Many health plans today give consumers a choice as to how they
would like to spend their health care money. This means that consumers
have a choice as to which doctor they see
or which hospital they will visit for a service. This is a wonderful opportunity for
consumers as long as their health plan supplies them with the information needed to
make educated health care decisions.
Often, it is the nature of a consumer to
make decisions based strictly on cost.
Consumers are looking for the most bang for
their bucks. This is not always the best way
to choose health care services, says Edward
McCallister, chief information officer for
UPMC Health Plan. A consumer should
never separate cost and quality and view
each as a separate entity, says McCallister. It
is the role of the health plan to make sure that
the consumer understands the importance
and overall effectiveness of viewing both
cost and quality as one.
Smart Business spoke with McCallister
about how increased access to information
impacts health plans and consumers.
Does a health plan have a responsibility to
give consumers information about both the
cost and quality of health care?
As a health insurer, a health plan has
access to an abundance of data related to
health care and consumer options.
Insurers are also responsible for the health
dollar for many consumers. Therefore, it is
necessary we provide consumers with as
much information as possible to help them
through the decision-making process, providing them with options for the best care.
It is also important that we provide the
consumer with an understanding of the
costs and services of health care.
Is value the best approach when it comes to
health care services?
In a consumer-driven market, it is difficult to assist consumers in understanding
the significance of the overall picture.
Taking a holistic view of health care is how
both business owners and consumers
should approach health care decision-making. Often, people only consider health care when they are ill or in need of services. It is more effective if business owners
and consumers take a preventative
approach to health care. Wellness programs and preventative measures significantly decrease overall health care costs.
This may be the first step to decreasing the
bottom line of costs for consumers.
For instance, one needs to consider many
factors when choosing a health care facility. When choosing between one hospital
and another, you may not be comparing
apples to apples. There are hospitals that
specialize in certain services, there are different specialized doctors at each hospital,
and there are varying volumes of services.
These variables must be taken into consideration when making comparisons.
Should a health plan encourage consumers
to take a more active role in the health care
process, and how can that be done?
The health care system has changed significantly in the past few years. Today,
employers are requiring that employees
take a more active role in their health care
services and spending. This means that
employees must receive as much information as possible from their health plan to
make informed decisions.
One example of how they can become
more informed is to look for an insurer who can provide them with online tools.
This gives the consumer access to information 24-7. It is also important to have different mediums through which to access
information. A consumer should have the
ability to utilize online, telephonic and on-site access.
Can there be true transparency in health care
information?
Yes, there can be transparency, but there
are still obstacles that need to be overcome. The first is, even with transparency,
it is often hard to make valid comparisons
between health care facilities because the
services are not always the same in each
hospital. Another issue with transparency
is that much of the data we use are not current. There is a need for more real-time
data so that consumers can weigh all factors and make informed decisions.
For health care consumers, it can be dangerous to use one factor, such as cost, to
make determinations about purchasing
services. There is no ‘blue-light special’
when it comes to health care. Consumers
need to determine their needs and find a
health care service that meets those needs
with quality service at an acceptable price.
It is the responsibility of the health care
industry to supply the education and information for consumers to make the appropriate decision for their needs.
Are insurers willing and/or able to offer cost
and quality information to members?
Actually, it is not a matter of whether
health care insurers are willing to offer this
type of information to consumers. We are
obligated to do so. Consumer-directed
health plans are placing the dollar in the
consumers’ hands and asking them to
make decisions. Therefore, they are entitled to as much information as we have so
they can make the best decisions for their
needs.
EDWARD MCCALLISTER is the chief information officer for
UPMC Health Plan. Reach him at [email protected] or
(412) 454-7710.
