Open enrollment season is upon us and employees are scrambling to find the best health benefits package for the right price. But this year is different — consumers are responsible for more of their own healthcare costs than in the past. Employers can play a critical role by promoting useful benefits solutions that are powerful, easy to use and save members money. This will result in a healthier and more productive workforce.
Empowered Patients Vs. Empowered Consumers
Framing patients as consumers is a new development that reflects their growing involvement in healthcare. Patients receive care while customers make choices. Engaged patients follow treatment regimens from their physicians, but engaged consumers are responsible for their health status and associated costs. An empowered healthcare consumer has the knowledge, ability, resources and motivation to identify and make healthy choices.
Healthcare Reform and the Rise of the Empowered Consumer
So how did we get here? The healthcare consumer concept emerged after the passage of the Affordable Care Act. It served as a framework designed to boost health status while cutting healthcare expenditures. The logic goes that if individuals are responsible for their own healthcare spending, they’ll make wiser and less costly decisions regarding the services they obtain. In 2018 the Cadillac tax will go into effect as part of the Affordable Care Act. Employers that provide generous health benefits, defined as plans exceeding $10,200 for an individual and $27,500 for a family, will face a 40% tax. Smart and proactive companies have already taken steps to ensure that their plan designs meet the needs of their employees after the tax is in place. For example, high deductible health plans (that place the onus on employees to pay for their own healthcare spending) are proliferating. With this newfound autonomy in the healthcare spending equation, patients have been reframed as “consumers” who have the power to select where they obtain care. However, consumers require the knowledge to make educated decisions about their healthcare. Only technology can provide this information in a timely and accurate manner.
Why Do Healthcare Consumers Need Technology?
The problem with consumer healthcare is that our current technology solutions don’t always help consumers acquire the right knowledge to make decisions. On the pharmacy side, plan information should be aggregated and presented to consumers in order to help them find medications. On the cost side, prices should be exposed to consumers so that they can make the best health and financial decisions given their circumstances.
In theory this transparency empowers consumers, but in practice it’s difficult to achieve. Employers could end up sitting on the sidelines as their employees struggle to manage their health and spending. However, there are steps that companies can take to support their workers’ healthcare journeys.
Case Study: Fostering Pharmacy Benefits Transparency with OneRx
Costs across healthcare are rising and consumers are feeling the pinch more than ever before. But the price of medications has experienced a particularly dramatic rise, increasing over 10% in the past year. High deductible health plans are compounding these issues, as workers are expected to pay for more of their own prescription drug costs. Consumers usually don’t know how much a drug will cost until they get to the pharmacy. Prices vary widely by pharmacy and it’s sometimes cheaper to pay the cash price for a drug instead of using insurance. It’s difficult or impossible to know what’s covered by a formulary or the details of a pharmacy benefits plan when you’re filling prescriptions and on the go. It’s imperative that employers enable price transparency for medications — we cannot expect patients to be good consumers if they don’t have pricing information readily available.
OneRx is a free mobile app that allows users to compare the lowest prices on prescription drugs at local pharmacies. It’s the first solution that meets the needs of both insured and uninsured Americans. Employees can input their insurance details and search for medication prices, then compare how much it will cost them with or without insurance.
This is integral — according to Truveris’ research, 35% of covered individuals do not realize that it can be cheaper to pay for medications using savings solutions like coupons and discounts, rather than their healthcare plan.
Employees can track their deductible spend and receive alerts about any barriers to filling prescriptions, like prior authorizations, as well as changes to their formularies (for example, if a cheaper generic drug becomes available).