2017 Trends: Consumer Responsibility

The pressure on consumers is continuing to rise. As health plans, employers, and providers work to figure out the role they can and should play in the modern healthcare system, consumers are faced with more impactful decisions and financial responsibility related to their healthcare. Consider (cue Billy Joel’s “Pressure”):

  • Enrollment in high-deductible health plans (HDHPs) have jumped to 29 percent in 2016 from 17 percent just five years ago among employer-sponsored health insurance.
  • The Trump Administration has expressed increasing  access to healthcare savings accounts and contribution limits (Paul Ryan’s plan would more than double the limit for families to $13,100 from $6,750), and make it easier to pass the money in HSAs to heirs.
  • Paul Ryan’s plan for Medicare would also, much like current exchanges, increase private competition for Medicare and give consumers more options to consider.
  • Narrow networks characterize nearly half of plans on the ACA’s health insurance marketplace and insurers like Blue Cross Blue Shield of North Carolina indicate this trend will only grow.
  • Fidelity estimates a 65-year-old couple retiring today needs $260,000 to cover medical expenses; that’s $15,000 higher than Fidelity’s estimate from 2015.

While there’s a lot at stake for the healthcare consumer, there’s also no shortage of companies trying to empower or engage them every step of the way. From hospital and physician “quality scorecards” to procedure cost estimators like HealthSparq, tools that give consumers discounts and compare pricing for prescriptions, like GoodRx, or even organizations using big data and crowd sourcing to help people find the right drug, like iodine. Also consider the full range of retail clinics, urgent care clinics, and virtual care from companies like MDLIVE that offer alternatives to expensive, inconvenient care.

And on the hot topic of HSAs, Walgreens and Alegeus, a platform for health benefit accounts (e.g., FSAs, HSAs, etc.) used by employers, third-party administrators, and health plans, struck a partnership in 2015. The agreement gives Alegeus clients the opportunity to tie Walgreens’ existing rewards program to their own efforts, encouraging consumers to make good choices regarding their health and healthcare finances.

So, we’ve got incentives, resources, and tools – the primary ingredients for successful healthcare consumerism, right?

Not so fast.

Let’s just talk about the money. The average deductible for someone with an employer-sponsored health plan is $1,221 (if you eliminate people who don’t have a deductible, the number rises to $1,478).  Now juxtapose that with a recent survey by the Federal Reserve that found 47 percent of respondents don’t have enough money saved to cover a $400 emergency.


Yes, HSAs can certainly help in this regard, but the consumer has to make the choice to divert money to the HSA.

And what about the impact of these incentives?  Not surprisingly, research has found that people with a lower income who have a high-deductible health plan reduce the amount of healthcare services they use. And if this meant people were skipping visits to the ER or unnecessary testing, everyone would cheer. Instead, it seems as though people are skipping the routine visits that could lead to improving health and early diagnosis, which is better for everyone in the long run.

Healthcare consumerism. Consumer engagement. The empowered healthcare consumer. No matter how we say it (and we’ve been saying it for a long time), we’re not there yet.

What we should know by now is that we can’t meet consumers where we want them to be, we need to meet them where they are. And where exactly are consumers? They are short on time and attention span. They expect uber-convenient, high-quality experiences and aren’t likely to be motivated by anything less. They are mystified by the healthcare system.

And, they are drowning in sticks and carrots. All they really want is a much-needed helping hand.

Who’s game?

November 30, 2016
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