Healthcare consumerism: embrace it or step aside

Today’s consumers have high expectations when making a retail purchase. These same demands apply when purchasing health insurance and getting medical care. Health plans that don’t meet customers’ expectations may be left out in the cold.

The trend-dubbed healthcare consumerism-marks a shift toward greater consumer choice and responsibility. “With that comes increased consumer cost sharing,” says Robin Gelburd, president, FAIR Health, New York, New York. “Whether enrolling in a plan, selecting a provider, paying for benefits, or deciding where to receive healthcare services, consumers are expected to take an active role in managing their healthcare and benefits.”

For many decades, business owners and human resources professionals-who worked with expert advisers such as brokers and consultants-selected benefits for the commercial sector. Employees did not have a lot of choices, if any, and therefore did not require much education or information to differentiate between those choices. Fast forward to 2015, and many consumers are now presented with dozens of choices on public and private exchanges.

Douglas Field, chief executive officer, The Institute for HealthCare Consumerism, Alpharetta, Georgia, notes that healthcare consumers also want tools and programs to help them become better consumers of healthcare. “This includes access to transparency tools so they can find the right care at the right price,” he says.

The trend of healthcare consumerism will require health plans to make several changes to the way they have traditionally interacted with customers. “Simply put, if a health plan ignores healthcare consumerism it will fail,” Field says. “The competition will take them out.”

Next: Forces at work

Multiple factors are contributing to the rise of healthcare consumerism. First of all, due to rising healthcare costs, employers are asking employees to bear a greater share of the burden. “It was hoped or anticipated that making plan members more responsible for, and sensitive to, the cost of their healthcare might change consumer behavior,” says Gelburd. “But healthcare industry, community leaders, and consumers all soon realized that patients could not be expected to make decisions to control costs without access to better information about the cost and quality of care.”

Another major contributor to the upward trend of healthcare consumerism is the growth of government-based healthcare. This includes the passage of the Affordable Care Act (ACA), which has led to significant growth in Medicaid due to the Medicaid expansion, while at the same time Medicare is growing due to the aging population. “This has led to growth within federal healthcare models, which by definition are individual, consumer-based health plans,” says Larry Bridge, senior vice president, strategy and corporate development, TriZetto, a Cognizant Company, in Englewood, Colorado.  

Meanwhile, benefit plan designs have continued to increase patient responsibility through larger copayments, deductibles, and/or co-insurance. “The plans available on ACA’s public exchanges have contributed to this quite a bit, in addition to the general trend toward more consumer responsibility in employer-sponsored care,” says Chris Seib, chief technology officer and co-founder, InstaMed, based in Philadelphia, Pennsylvania and Newport Beach, California.

As consumers are given more choices-both in selecting their health plans through public or private exchanges, and in selecting their providers for various services-they are demanding simple and convenient access to services with a straightforward experience. This includes everything from appointment scheduling, to receiving care, to having a clear understanding of their payment responsibility combined with convenient ways to pay.

For 10 ways health plans should adjust to the rise of healthcare consumerism, click here.