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 firstname.lastname@example.org or (412) 454-7710.