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Health Care Finance Leaders Look to Cut Costs and Improve Patients’ Financial Experience — Think AI and Venmo

One half-of health care financial leaders plan to invest in technology to cut costs — and most believe that AI has the potential to re-define the entire finance function as they look to Leading the transformation, a study conducted by U.S. Bank among U.S. health finance leaders thinking about emerging technologies.               U.S. Bank fielded a survey among 200 senior health care financial leaders in the U.S., 30% of whom were group CFOs, 20% regional/divisional CFOs, 25% senior managers, and the remaining various flavors of financial managers. All respondents were responsible for at least $100

 

Why Is So Much “Patient Experience” Effort Focused on Financial Experience?

Financial Experience (let’s call it FX) is the next big thing in the world of patient experience and health care. Patients, as health consumers, have taken on more of the financial risk for health care payments. The growth of high-deductible health plans as well as people paying more out-of-pocket exposes patients’ wallets in ways that implore the health care industry to serve up a better retail experience for patients. But that just isn’t happening. One of the challenges has been price transparency, which is the central premise of this weekend’s New York Times research-rich article by reporters Sarah Kliff and

 

Health Consumer Behaviors in the U.S. Stall, Alegeus Finds in the 2019 Index

In the U.S., the theory of and rationale behind consumer-directed health has been that if you give a patient more financial skin-in-the-game — that is, to compel people to spend more out-of-pocket on health care — you will motivate that patient to don the hat of a consumer — to mindfully research, shop around, and purchase health care in a rational way, benefit from lower-cost and high-quality healthcare services. For years, Alegeus found that patients were indeed growing those consumer health muscles to save and shop for health care. In 2019, it appears that patients have backslid, according to the

 

The Hospital CFO in the Anxiety Economy – My Talk at Cerner’s Now/Next Conference

As patients have taken on more financial responsibility for first-dollar costs in high-deductible health plans and medical bills, hospitals and health care providers face growing fiscal pressures for late payments and bad debt. Those financial pressures are on both sides of the health care payment transaction, stressing patients-as-payors and health care financial managers alike. I’m speaking to health industry stakeholders on patients-as-payors at Cerner’s Now/Next conference today about the patient-as-payor, a person primed for engagement. That’s as in “Amazon-Primed,” which patients in their consumer lives now use as their retail experience benchmark. But consumers-as-patients don’t feel like health care today

 

On Amazon Prime Day, What Could Health Care Look Like?

Today is July 15, and my email in-box is flooded with all flavors of Amazon Prime’d stories in newsletters and product info from ecommerce sites — even those outside of Amazon from beauty retailers, electronics channels, and grocery stores. So I ask on what will probably be among the top ecommerce revenue generating days of all time: “What could health care look like when Amazon Prime’d?” I ask and answer this in my book, HealthConsuming, as chapter 3. For context, this chapter follows two that explain how patients in the U.S. have been morphing into health consumers based on how health

 

What $285,000 Can Buy You in America: Medical Costs for Retirees in 2019

The average 65-year old couple retiring in 2019 will need to have a cash nest-egg of $285,000 to cover health care and medical expenses through retirement years, Fidelity Investments calculated. Fidelity estimates the average retiree will allocate 15% of their annual spending in retirement on medical costs. As if that top-line number isn’t enough to sober one up, there are two more caveats: (1) the $285K figure doesn’t include long-term care, dental services and over-the-counter medicines; and, (2) it’s an after-tax number. So depending on your tax bracket, you have to earn a whole lot more to net the $285,000

 

In the U.S., Patients Consider Costs and Insurance Essential to Their Overall Health Experience

Patients in the U.S. assume the role of payor when they are enrolled in high-deductible health plans. People are also the payor when dealing with paying greater co-payments for prescription drugs, especially as new therapeutic innovations come out of pipelines into commercial markets bearing six-digit prices for oncology and other categories. For mainstream Americans, “the math doesn’t add up” for paying medical bills out of median household budgets, based on the calculations in the 2019 VisitPay Report.  Given a $60K median U.S. income and average monthly mortgage and auto payments, there’s not much consumer margin to cover food, utilities, petrol,

