Consumer-Directed Health Care
What It Delivers, What It Needs
By Susan Messenheimer and Carol Weiszmann, aimpublications.com
Research has shown that health care spending goes down when consumer health awareness goes up — that is,
when consumers take more responsibility for understanding what keeps them healthy and decide for themselves
how to spend finite health care dollars.
This is the chief driver of the movement toward consumer-directed health plans (CDHPs), in which health reimbursement accounts (HRAs) or health savings accounts (HSAs) are used to directly purchase non-routine health care services. Traditional insurance, on the other hand, covers non-routine expenses only after a high deductible is met.
Enrollment in these consumer-driven plans is rising. In 2007, it climbed to 5% from 3% of all covered U.S. employees, according to one study.*
The debate continues about the success of CDHPs. Some studies show that they lead to a decrease in health care use by lower-income consumers. Others confirm that they lead to increased engagement in wellness programs. Blue Cross Blue Shield Association’s 2007 CDHP Member Experience Survey, for instance, found that those eligible for HSAs were 17% more likely to participate in an exercise program than those enrolled in non-CDHP products. HSA-eligible consumers were also more likely to get involved in programs addressing smoking cessation (20% of HSA-eligible consumers versus 6% of those not eligible for HSAs), stress management (22% versus 8%), and nutrition and diet programs (27% versus 12%).**
The Importance of Information
CDHPs work best when participants have information — and plenty of it.
Some of this information deals with the plans themselves and their specific offerings. In some cases, however, consumers would benefit from better-designed plan provider Web sites and more efficient methods for tracking plan usage.
But much of what will make CDHPs more effective at lowering health care costs and improving health care itself involves patient-centered information. This means widespread implementation of health information technologies—electronic medical records based on universally adopted standards, secure exchange of authorized information, computerized ordering of prescriptions and other medical tests, and clinical decision support tools. These innovations are necessary to reduce medical errors and improve the quality of health care delivery.
Also important to increasing the success of CDHPs is the use of evidence-based medicine (EBM). This involves systematically applying the best evidence from scientific research to both individual medical decision-making and assessing organizations’ quality of health care delivery and health care policy and regulations.
As health care consumers and providers become more adept at using information tools and technologies, everyone will benefit from higher-quality care.
* National Survey of Employer-Sponsored Health Plans 2007, Mercer (www.mercer.com/referencecontent.jhtml?idContent=1287790)
Family physicians are the cornerstone of U.S. primary care. Accordingly, few organizations are doing more to positively impact the future of medicine than the American Academy of Family Physicians (AAFP). Working hand in hand with business leaders to improve the quality of health care for every American, AAFP is helping to eliminate unnecessary health care spending and bring about some long overdue modernizations to the practice ofmedicine. These include importantmedical innovations such as health information technologies, secure electronic health records and evidence-based medicine, all of which are designed to better connect doctors with their patients and make health care more effective and efficient. The strengthened relationships between patients and doctors allow family physicians to better prevent disease and coordinate a higher quality of care for every patient. It is patient-centered primary care at its finest, where doctors better knowtheir patients and can better serve themas a result.