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Get smart, get healthy

Consumer patients drive new push for understanding medical benefits

By James Mitchell

Page 40

Before people fully understand insurance costs and deductibles in a post-Affordable Care Act (ACA) world, providers and employers say that some basic education must come first.

“Health care is very complex for any individual to figure out,” said Andy Hetzel, vice president of communications at Blue Cross Blue Shield of Michigan. “Becoming literate in the terminology is like asking someone to learn a new language.”

It’s a complicated dialect with terms and phrases that, a generation ago, were the province of benefits specialists and human resources departments. Card-carrying employees didn’t have to do much more than take care of minimal copays for office visits and prescriptions.

That formula has reversed. Today’s patients are customers who pay a higher percentage of deductibles and premiums, money spent by a health-conscious society with seemingly endless choices to make for care and treatment.

“People have more accountability for managing their own costs and accessing the services they need. It’s incumbent for us in health care to understand that,” Hetzel said.

For about seven years, the company has explored how to get their message out through online forums and social media platforms, but also how to understand patient questions.

“Listening is a major component of using social media well,” Hetzel said. “The content is there because people are talking about it.”

Survey Says: Is the Price Right?

This brave new world of health care is an unprecedented opportunity for an informed public to take charge of their treatment – and costs – provided they understand the terms.

“Consumers now have to be shoppers,” said Jonathan So, senior director of health care initiatives at the Detroit Regional Chamber. “They have to now be good patients and good consumers. They need to be more engaged in their care and spend the right amount of money for the best outcome. The price of something doesn’t necessarily mean it’s better.”

So said the health care landscape began shifting even before the ACA, influenced by across-the-board cost increases. Inflation on the supply end went hand-in-hand with consumers bearing increased responsibilities for higher deductibles and copays.

Improving health care literacy begins with baseline knowledge of the state of public literacy on the subject. A national study, a joint venture between the University of Michigan and the Detroit Regional Chamber’s Health Forward initiative, is underway to determine a starting point for that education.

“There’s a lot of noise in the system,” So said. “But which information is good? How do we get that into the bands of consumers? You can get a lot of information, but that doesn’t always translate to using it to make the best decision.”

Health Smart, Cost Smart

The need for consumer education has never been more pronounced for both health and financial reasons, said Jeffrey Kullgren, assistant professor of internal medicine at the University of Michigan.

“Patients can and should be more involved,” Kullgren said. “The practical reality is that consumers are paying more out-of-pocket before their insurance kicks in.”

Kullgren said one-third of American adults whose insurance comes from an employer or a private purchase are enrolled in high-deductible plans, which have deductibles beginning at $1,300 or more for individuals and $2,600 or more for a family.

“Those plans demand that consumers are more knowledgeable and use money wisely to get the most help,” Kullgren said. “That’s the current landscape.”

Along with consumer awareness and outreach by insurance carriers, the providers themselves are under increased pressure to provide services and information about health care options.

“Their expectations are high for transparency,” said Susan Greene, director of occupational health at Henry Ford Health System. “We have obligations to keep them safe and give them access (to information). They expect us to heal them, give them the right care, and not waste their time and money.”

Greene said Henry Ford has put a priority on educating consumers and, in a competitive market, encourage patients to become their own best advocate through screenings, treatment plans and wellness programs.

“We’re excited that the needle is moving toward health,” Greene said. “Employers are leery of the escalating costs, and this is a way to take matters into their own hands.”