Even with a working website, we must tackle healthcare’s opacity

November 22, 2013

Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us.

Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance marketplaces — assuming Healthcare.gov will remedy the basic functionality issues that have dogged it in the weeks since launch.

Beginning January 1, 2014, everyone will be required by law to have health insurance; the marketplaces will help consumers find and purchase new plans. But what happens then? Are there easily available doctor appointments covered by these plans, or will patients come up empty-handed when seeking care? Is an insurer’s online directory up-to-date or wildly inaccurate? Which plans have better customer service and which have none?

As patients, it’s vital to know the level of care access an insurance policy will actually provide. Without this basic consumer information, your brand new insurance card is like a mystery phone. All you can do is carry it in your pocket and hope that it gives you the coverage you need, when you need it, at a price you can manage. In reality, it may fail you when you need it most.

This is the opacity American patients have become accustomed to, and it is deeply problematic. Healthcare is perhaps the most important service we consume — but as consumers, we are far less well-informed than when we shop for travel, leisure, electronics, cuisine, et cetera.

Unfortunately, insurance plans differ enormously in the accessibility of care that they provide. In independent research my company conducted to create Care Access Grades listed on HealthMarketplace.com, we found that some insurance directories are relatively accurate, while some have an abhorrently low 20 percent accuracy quotient. We also found that doctor availability is over 1000 times better in some health plans than in others.

The consequences for patients and for the healthcare system are not trivial. Consider the patients who cannot find a doctor in time to treat problems early. They frequently end up in overcrowded emergency rooms, where health outcomes are worse and treatment is four times as expensive. These inefficiencies and poor results are so commonplace they escape notice.

The risk of making a poor coverage choice is especially great for currently-uninsured Americans who will soon purchase ACA-mandated policies; many of these shoppers will unwittingly end up in “narrow networks.” These plans carry small groups of carefully selected providers, making it incredibly important that patients can assess their availability before purchasing. According to a recent, unpublished McKinsey and Company study (described by the Healthcare Financial Management Association), nearly half of new ACA plans will be of the narrow network type. Even savvy ACA healthcare consumers are left simply hoping that their insurer does not railroad them into a plan with invisible defects.

It is high time that we recognize transparency as more than an amenity; it is an essential aspect of a functional healthcare system, and we are suffering in its absence. Both the private and public sectors have an incumbent responsibility to foster it in their own domains.

That means we need to bring robust, verified, data-driven performance indicators (like closed-loop consumer feedback and doctor availability) to the insurance shopping experience. Conversely, we need to see patient feedback as an asset and an opportunity, rather than as a liability. We must realize that the “data plan” is just as important for patients as the “phone” itself.

Moving toward transparency will require widespread and varied effort from insurers, providers, hospitals, and healthcare IT entrepreneurs, but the end goal is simple and shared: create an environment in which patients have the information they need to make responsible decisions.

If we fail, we risk contributing to the inefficiencies and inadequacies of the healthcare system we all know today. If we succeed, we can look forward to more consumer empowerment — and better, more efficient healthcare — for everybody.

PHOTO: Doctors and nurses work on a patient in the Ryder Trauma Center at Jackson Memorial Hospital in Miami, Florida  September 30, 2013. REUTERS/Joe Skipper

One comment

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Insurance in inherently non-transparent. Every insurance company has an angelic side that sells you your insurance and tells you they are your friendly neighbor who is always there and you are safe with them. Every insurance company also has a devilish side, the adjustors, whose job it is to pay out as little as possible. They know the fine print by heart and they have better,meaner lawyers than you do.

The only sure thing about insurance is that you and I pay premiums.

Posted by Oma | Report as abusive