 

Consumers Don’t Know What They Don’t Know About Healthcare Costs

The saving rate in the U.S. ranks among the lowest in the world, in a country that rates among the richest nations. So imagine how well Americans save for healthcare? “Consumers are not disciplined about saving in general,” with saving for healthcare lagging behind other types of savings, Alegeus observes in the 2018 Alegeus Consumer Health & Financial Fluency Report. Alegeus surveyed 1,400 U.S. healthcare consumers in September 2017 to gauge peoples’ views on healthcare finances, insurance, and levels of fluency. As patients continue to take on more financial responsibility for healthcare spending in the U.S., they are struggling with finances and

 

The Top Pain Point in the Healthcare Consumer Experience is Money

Beyond the physical and emotional pain that people experience when they become a patient, in the U.S. that person becomes a consumer bearing expenses and financial pain, as well. 98% of Americans rank paying their medical bills is an important pain point in their patient journey, according to Embracing consumerism: Driving customer engagement in the healthcare financial journey, from Experian Health. Experian is best known as the consumer credit reporting agency; Experian Health works with healthcare providers on revenue cycle management, patient identity, and care management, so the company has experience with patient finance and medical expense sticker shock. In the

 

Health Care for a Typical Working Family of Four in America Will Cost $28,166 in 2018

What could $28,166 buy you in 2018? A new car? A year of your child’s college education? A plot of land for your retirement home? Or a year of healthcare for a family of four? Welcome to this year’s edition of the Milliman Medical Index (MMI), one of the most important forecasts of the year in the world of the Health Populi blog and THINK-Health universe. That’s because we’re in the business of thinking about the future of health and health care through the health economics lens; the MMI is a key component of our ongoing environmental analysis of the

 

Having Health Insurance Is a Social Determinant of Health: the implications of growing uninsured in the U.S.

The rolls of the uninsured are growing in America, the latest Gallup-Sharecare Poll indicates. The U.S. uninsurance rate rose to 12.2% by the fourth quarter of 2017, up 1.3 percentage points from the year before. 2017 reversed advancements in health insurance coverage increases since the advent of the Affordable Care Act, and for the first time since 2014 no states’ uninsured rates fell. The 17 states with declines in insurance rates were Arizona, Colorado, Florida, Hawaii, Illinois, Indiana, Iowa, Missouri, New Mexico, New York, North Carolina, South Carolina, Texas, Utah, Washington, West Virginia, Wisconsin, and Wyoming. Among these, the greatest

 

Universal Health Care and Financial Inclusion – Two Sides of the Wellness Coin

Two weeks in a row, The Economist, the news magazine headquartered in London, included two special reports stapled into the middle of the magazines. Universal health care was covered in a section on 28 April 2018, and coverage on financial inclusion was bundled into the 5th May edition. While The Economist’s editors may not have intended for these two reports to reinforce each other, my lens on health and healthcare immediately, and appreciatively, connected the dots between healthcare coverage and financial wellness. The Economist, not known for left-leaning political tendencies whatsoever, lays its bias down on the cover of the section here: universal healthcare

 

Majority Rules? The Right to Affordable Health Care is A Right for All Americans

If we’re playing a game of “majority rules,” then everyone in America would have the right to affordable health care, according to a new poll from The Commonwealth Fund. The report is aptly titled, Americans’ Views on Health Insurance at the End of a Turbulent Year. The Fund surveyed 2,410 U.S. adults, age 19 to 64, by phone in November and December 2017. This is the sixth survey conducted by the Fund to track Americans’ views of the Affordable Care Act; the first survey was fielded in mid-to-fall 2013. 9 in 10 working-age adults say “yes” indeed, my fellow Americans

 

Consumer Health and Patient Engagement – Are We There Yet?

