How Consumer Engagement Brings Better Coverage Decision-Making

November 30, 2015 - Consumer engagement and awareness is key when payers aim to raise their enrollment rates before the enrollment period rolls around. First, it is vital to improve the health literacy of the everyday consumer so that these individuals understand which plan best suits their health needs.

The Advisory Board Company mentioned that workshops can be beneficial for consumers looking to learn more about health insurance terms and select the best healthcare coverage plan for their family. By providing greater education to the public regarding health insurance, consumer engagement will be high and many will be more prone to selecting a plan from you – the payer.

As more insurers and providers move away from fee-for-service payment models – which may have brought rising healthcare costs for all – and position themselves to adopt alternative payments and value-based reimbursement arrangements, patient engagement will continue to play a major role in the decision-making process of healthcare coverage.

Today, the federal and state health insurance exchanges offer a variety of choices for the individual consumer while employers provide additional opportunities for healthcare coverage. The Health Affairs publication reported how one payer – UnitedHealthcare – was using consumer engagement to better support its beneficiaries.

The national payer analyzed data to identify any gaps in healthcare, used valuable information to help consumers determine the best treatment decisions, and allowed their consumer base to compare costs and provider quality. Additionally, the payer used financial incentives to stimulate their patient base in preventing disease and improving their overall health and wellness.

For example, those enrolled in one UnitedHealthcare program can receive premium reductions if they ensure diagnostics like cancer screenings are completed and they achieve certain reductions in their body mass index throughout twelve months.

“Since the Rewards for Health program launch, UnitedHealthcare has seen significant improvements in both quality and cost for its employee population. In the program’s first 24 months, 82 percent of employees earned points, and improvements were made in all quality measures over three years, with particularly large increases identified in wellness visits and office-based screenings, colorectal cancer screenings, and retinal eye exams for people with diabetes,” the Health Affairs article reported.

“[The] experience at UnitedHealthcare shows that rewarding healthy behavior works… Were likeminded strategies to be used more broadly, they could be an effective tool in helping to improve consumer health, achieve wide-scale cost reductions, and advance a higher-performing health system in America. It’s time for broad-based national action to focus on health, including designing effective incentives to activate consumers and stimulate healthy behavior.”

Consumers also benefit from being able to access key health insurance information electronically and essentially having their questions answered through a portal system. These types of patient engagement programs can play a major role in ensuring those enrolled in a plan will continue to choose similar coverage options.

While providers focus on increasing engagement, payer-supported consumer engagement can also impact the healthy behaviors of the general public. It is time to focus on creating a more engaged and health-oriented consumer base.

A brief from Health Affairs mentions how overall medical costs can be reduced with greater patient engagement. This may be due to the fact that patients who are actively engaged in their overall health tend to have better outcomes.

Many organizations including payers are now putting their focus on consumer engagement including helping them make more decisions on their coverage options and provider network choices. A large part of ensuring better outcomes, lower costs, and greater patient engagement is to incentivize patients to receive preventive care and follow healthy behaviors like exercising regularly. Payers can do so through premium reductions and other incentive programs.

The brief outlined several levels of patient and consumer engagement including direct patient care in which patients and doctors discuss the diagnosed condition and treatment preferences, healthcare organizations seeking consumer input with regard to patient needs, and voting rights on public health policies or laws.

“One strategy consistent with the first level of engagement… is shared decision making, in which patients and providers together consider the patient's condition, treatment options, the medical evidence behind the treatment options, the benefits and risks of treatment, and patients' preferences, and then arrive at and execute a treatment plan,” the brief stated.

“The strategy is often used with patients who have ‘preference-sensitive’ conditions or treatment options – that is, they may or may not choose particular treatments, or to be treated at all, depending on their own feelings about the risks versus the benefits of treatment, their ability to live well with their conditions, or other factors.”

Greater consumer engagement is also vital because it could truly move providers away from the fee-for-service approach and reduce unnecessary tests or procedures. This is because when given real choices in treatment, patients tend to choose less invasive and thereby less expensive procedures, Forbes reports. It is also important to note that the more invasive procedures can often be medically unnecessary and cost more.

Payers can work with providers to ensure a more established relationship between primary care doctors and the patient base. By spending more time speaking to patients, less costly procedures, specialist visits, or even unnecessary prescriptions can be avoided. Currently, patient-centered medical homes are aiming in the right direction when it comes to increasing patient engagement as well as reducing unnecessary tests and wasteful spending.

Additionally, when it comes to end-of-life decisions, doctors are often incentivized to do more risky procedures and treatments that may have little chance of improving a patient’s quality of life or extend their lifespan. For example, it may be more beneficial to allow elderly patients and caregivers to decide on more pain-free, comfortable care with regard to end-of-life scenarios.

By moving away from fee-for-service reimbursement models and adopting consumer engagement initiatives, payers can offer greater incentives for their beneficiaries to adopt certain healthcare coverage plans.