Key Steps toward Affordable Health Insurance Platforms

January 15, 2016 - The average insured consumer is facing a whole new landscape when it comes to managing the costs of care. The prices surrounding health insurance plans and coverage options are rising steadily while wages and inflation rates remain relatively steady. This is all problematic for the everyday consumer and his or her family.

A 2015 Employer Health Benefits report from the Henry J. Kaiser Family Foundation discovered that the average annual premiums for employer-sponsored healthcare coverage were $6,251 for individual plans and $17,545 for family plans.

This is a rise of 4 percent since 2014 while inflation rates decreased by 0.2 percent and wages rose by only 1.9 percent. The most troubling statistic is that the costs of premiums for family health plans jumped 27 percent over the last five years.

Another survey from both The New York Times and the Kaiser Family Foundation found that one in five individuals who have healthcare coverage are finding it difficult to pay their medical bills. Additionally, 53 percent of people without health insurance are finding it challenging to cover their healthcare costs.

The patient advocacy group Partners for Better Care is attempting to change these troubling statistics and bring about quality, affordable, and accessible healthcare services with greater cost transparency among health insurance companies and providers. To learn more about the organization’s plans for helping health payers address consumer needs, HealthPayerIntelligence.com spoke with Mary Richards, Executive Director at Partners for Better Care.

When asked how the federal government can bring more affordable, accessible, and better quality healthcare to the American people, Richards answered, “Partners for Better Care is a coalition for patient advocacy with many experts in individual spaces interested in developing patient-centered quality care. Quality care exists but not all people have the same access.”

“There are a couple of things that can be done to ensure that quality care is accessible to millions of Americans we represent,” she continued. “We see that availability is a huge question and the ability to determine if you have access to affordable care is necessary.”

“Let me be specific - As Americans are increasingly obtaining health options through the exchange, employers, or different models of payment through Medicaid, being able to discern and determine up-to-date and easy-to-access information including therapy caps and out-of-pocket costs through various mechanisms – that transparency – that kind of information is hard to find if one can find it at all.”

“As a coalition, we’ve been looking at these issues for a long time,” Richards explained. “As healthcare stakeholders come together to discuss these issues, patients living with multiple chronic conditions should be a part of the discussion. In order to develop patient-centered, quality care, we need to work toward representing people with chronic conditions and really bring that perspective and make it understood.”

When asked how health payers could work toward educating consumers about covered services and actual out-of-pocket costs, Mary Richards responded, “I think one of the things that we think as important as Partners for Better Care is transparency of cost and information.”

“We want people to have access to good information during enrollment periods and also throughout the year,” she mentioned. “Simply making sure that a fairly detailed level of information is available and essential prior to enrollment is a real necessity.”

“Partners for Better Care will be digging into ways to answer that question further. We are finalizing a patient charter to rally around and build an action agenda. I do expect payers can ensure patients have access to cost as well as value, which is a core function of what we’ll be advocating for.”

“Payers are thinking about it,” she continued. “There are all sorts of new ways payers are looking to provide more information. We see 2016 as the year of greater patient and healthcare dialogue.”

In reference to the question ‘How can health payers engage consumers and ensure that they will get needed care?’ Mary Richards positioned, “Partners for Better Care represents 10 million people living with chronic conditions. We make sure many advocacy groups are looking at these issues. We attempt to uncover where middle class Americans stand on these issues.”

“We saw problems associated with health costs reflected in the Kaiser Family Foundation report released a week ago,” she went on. “While we have a sophisticated client base, there is a lack of literacy in healthcare. We need to find ways to unpack the glossary of terms.”

“Folks who are busy and intelligent still need plenty of tools to understand these terms. While co-pays and deductibles are well understood, other formulary ideas are less well understood,” Richards elucidated. “We look to increase healthcare literacy.”

“We have heard from advocates like the Parkinson’s Network that few patients with Parkinson’s disease don’t have some other health concern, so many with chronic conditions suffer from multiple medical problems.”

“Many patients may have questions about monthly prescriptions such as Parkinson’s drugs, medications for heart disease, or Diabetes drugs,” she continued. “Patients need to be able to access this information. Some folks are spending days looking for that information. As of today, it takes a couple of weeks for folks to understand what their out-of-pocket costs look like.”

When asked what steps health insurance companies and federal agencies can take to really make healthcare more affordable and provide better options to the consumer base, Richards answered, “I think one of the things we’ve uncovered is that, when patients are involved in their own care, we see better outcomes and lower cost.”

“Payers need to include the experience of patient advocates. Patient advocates need to be at the table to discuss what quality care looks like,” Richards mentioned. “Payers need to make sure that those folks living with chronic conditions are also at the table to participate in the conversation in order to improve health outcomes.”

“Leaving the patient voice behind is a mistake,” she concluded. “You need those stakeholders in a full and meaningful discussion. It’s just like when the healthcare system doesn’t leave out the pharmacist when discussing drug delivery. Patients have an important part in the system.”