Data and Transparency Aid in Shift to Outcome-Based Health Care

  • October 4, 2016
  • Blog

I was recently asked to join a panel on the current state of private exchanges and how consumer-oriented enrollment experiences can drive greater engagement with benefits throughout the year. Represented were a policy expert, a benefits advocate for some of the nation’s leading employers, an actuary and a technology nerd (me). As typically happens when speaking of health care consumerism, the conversation gravitated toward the topic of transparency. We were unanimous in our belief that transparency is an essential component of pushing consumerism in health care. Yet we were also unanimous in thinking that we have a long way to go before transparency reaches its true potential for transforming health care benefits and utilization.

Why is health care transparency so important and yet so challenging to achieve, and what can we do to shepherd the industry into the future of benefits? The answers are myriad but narrow to a common theme: For transparency to take hold, it will take all of us, employers in particular, to be active agents of change.

You may read that statement, especially if you are in charge of administering benefits for your company or you are an agent or consultant working on behalf of employers, and think that you are simply the messenger and that real change must come from the providers and health insurance companies. The opaque pricing practices adopted by providers and payers have long been seen by them as necessary for competitive advantage. Unfortunately, that competitive advantage leaves consumers at a disadvantage. Indeed, the health care transparency movement was born out of how – forgive the made-up word – “untransparently” the health care industry has operated for too long.

To be sure, things are moving in the right direction. Forward-thinking payers have formed partnerships with companies like Castlight Health and Healthcare Bluebook in hopes that being more consumer-friendly will be good for their customers and good for business. The Blues Association has published studies on the price disparities for similar procedures across the networks of their many member groups. Even some provider networks and individual providers have dipped their toe into consumerism by publishing their prices for certain procedures. (It helps as well that the Affordable Care Act has mandated more pricing transparency among providers.)

So yes, payers and providers seem to be getting the message. That’s where companies, and especially benefits administrators, come in as the messenger.

We often think of being the messenger as a thankless and powerless job. Somebody else did something – I’m just here to tell you about it. In reality, the messenger is as powerless or powerful as they want to be. In employer-based benefits, the administrator (whether internal or a broker/consultant) is the messenger to employees about what their benefits offerings are and how to make the most of them. They are also the messenger to the payers and providers (and/or consultants and brokers) on what they want for their employees. If they take charge of these channels of communication, they are less the messenger and more the hub of activity, relaying benefit program needs on one hand and relaying outcomes on the other. This dynamic makes administrators a far more effective change-agent for health care transparency than we may have previously thought.

With this new mindset in place, the question becomes: How do we empower company benefits administrators to, in turn, empower their employees to be better health care consumers with the help of transparency tools?

First, make online tools central to managing health care.

It seems as though you can do pretty much anything online these days, from booking travel to ordering a pet for a day, so why should health care be any different? For consumers to contribute to accelerating health care transparency, they first need to become accustomed to managing all of their health care needs online – from enrolling in health care benefits to comparing the costs of a procedure to managing their expenses and health-based financial accounts.

The crazy thing about health care transparency is that consumers don’t just need it, they want it – because transparency is the norm in virtually every other buying decision they make online and offline. When consumers are looking for a car mechanic or a new refrigerator they most likely go online, visiting multiple sites to research reviews and to shop around for the best price. Offering online tools that mimic this experience helps employees make informed decisions about their health care. Price comparison tools can show employees what kind of costs are associated with a specific health plan.

In addition to empowering employees to become more active and educated participants in their health care decisions, online health care tools will also train them to pause and consider the actual expenses associated with health care. As high deductible health plans become more widespread and deductibles associated with more traditional plans continue to rise, this will become even more vital. Instead of going to the doctor for a fever, consumers may consider telehealth services instead. Health care transparency can help lead them to that decision. Or rather than accept a certain high-cost brand medication just because, patients may be automatically directed to a generic version. These aren’t future things – they’re available now. Making online tools central to managing health care and encouraging employees to use the data available to them will go a long way in aiding the shift to greater health care transparency.

