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Is “Consumer-Driven Health Care” Code for High-Deductible Health?

driving-patient-activation-with-psychographic-segmentation1Touted as the future of the health care industry, consumer-driven health care is clearly gaining momentum. Propelled by the opening of health insurance exchanges and a growing number of employers shifting insurance costs to their employees, millions of consumers are shopping for health plans — a move that many felt would empower individuals to take control of their health care. Yet, some experts openly question whether consumer-driven health care will lead to the hoped-for improvements in patient outcomes.

A year after the initial launch of the health insurance marketplace, the high concentration of low cost, high-deductible plans has led to low satisfaction levels as health care consumers find themselves ill-prepared to take on the shift in cost and responsibility.

Reality Doesn’t Quite Live Up to the Hype

In theory, according to the Center for American Progress, the increased financial exposure created by high-deductible plans should “encourage patients to act like consumers, comparing quality and costs and negotiating lower prices.” In reality, however, consumer-driven health care is falling short for several reasons.

  1. The appropriate use of care has not improved. While millions of previously uninsured Americans have joined the ranks of the insured, many selected low-cost, high-deductible plans. This cost-motivated behavior has led to a proliferation of consumers who are two times more likely to delay or avoid care.
  2. Access to health insurance is not access to health care.  Because of increased administrative burden, lower reimbursement and myriad other reasons, many physicians are (considering) leaving practice. Increased demand with decreasing supply means enhanced scarcity of resources.
  3. A lack of transparency on costs and quality still inhibits consumers from effectively managing their health care experiences.
  4. Consumers may be willing to spend time on research, comparing prices and features on various vehicles before investing in an SUV, but the same cannot be said when it comes to the higher stakes of health. When a loved one is sick, shopping around for the best deal or weighing the pros and cons of different treatments is not a consideration. 

The bottom line? Consumers are not yet happier in this new consumer-driven health care market.

According to surveys, satisfaction among individuals with consumer-driven health care plans is more than 30 percent lower than their counterparts with traditional plans. And the gains in the quality of care and better patient outcomes are failing to meet expectations too.

How Patient Engagement Fits into the Picture

In order to address the problems bubbling to the surface, hospitals and insurers must find ways to engage consumers on different fronts.

Education

The best way to ensure that consumers make better decisions when selecting health care plans is to teach them how to evaluate their personal health care needs and identify plans that fit both their needs and their budgets.

In 2013, then Health and Human Services (HHS) Secretary Kathleen Sebelius announced $67 million in grants to support insurance “navigators” to help consumers shop for and enroll in plans through the federal and state insurance marketplaces. But as the numbers show, these efforts haven’t had as much impact as could be hoped. Hospitals and other health care organizations need to take a greater role in helping to educate consumers on their options.

Important to note: Education does not mean more information.  Simply providing more information to consumers will not trigger desired behavior change. According to research by Johns Hopkins’ schools of Public Health and Medicine, 53 percent of physicians are overweight or obese. A study published in the Journal of the American Medical Association found that a quarter of Licensed Practical Nurses smoke. If the most informed and educated people regarding health struggle to maintain healthy habits, how is the average patient expected to do any better?

Education needs to connect with consumers on an emotional level, tapping into motivations and made personally relevant. Deep consumer insights are necessary to achieve this.

Accountability

In an article earlier this year, Information Week quoted Sharp HealthCare CIO, William A. Spooner, who told an eHI panel, “We’re trying to reap a health improvement, but patient engagement doesn't mean patient accountability.”

Whether consumers have traditional insurance plans or HSAs and high-deductible exchange plans, the best way to ensure they achieve lower health care costs is to encourage positive health behaviors to reduce the need for hospitalizations. Instilling a sense of accountability will depend on personal patient motivations and priorities, unlocked through consumer insights.

Loyalty

If efforts to increase accountability are effective, the end result will be better health and ultimately lower utilization of hospital services. Hospitals could engage consumers by behaving more like a retail store — offering greater transparency on price, higher quality and enhanced services to attract a loyal following. Retailers rely on deep consumer insights to design their shopper experience; healthcare organizations should do the same.

Getting Results

Engaging patients on any of these fronts — education, accountability and loyalty — will be a challenge, especially if health care organizations take a “one size fits all” approach.

In order to realize advantages from consumer-driven health care, hospitals, insurers and other health care-related companies need deep insights into consumers to craft more effective messages that engage consumers.

c2b solutions conducts an annual, national study on consumer attitudes, needs and behaviors across many channels of health care. The next national study will be fielded in January 2015, and health care organizations can access this data at a significant savings versus pursuing such research on their own.

In addition, c2b solutions has developed a proprietary psychographic segmentation model that allows organizations to better understand the motivations of consumers and target audiences for maximum effect in their education and advertising efforts.

Psychographic Segmentation and its Practical Application in Patient Engagement and Behavior Change

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