Four priorities your health plan must embrace to thrive in the future
Priority #2: Price transparency
The health plan of the future will provide consumers with the tools to evaluate and navigate the healthcare system, says Walsh. “These tools will be customized to individual values and preferences and will include interaction with physicians. Care and coverage will be more integrated—as consumers evaluate how to finance their care.”
HealthPartners uses measurement tools, such as the Total Cost of Care, to provide members with tailored cost information, Walsh says. “On either a desktop computer or a mobile phone, members can search for specific procedures and see the detailed out-of-pocket cost to them. The information is personalized based on their benefits and how much of their deductible they’ve met. Consumers can view that alongside information about the quality of the provider. This helps members find the highest-quality, most affordable care in each situation.”
When it comes to plan selection overall, Geraty envisions consumers selecting among plans available in individual markets and employer markets based on cost. For the individual markets, there will likely be three main options, he says:
1. An expensive option, offering full benefits and broader networks.
2. A higher-deductible, lower-cost option with significant copays. These plans are suited for catastrophic care only, and can be a good choice for younger, healthier populations.
3. A middle option that offers more choices for deductibles, copays, providers, and price and benefits options that vary with the wishes of the individual.
Employer markets will offer two options:
1. A plan selected by the employer with defined benefits and contributions (currently the most widely offered plan).
2. A secondary option giving employees the ability to choose a plan through private exchanges, with defined contribution from the employer, and the individual paying the balance.
Over time, James predicts that in addition to cost transparency, more consumers will demand transparency around value. “Transparency tools have made employers and plan members more aware of price, but quality is still largely a black box; there is no consumer report for health plans. In the future, it’s going to be critically important for consumers to understand the value and outcomes they’ll get from their plan, as well as other coverage options available.”