Along with artificial intelligence, patient engagement feels like the new black in health care right now. Perhaps that’s because we’re just two weeks out from the annual HIMSS Conference which will convene thousands of health IT wonks, users and developers (I am the former), but I’ve received several reports this week speaking to health engagement and technology that are worth some trend-weaving. As my colleague-friends Gregg Masters of Health Innovation Media (@2healthguru) and John Moore of Chilmark Research (@john_chilmark)  challenged me on Twitter earlier this week: are we scaling sustained, real patient engagement and empowerment yet? Let’s dive into the

 

Health Insurance Costs Stress US Whether We’re Rich or Not / and Why a $0 Budget for CFPB Matters for Healthcare

Health care costs cause anxiety for U.S. adults, regardless of their affluence, we learn in Uncertainty About Healthcare, the latest Stress in America poll from the American Psychological Association. The big stat is that 2 in 3 Americans say the cost of health insurance is a stressor for them or their loved ones, whether the person earns more or less than $50,000 a year. Underneath that top-line are some demographic differences. Millennials are most concerned about access to mental health care compared with Boomers and older adults. Reproductive care access is of most interest to Millennials and Gen Xers. Two-thirds

 

In the U.S., Spend More, Get Less Health Care: the Latest HCCI Data

Picture this scenario: you, the consumer, take a dollar and spend it, and you get 90 cents back. In what industry is that happening? Here’s the financial state of healthcare in America, explained in the 2016 Health Care Cost and Utilization Report from the Health Care Cost Institute (HCCI). We live in an era of Amazon-Primed consumers, digital couponing, and expectations of free news in front of paywalls. We are all in search of value, even as the U.S. economy continues to recover on a macroeconomic basis. But that hasn’t yet translated to many peoples’ home economics. In this personal

 

Healthy Living in Digital Times at CES 2018

Connecting Life’s Dots, the organization Living in Digital Times partners with CES to deliver conference content during the show. At CES 2018, LIDT is connecting a lot of dots to help make health streamline into daily living. Robin Raskin, founder, kicked off LIDT’s press conference setting the context for how technology is changing lifestyles. Her Holy Grail is to help make tech fun for everybody, inclusive for everybody, and loved by everybody, she enthused. LIDT has been a presence at CES for many years, conceiving the contest the Last Gadget Standing, hosting  tech-fashion shows with robots, and supporting a young innovators

 

Patients Continue to Grow Healthcare Consumer Muscles, Alegeus’s 2017 Index Finds

Patients’ health consumer muscles continue to get a work out as more people enroll in high-deductible health plans and face sticker shock for health insurance premiums, prescription drug costs, and that thousand-dollar threshold. The 2017 Alegeus Healthcare Consumerism Index finds growth in patients’, now consumers’, interest and competence in becoming disciplined about planning, saving, and spending for healthcare. Overall, the healthcare spending index hit 60.1 in 2017, up from 54.4 in 2016. This is a macro benchmark that represents most consumers exhibiting greater healthcare spending engagement with eyes on cost as well as adopting purchasing behaviors for healthcare. Underneath that

 

The Patient as Payor – Consumers and the Government Bear the Largest Share of Healthcare Spending in America

The biggest healthcare spenders in the United States are households and the Federal government, each responsible for paying 28% of the $3.3 trillion spent in 2016. Private business — that is, employers covering healthcare insurance — paid for 20% of healthcare costs in 2016, based on calculations from the CMS Office of the Actuary’s report on 2016 National Health Expenditures. The positive spin on this report is that overall national health spending grew at a slower rate in 2016, at 4.3% after 5.8% growth in 2015. This was due to a decline in the growth rates for the use of

 

The Patient Is The Vector: Health 2.0 – Day 2 Learnings

  Question: “What is the opposite of ‘patient-centered care?'” asked a panelist on Day 1 of the 11th Annual Health 2.0 Conference. Answer: “‘Physician-centered care.'” Even physicians today see the merits of patient engagement, as this survey from New England Journal of Medicine found earlier this year. Since the launch of the first Health 2.0 Conference in 2007, the patient has played a growing role in session content and, increasingly, on the big stage and panel breakout sessions. A panel I attended on Day 2 convened five developers of patient engagement platforms and digital tools to help healthcare look and

 

