National Consumers League

From patient to consumer: Reimagining health care from a consumer perspective

family-on-bikes.jpgThe following Huffington Post op-ed was published August 18, co-authored by NCL's Sally Greenberg and Marilyn Tavenner, the President and CEO of America's Health Insurance Plans.

Navigating our health care system is no easy task. For decades, consumers have been forced to contend with a fragmented health system that makes decision making an all-consuming challenge. Whether it’s choosing a provider, knowing where to get information about cost or quality of doctors, or understanding a dictionary of complex health care terms, many consumers often feel left to fend for themselves in a system that is working against them.

For many individuals, it’s hard to know where to start. A recent state analysis by Rice University in Texas found that 42 percent of consumers who bought their own insurance felt like they lacked a clear understanding of their health insurance plans. Nearly a quarter of those surveyed who had employer-sponsored coverage still struggled with understanding their benefits.

We need to find a way to change this. While we all recognize the seismic shift underway as the age of consumerism in health care finally takes hold, we have to ask ourselves if we are truly practicing what we preach. We all have a responsibility to provide consumers with the transparent, actionable information they need to make smart choices about their care.

The good news is that online and mobile apps are making it increasingly easy for consumers to access information on their own time and with relative simplicity. Health plans have rolled out provider cost and quality calculators, and websites like FAIR Health make it possible for patients to see what a typical doctor’s visit or MRI will cost before they even walk into a provider’s office.

But even with this push towards more available data, we know that individuals and families still struggle when it comes to understanding and using their insurance benefits. Commonly searched online terms around insurance include, “what are deductibles?”, “finding a doctor,” and “how much will I pay in premiums?” Consumers are clearly telegraphing the need for simple, easy-to-understand information about their coverage.

Recently, our two organizations came together to compare notes on how we could collaborate to improve consumers’ health care experience. As a first step, we agreed that while there is a wealth of information in the market available for consumers, it is often poorly organized, out-of-date, or like the health care system itself, requires consumers to search multiple places for the information they need. Our first joint project will bring critical information together and present it in ways that are useful for consumers. We will rely on AHIP’s considerable knowledge of health insurance and NCL’s more than 100 years of consumer education to make information accessible, understandable, and actionable.

Our work builds upon what we have learned over the past several years on the frontlines of this health care transformation. A recent report from McKinsey found that although consumers are beginning to research their health plan choices, many of them are not yet aware of key factors they should consider before selecting coverage, such as the type of health plan and provider network, level of coverage, premiums, cost-sharing, covered services, drug formularies and tiers, and health status and anticipated utilization. Even once they have their insurance plan, many consumers may not be aware of all the benefits that are included, including free preventive services, disease management programs, fitness plans - and equally important, the tools they have available to get the best value for their health care dollars.

As consumers prepare for the upcoming open enrollment periods for Medicare and the Exchanges, AHIP and NCL will share new consumer resources and information answering some of the important questions about insurance coverage and health care ranging from how to choose a health plan to how to choose a doctor, as well as consumers’ rights if they feel they’ve been inappropriately denied a product or service that should be covered by their plan.

We know that health care isn’t always simple, but if we are to be successful in moving towards a patient-centered health system, we have to start by making health care information more accessible and usable for consumers. While this partnership is a first step, our hope is that our combined efforts will encourage and support the important work underway to improve consumers’ experience with the health system and the wellbeing of the country as a whole.

This article originally appeared in the Huffington Post.