Consumer Directed Healthcare: A High Stakes Game

Consumer Directed Healthcare (CDH) promotes increased awareness and consciousness about choice, cost and quality of health care. Rather than isolating consumers from the costs of healthcare, CDH plans engage consumers directly. The customer takes the lead in deciding where, when, how and from whom they receive care and use their benefits.

There are many players in the health care consumerism game these days, and they have a lot at stake. So what is it going to take to succeed?

Employers Winning at the CDH game means changing the way people think about health care and their insurance. The ability to educate a diverse employee population and help them navigate CDH benefits is critical. Education starts with easy-to-understand product guidance and is supported with ongoing communication. Missteps in a CDH rollout can derail the most well-intentioned efforts. Plans won’t deliver the long-term premium savings employers are counting on if employees are not prepared.

Employees The consumer’s new responsibility is to deal with their day-to-day health care expenses. Don’t sell consumers short about managing a health care budget and comparison shopping. The blindfold is coming off as CDH plans facilitate confident decisions, easy-to-read plan guides, real-time account tracking, provider price and quality comparisons, wellness incentives and vast libraries of clinical content. Sophisticated, customer-friendly care management support and personal health records add increased consumer independence.

Health Plans Proof-of-concept is going to make or break CDH over the next 18 months. Tough questions from smart CFOs and concerned benefit managers need answers:

• Can CDH deliver sustained savings once the “low hanging fruit” of young and healthy enrollees is harvested?

• Are assumptions around CDH product pricing realistic, given the years of consumer insulation by $20 co-pays and an entitlement mindset?
• Will CDH patients forgo needed medical care when it comes to dipping into their own wallet and increase costs at the back-end?

Brokers As today’s consumers become tomorrow’s payers, brokers need to move from benefit salesperson to consultative financial counselor—integrate health benefit options into long-term asset protection and evaluate the tax implications of HSA plan designs. It takes disciplined training and detailed, yet practical, product presentations to close a CDH sale. Brokers must demonstrate bottom-line value, and show benefit managers and consumers how to transition to a CDH plan.

Providers CDH often means open access to local provider cost and quality information. This changing competitive dynamic market is encouraging physicians and hospitals to demonstrate value and, change their approach to patient management. CDH reinvents the connection between he provider and patient. As doctors and hospitals adapt to CDH rules, they are beginning to understand what’s in it for them—increased loyalty and improved patient satisfaction. Over time, location of medical services, price transparency and care management will further transform medical delivery.

Consumerism will continue to influence employers and their individual health benefit purchasing decisions. We will see an increased emphasis on employee behavior modification, CDH benefit ROI and medical care delivery. Well-crafted CDH introduction strategies and customer communications will increase product uptake. By removing the intimidation and confusion that usually greets healthcare consumers, CDH can achieve educated buy-in and boost consumer confidence in their healthcare decisions. Ultimately however, only a track record of bottom-line financial impact and customer satisfaction will determine winners in this high stakes game.