Out-Of-Pocket Healthcare Costs Grow in the Family Budget

For each dollar spent on healthcare in the United States, families paid 28 cents, according to the U.S. National Health Expenditure Accounts for 2015. Welcome to the new era of Americans and medical banking, with new insights provided by the largest of banks, JP Morgan Chase, in Paying Out-of-Pocket: The Healthcare Spending of 2 Million U.S. Families, from JP Morgan Chase. Chase is the largest bank in America based on its assets. They’ve mined 2.3 million de-identified records of Chase consumers in their banking network to learn about customers’ healthcare spending. These data represent spending between 2013 and 2016, detailed

 

Patients’ Healthcare Payment Problems Are Providers’, Too

Three-quarters of patients’ decisions on whether to seek services from healthcare providers are impacted by high deductible health plans. This impacts the finances of both patients and providers: 56% of patients’ payments to healthcare providers are delayed some of the time, noted in Optimizing Revenue: Solving Healthcare’s Revenue Cycle Challenges Using Technology Enabled Communications, published today by West. Underneath that 56% of patients delaying payments, 12% say they “always delay” payment, and 16% say they “frequently delay” payment. West engaged Kelton Global to survey 1,010 U.S. adults 18 and over along with 236 healthcare providers to gauge their experiences with

 

A Couple Retiring Today Will Need $275,000 For Health Care Expenses

A 65-year-old couple in America, retiring in 2017, will need to have saved $275,000 to cover their health and medical costs in retirement. This represents a $15,000 (5.8%) increase from last year’s number of $260,000, according to the annual retirement healthcare cost study from Fidelity Investments. This number does not include long-term care costs — only medical and health care spending. Here’s a link to my take on last year’s Fidelity healthcare retirement cost study: Health Care Costs in Retirement Will Run $260K If You’re Retiring This Year. Note that the 2016 cost was also $15,000 greater than the retirement healthcare costs calculated

 

Price-Shopping for Healthcare Still A Heavy Lift for Consumers

Most U.S. consumers support the idea of price-shopping for healthcare, but don’t practice it. While patients “should” shop for health care and perceive differences in costs across providers, few seek information about their personal out-of-pocket costs before getting treatment. Few Americans shop around for health care, even when insured under a high-deductible health plan, conclude Ateev Mehrotra and colleagues in their research paper, Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information. The article is published in Health Affairs‘ August 2017 issue. The bar chart shows some of the survey results, with the top-line finding

 

Pharmacy and Outpatient Costs Will Take A Larger Portion of Health Spending in 2018

Health care costs will trend upward by 6.5% in 2018 according to the forecast, Medical Cost Trends: Behind the Numbers 2018, from PwC’s Health Research Institute. The expected increase of 6.5% is a half-percentage point up from the 2017 rate of 6.0%, which is 8% higher than last year’s rate matching that of 2014. PwC’s Health Research Institute has tracked medical cost trends since 2007, as the line chart illustrates, when trend was nearly double at nearly 12%. The research consider medical prices, health care services and goods utilization, and a PwC employer benefit cost index for the U.S. The key

 

As High Deductible Health Plans Grow, So Does Health Consumers’ Cost-Consciousness

A person enrolled in a high-deductible health insurance plan is more likely to be cost-conscious than someone with traditional health insurance. Cost-consciousness behaviors including checking whether a plan covers care, asking for generic drugs versus a brand name pharmaceutical, and using online cost-tracking tools provided by health plans, according to the report, Consumer Engagement in Health Care: Findings from the 2016 EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey from EBRI, the Employee Benefit Research Institute. A high deductible is correlated with more engaged health plan members, EBRI believes based on the data. One example: more than one-half of people enrolled

 

Medicines in America: The Half-Trillion Dollar Line Item

Prescription drug spending in the U.S. grew nearly 6% in 2016, reaching $450 billion, according to the QuintilesIMS Institute report, Medicines Use and Spending in the U.S., published today. U.S. drug spending is forecasted to grow by 30% over the next 5 years to 2021, amounting to $610 billion. In 2016, per capita (per person) spending on medicines for U.S. health citizens averaged $895. Specialty drugs made up $384 of that total, equal to 43% of personal drug spending, shown in the first chart. Spending on specialty drugs continues to increase as a proportion of total drug spending: traditional medicines’ share

