By Cyndy Nayer, July 1, 2013
There are more studies being translated for consumer sites and broader business reach. Small and large businesses alike know that up to 20 cents of every revenue dollar goes toward health care. Understanding what works, what appears to work, and what really isn’t hitting the mark is crucial for business success.
This article echoes the findings of studies from Employee Benefit Research Institute (EBRI), Kaiser Family Foundation, and others. When folks have to choose between paying out of pocket for appropriate care and paying the rent, the care falls behind. Study after study have shown that, over the past 5 years, fewer prescriptions have been filled, more prescriptions have been subject to non-compliance (pill splitting, etc.), fewer follow up physician visits and tests/labs have been performed, all of which hinder outcomes.
AHIP recently published an infographic showing the increase in CDHP plans. These increases appear to dovetail with the lower adherence to protocols that could prevent rescue treatments and avoidable inpatient days.
The opportunity in value-based design is to follow the high-value protocol and treatments. These can be place on special designs that encourage the appropriate behaviors. Further, direct contracts with providers, urgent care centers, and pharmacist coaches can help to manage high-cost chronic care, even within account-based consumer-directed plans.
Let’s spread the word: consumer-directed can work, but the insurance plan design and contractual arrangements for appropriate, outcomes-based quality providers, are essential.