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    The key to understanding consumer-centric healthcare

    For over a decade, we have seen the steady rise of consumerism in healthcare. Far more than an emerging trend, it is now something that will dramatically alter the U.S. healthcare delivery system...for the better.


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    The changes that have occurred thus far are likely to pick up speed, in part because of who will be working for the White House. Trump’s choice for Secretary of Health & Human Services, Tom Price, MD, is a supporter of consumer-centric health plans. Further, Vice President Mike Pence brings with him experience as governor of Indiana where he oversaw the implementation of consumer-centric healthcare policies. Adding to that, Pence’s health plan architect was Seema Verma, who’s been tapped to head the Centers for Medicare & Medicaid Services (CMS).

    The essentials of consumer-centric healthcare include empowering the patient to make choices, be involved in the decision-making process for her/his care and, it should be emphasized, understand what the costs are upfront by way of transparent pricing and candid conversation.

    The driver behind this consumerism is the emergence of high-deductible health plans (HDHP). Back in the day, a patient’s financial responsibility for their healthcare was often a single digit percentage of the cost, if that. Now, with HDHPs, a patient is confronted with 30% to 50% of the financial responsibility for their care.

    It is simplistic to label high deductibles as the villain. At the heart of Indiana’s Healthy Indiana Plan (HIP 2.0) for Medicaid patients, is an HDHP along with a health savings account (HSA) that is built by plan members paying 2% of their income into it each month, along with subsidies from the state. Until their deductibles are reached, patient payments can be made from the HSA. On the surface, this is pretty standard stuff. Interestingly, a report issued in July 2016 by the Lewin Group found that the plan helped to:

    ●      Reduce the number of uninsured low-income Indiana residents and increase access to healthcare services

    ●      Promote personal health responsibility

    ●      Promote disease prevention and health to achieve better health outcomes


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    Along with those accomplishments, the study found plan member satisfaction rates were high, with 80% indicating they were satisfied with the program. These members also engaged with their healthcare process. For example, 42% checked the balances in their accounts every month and 27% asked providers about the cost of care. Just 1% to 2% of members missed an appointment because of cost. Lastly, Indiana reported that a varying co-payment feature for emergency department use resulted in fewer inappropriate uses of emergency services as compared to the traditional Medicaid benefit.

    Next: All too often, attention is placed on the clinical side of healthcare


    Tom Furr
    Tom Furr founded Durham, North Carolina-based PatientPay, a patient payment solutions company that offers online billing, collection and ...


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