A new set of health insurance benefit design principles issued by a multistakeholder group stresses the need for engaging consumers to improve health outcomes. But it doesn’t address the growing use of high deductibles that often discourage them from seeking needed care.
The six principles developed by the Health Care Transformation Task Force recommend that payers, providers, and purchasers collaborate to create high-performance networks that enable people-centered care, using consumer input in the care redesign process.
The task force, which includes insurers like Aetna, providers like the Cleveland Clinic, and consumer advocates like the National Health Law Program, laid out broad concepts to encourage greater incorporation of the consumer’s voice into health plan design.
“There’s a lot of talk about putting consumers first,” said Jeff Micklos, the task force’s executive director. “It should be happening but it’s not necessarily happening. We’re working with our members on implementation strategies, reflecting on the need to do better.”
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Many consumers, however, don’t feel their needs are being met by the high-deductible plans commonly offered by employers and in the individual market. In 2018, 39% of large, corporate employers surveyed by the National Business Group on Health offered high-deductible plans as their only option.
The survey found that will drop to 30% next year, as employers recognize their workers don’t like high-deductible plans and that they aren’t necessarily effective in weeding out unnecessary care.
Dr. Mark Fendrick, director of the Center for Value-Based Insurance Design at the University of Michigan, said too many health plans have cost-sharing features that discourage patients from seeking appropriate care.
He said the task force’s principles fail to offer specific strategies to align financial incentives for providers and patients, which would both improve health outcomes and get costs under control.
“I’m pleased to see that most value-based plan models encourage me in my primary care practice to work with diabetic patients on their blood sugar, blood pressure, and eye exams,” he said. “Unfortunately, as they are increasingly enrolled in high-deductible plans, my patients can’t afford the care they need.”
Micklos said his task force has a different work group developing a consumer perspective on high-deductible plans.
The task force encouraged the development of “high-performance” networks based not just on cost but also on higher quality of care. It said providers, payers, and purchasers should closely consider network adequacy, behavioral health, and reduced cost sharing for medical complex patients.
That’s consistent with a recent commentary in the New England Journal of Medicine urging value-based plans to focus more on selecting providers on the basis of quality rather than simply on the lowest price.
The authors said providers and payers “need to offer patients more positive reasons to use high-value providers,” such as services that are “more convenient and responsive to patients’ daily realities.”
True valued-based plans must “provide a more effective product that could appeal to consumers on the basis of premium as well as greater satisfaction,” said Paul Ginsburg, a health policy professor at the University of Southern California, who co-authored the commentary.
Jeff Goldsmith, a national adviser at Navigant, was critical of the task force’s guidelines. “As a consumer, this sounds like a lot of rhetoric,” he said. “Value-based is a slippery term, as is consumer-centric. The transition to a value-based healthcare system isn’t moving very fast, is it?”
Date: November 7, 2018