Second, lean in to health care transparency tools.

There’s been much talk about the enormous potential health care data has on increasing transparency around costs and quality of care. Critics of late, however, have been questioning the actual impact transparency tools are having on consumer behavior and outcomes and that consumers don’t actually use the tools at their disposal.

Mea culpa. The critics are partially right. When you compare the available health care transparency tools to consumer tools on sites like Amazon or TurboTax (a meaningful point of comparison when considering the complexities of health and benefits), they may not be as robust because they haven’t been around nearly as long. But here’s the thing: they are far, far better than leaving an employee to do the work on their own. While payers and providers are shifting their mindsets on transparency, companies focused on this area are making phenomenal progress while understanding that there is much to be achieved yet. The trick is to find what connects with your employees in a meaningful way based on what is available.

There are undoubtedly scenarios where utilizing health care transparency tools doesn’t make sense or is simply not possible. For example, those in emergency situations don’t have the time or mindset to “shop around” for the least expensive option (although, with location services and smartwatches, even these kinds of circumstances are becoming perfect test cases for health care transparency). But there are a multitude of scenarios where an individual has some time to decide on what doctor and/or hospital they want to visit. More importantly, they have time to shift their mindset from the consumptive model we’ve lived with for decades in U.S. health care to a preventive approach, which is where transparency tools can really shine. And here’s where being the messenger becomes empowering and vital.

Third, communicate the value of transparency tools at every turn.

A key issue with transparency tools is that they may not readily fit into the enrollment-focused, workflow-centric model of employer health care and benefits management. That’s why you need to remember your transparency ABCs: Always Be Communicating.

I once heard Stephen Levitt, the acclaimed co-author of “Freakonomics”, get asked what the best way is to encourage employees to shift to a new benefit program or offering, like shifting from a PPO to an HDHP. Levitt, who has transformed the thinking of many on sacred cow issues like real estate and child safety seats, said without hesitation that, from a behavioral economics perspective, the most effective way to get people to do as you tell them is… to tell them what to do. In other words, if you want employees to know how important health care transparency tools are to them, tell them exactly how to use them, then do everything you can to get them to keep using them.

Communication transparency begets health care transparency. Employers can express the worth of transparency tools and the scenarios where price transparency tools are valuable. Individuals looking to validate a recommendation from a friend or doctor, or employees looking to see how close they are to meeting their deductible are just two scenarios where these tools could make a major difference in not only their peace of mind, but the ultimate outcome of medical treatment. It will undoubtedly take time to transition to outcome-based health care and will require cooperation from all parties involved; however, there are a few things employers can do to not only prepare their workforce for these changes, but to encourage them to become active proponents of this shift.

Here are some ideas on how to do so:

  • Send them email notices with examples of ways people have saved money through health care transparency.
  • Hold quick seminars on how to get the most out of the tools.
  • Offer incentives to use the tools.
  • Get your company mavens to use the tools and then evangelize them.
  • Link the tools to your health plans, to signify how important transparency is to their health care.
  • Make videos explaining the tools and how to get the most out of them.

These are just a handful of ideas. Some of you are certainly saying “We don’t have the time/resources/energy to do all of those things”. Agreed. Whichever health care transparency company with which a company partners should be actively helping with adoption. They want people to use your tools, and they will be emphatically willing to support your communication efforts because they know it’s not enough to just invest in online tools to help employees manage their costs – employers must also educate them on the value of using these resources.

Pushing participation doesn’t just create health care consumers, it sets off a flywheel of making health care transparency tools better. The more consumers contribute their experience, choices and feedback (in the form of, among other things, reviews), the more they will benefit. And the more each employee benefits, the more we all benefit. Because ultimately we are all consumers, and ultimately what we all want is to be healthy and happy, and to know that we are able to make well-informed decisions for ourselves and our families. It’s that transparent.