An Innovative Solution to Rising Healthcare Costs

Time to start putting more emphasis on 'health' than 'care'

by Mark S. Gaunya, GBA

The Problem

Healthcare costs are soaring. American healthcare spending reached $2.9 trillion in 2014 – and will exceed $4 trillion by 2018 if left on its current course. The Affordable Care Act (ACA) is exacerbating the problem through additional taxes, fees and assessments.

After many failed attempts to control these costs, it’s time to rethink the word “healthcare” by putting more emphasis on health and less on care. A paradigm shift is needed, and this starts by seeing ourselves as consumers of healthcare who are in control of what our dollars purchase, and not as patients who passively accept what’s offered by physicians or an employer’s health plan.

The Cause

Traditional health insurance options haven’t just failed to stop the bleeding – they have also kept us in the dark and robbed of us our choices. Everyone is responsible for a small part of healthcare spending, and individuals have the power to turn the situation around. Consumers have a big role in getting healthcare spending under control, but most healthcare users don’t understand how their choices have contributed to the current challenge. They don’t understand the true costs of their lifestyle choices and the impact those choices have on the cost of healthcare Did you know that from 2004 to 2014, the average cost of Lasik eye surgery rose by 15%, much slower than the overall rate of inflation.

By comparison, healthcare spending increased by 107% over that same period. Lasik is an elective surgery not covered by insurance; those who decide they want or need the procedure pay for it out of their own pockets. Because it’s their money they’re spending, they’re unlikely to make frivolous decisions—they won’t, on a whim, run to a Lasik eye surgeon to undergo a costly and invasive procedure without first doing their homework.

Medical procedures paid for with consumers’ hard-earned money are carefully researched, considered, and weighed against other options. It’s what an informed healthcare consumer does. In contrast, most consumers are unaware of the actual costs of the healthcare services covered by their insurance plans. When billing and payment are arranged between doctors and insurance companies, consumers don’t think twice about going to the doctor or getting a prescription filled. For most consumers, it’s just a co-pay.

Simply put, when there isn’t a “real cost” associated with medical care, consumers won’t take the time to consider the cost or whether they really need the service they’re seeking – this kind of behavior leads to unnecessary use of healthcare and drives up cost.

The Current Solution

The difference between using traditional managed-care techniques to reduce costs and helping consumers monitor their own behaviors and healthcare spending is driven by one major factor: motive. Consumers are focused on saving money, especially when it’s their own.

Their focus on money is tempered by attention to their health. By becoming better informed about the care they receive and the lifestyle choices they make every day, consumers not only avoid using the system unnecessarily but also guarantee their health is the #1 priority for them and their families. That mindset benefits their employers and the insurance companies underwriting their risk.

A New Approach

Real behavior change isn’t easy and your employees need help learning how to make more informed choices and live a healthier, more responsible lifestyle. How do you help them? By implementing a Consumer-Driven Health and Wellness Plan (CDHP), you can build a culture of health and well-being and tailor its design to meet the unique needs of your employees and their families.

Consumer-driven health plans (CDHP) are health insurance plans that combine a lower premium, high deductible health plan (HDHP) with a healthcare account and a commitment to health and well-being. The tax-preferred money contributed to a healthcare account, combined with some out-of-pocket expenses, covers healthcare spending up to the amount of the annual deductible.

This health insurance solution is highly effective because of its philosophy, which is governed by three principles: transparency, responsibility, and opportunity.

Principle One: Transparency

In a traditional health insurance plan, a consumer goes to a health services provider without considering the visit’s cost. In most cases, all the consumer pays toward the cost of the service is his or her co-pay. The inherent design of this health insurance product hides the rest of the cost from the consumer. Without knowing the true costs, consumers have no incentive to consider their options and choose the most appropriate, cost-effective treatment.

Principle Two: Responsibility

With knowledge comes responsibility. Consumers have a responsibility to live a healthy lifestyle and mitigate health risk issues (i.e., diet, exercise, sleep and stress). They also have a responsibility to understand the value of the health services they receive – it’s up to them to make informed decisions about how they use them and carefully consider their options in a non-emergency situation.

A responsible decision about using health services could be as simple as speaking to a nurse or taking a day off work to rest instead of making a trip to the doctor. In most cases, consumers can access the health insurance company’s network of urgent care clinics or access a nurse help line for medical advice instead of going to the emergency room for non-emergencies. The help lines are staffed by nurses specifically trained to answer symptom-based questions and provide guidance.

Principle Three:

Opportunity The CDHP and Wellness solution comes with opportunities for the consumer to benefit physically and financially. Beyond improving the consumer’s health and general well-being, participating in a CDHP and Wellness plan offers significant financial advantages to the consumer in the form of unused dollars, which can be carried forward for future healthcare expenses.

Closing Thoughts

Health insurance is expensive because healthcare is expensive – and the ACA is forcing massive change in coverage and cost requirements. By making healthcare cost and quality information transparent and engaging, educating and empowering consumers, we might just be able to Bend the Healthcare Trend (www.bendthehealthcaretrend.com).

Adopting a CDHP and Wellness strategy is proven to help you control rising healthcare costs, improve the health and well-being of your employees and help them set “set aside” financial resources for future healthcare needs. It won’t be easy – nothing good ever is – but the return on investment of time, energy and resources is immeasurable and sustainable.

When you stop and really think about it, you can only control so much – what’s in your control to solve our healthcare crisis? It’s called shared responsibility and personal accountability. What does that mean? It means CDHP and Well-being.