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Health Care Consumers vs. Users

David P. Lind BenchmarkEver thought about what it means to be a health care consumer versus a health care user?

Health care consumers have skin in the game, money on the table. They work to protect their health and actively look for the best health care value—researching options and making educated choices.

Health care users pay their monthly premium, go to an in-network provider and that’s that. Oh, they pay copays, but  they don’t have an incentive or the information to seek out the best value. Sadly, most of us fit under this category much too often.

Employers’ efforts to manage health care costs are becoming more focused on getting employees to become health care consumers rather than users.

National studies, such as Kaiser/HRET, and local research, such as the Iowa Employer Benefits Study©, show that more employers are embracing two interrelated concepts when offering health insurance coverage to employees:

  • Consumer-Driven Health Plans (CDHPs)
  • Wellness initiatives

In Iowa, only 4.5 percent of employers were offering components of CDHPs in 2005, but this number increased to over 20 percent by 2011. Also, more employers show interest in implementing wellness initiatives, in some cases providing financial incentives for employees to participate.

Consumer-driven health initiatives:

  • Emphasize making healthy lifestyle choices—eating right, exercising, not smoking, monitoring health numbers, etc.
  • Encourage employees (and their dependents) to seek out the most cost-effective care when seeking health care services. (Unfortunately, consumers are not privy to the actual costs. This is a big problem. See Clueless on Costs.(Blog)

More and more employers are working on plan designs that offer incentives to facilitate behaviors that improve employee health and lower health care costs.

VBID

Nationally, large employers are embracing a philosophy called Value-Based Insurance Design (VBID), providing incentives to employees to utilize evidence-based medical services. Deductibles, copays and out-of-pocket costs can be less to employees (and dependents) if they adhere to particular drugs regimens and treatments recognized as the most medically effective, and more if they choose tests and procedures deemed “overused.” There are pros and cons to everything, and VBID is no exception.

Until we can find the elusive ‘silver bullet’ to reign in health care costs, employers will need to assess new opportunities to help employees become more effective consumers of health care. These are some of the tactics currently being utilized. Their actual impact on employee behavior and health care costs remains to be seen.

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