered by information and assistance as early in their decision-making process as possible. Let’s help them understand that high cost does not necessarily equate to high quality and that a surgical option is not always the only option.
Medical consumerism is a learned behavior; it is a composite of education, tools, and experiences which shape our healthcare choices and inform our responsible healthcare spend. We cannot expect to navigate these changes alone and mistake-free, from the outset. These are skills we will all acquire over time, and if we are to succeed early in this effort, it will be due in no small part to the assistance we receive in areas like treatment decision support, physician quality, and claims advocacy. The age of medical consumerism is upon us, and it is time to embrace this change.