At Pioneer, we’re advocates for greater usage of high deductible healthcare plans. Putting a high deductible in an insurance plan prompts a change in behavior, in aggregate, that results in lower utilization of healthcare and lower costs. The change is so dramatic that, in most cases, even when the employer funds a portion or all of the deductible, the cost savings on premiums is enough to result in savings.
But a sound philosophical and empirical basis doesn’t always mean that the implementation is going to be smooth. As a practical matter, my foray into actually using a plan has shown some substantial room for improvement by providers and insurers.
For someone like me, with a family and a handful of my own medical conditions, a high deductible plan results in a mountain of paperwork, rendering the “personal responsibility” side of managing my healthcare logistically impossible.
Here’s some of the challenges:
• Single episodes of care; multiple providers: Medical events that seem like a single episode of care result in bills from multiple parties. That trip to the emergency room ends up as a bill from the hospital, a physician’s practice, and one or more diagnostic entities (like radiology).
• Disconnect b/w doctors and plan design: In every single instance that I’ve mentioned my interest in minimizing costs to a doctor, they have been willing to work with me. The problem is they are not equipped with usable real-time access to information or background info on the myriad high deductible plan designs out there. Even with the best intentions, it’s hard for them to steer me to lower costs options.
• Limited decision making basis: A doctor suggests a diagnostic test and offers their in-house lab. Should I be calling alternative providers and shopping on the basis of cost? How would I do that? If I was aware of alternatives, what are my options in acute situations?
• Grey areas of coverage within a single procedure: Where it really gets murky is when different components of a medical procedure get split up as ‘covered’ and ‘uncovered’. The insurer’s benefit pamphlet has some simple references to this divide, but the reality is more complex. My CAT scan hits against my deductible but the radiologist who reads the CAT scan does not? In a single blood test series, certain tests are covered while I pay for others out of pocket. How would I know this?
• Inconsistent billing practices: Some providers bill on a discrete per-episode basis, while others bill on a cumulative basis. Most maddeningly, one Boston institution (looking at you, BIDMC) assigns a unique ID number to each episode of care (but not a unique billing ID number to each patient). So, if you use an online bill pay service, you’ve got to change the account number every time you pay a bill.
Each one of these items would be annoyance on its own. Put them together then multiply by life’s circumstance — multiple family members, multiple visits, and/or multiple specialists — and the result is a blizzard of bills and a proliferation of paperwork.
I’d love to be in a position to more aggressively manage my healthcare utilization and costs. But the reality is that the complexity of the billing process and the paucity of readily available comparative information makes it utterly impractical.
High deductible plans clearly hold down costs. But we have a long way to go before they truly empower consumers to actively participate in that process.
Also seen in Boston Magazine.