 

Financial Stress As A Health Risk Factor Impacts More Americans

A family in Orange County, California, paid a brother’s 1982 hospital bill by selling 50 pieces of their newly-deceased mother’s jewelry. “It’s what she wanted,” the surviving son told a reporter from The Orange County Register. The cache of jewelry fetched enough to pay the $10,000 bill. Patients in the U.S. cobble together various strategies to pay for healthcare, as the first chart drawn from a Kaiser Family Foundation report on medical debt attests. As health care consumers, people cut back on household spending like vacations and household goods. Two-thirds of insured patients use up all or most of their savings

 

Medical Bill Toxicity: 53% of Americans Say A Big Bill Is As Bad As A Serious Diagnosis

3 in 4 Americans’ health care costs have risen in the past few years. Two-thirds of Americans want to lower their costs, but don’t know how to do that. A survey from Amino released this week, conducted by Ipsos, has found that one in five people could not afford to pay an unexpected medical bill without taking on debt, and another 18% of Americans could only afford up to $100 if presented with an unexpected medical bill. This medical debt side effect more likely impacts women versus men, the less affluent, the unmarried, and those with no college degree. While

 

Will Republican Healthcare Policy “Make America Sick Again?” Two New Polls Show Growing Support for ACA

Results of two polls published in the past week, from the Kaiser Family Foundation and Pew Research Center, demonstrate growing support for the Affordable Care Act, aka Obamacare. The Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid was published 24 February 2017. The first line chart illustrates the results, with the blue line for consumers’ “favorable view” on the ACA crossing several points above the “unfavorable” orange line for the first time since the law was signed in 2010. The margins in February 2017 were 48% favorable, 42% unfavorable. While the majority of Republicans continue to be solidly

 

Medical Debt Is A Risk Factor For Consumers’ Financial Wellness

The top reason US consumers hear from a debt collector is due to medical bills, for 6 in 10 people in Americans contacted regarding a collection. This month, the Consumer Financial Protection Bureau (CFPB) published its report on Consumer Experiences with Debt Collection. Medical bill collections are the most common debt for which consumers are contacted by collectors, followed by phone bills, utility bills, and tax bills. The prevalence of past-due medical debt is unique compared with these other types because healthcare cost problems impact consumers at low, middle, and high incomes alike. Specifically: 62% of consumers earning $20,000 to

 

More Patients Morph Into Financially Burdened Health Consumers

Health care payment responsibility continues to shift from employers to employee-patients, More of those patients are morphing into financially burdened health consumers, according to TransUnion, the credit agency and financial risk information company, in the TransUnion Healthcare Report published in June 2016. Patients saw a 13% increase in their health insurance deductible and out-of-pocket (OOP) maximum costs between 2014 and 2015. At the same time, the average base salary in the U.S. grew 3% in 2015, SHRM estimated. Thus, deductibles and OOP costs grew for consumers more than 4 times faster than the average base salary from 2014 to 2015.  In

 

What Financial Health Means to Me: It’s Baked Into Wellness

Today is Financial Wellness Day. Do you know how financially well you are? Let me take a crack at that answer, even though I haven’t seen your bank account (which you may not even have as over 20% of people in the US are, as financial services companies would call you “un-banked” or “under-banked”.) You have some level of fiscal stress, ranging from a little to a lot. You aren’t taking all of your summer vacation your employer extends to you. You’re spending around $1 in every $5 of your household budget on health care. And your sleep isn’t as

 

Financial Toxicity: The High Cost of Cancer Drugs in the U.S.

Two news items published in the past week point to the yin/yang of cancer survivorship and the high prices of cancer drugs. The good news: a record number of people in the US are surviving cancer, according to the American Cancer Society. That number is 15.5 million Americans, according to a study in the cancer journal CA. Note the demographics of cancer survivors: One-half are 70 years of age and older 56% were diagnosed in the past ten years, and one-third in the past 5 years Women were more likely to have had breast cancer (3.5 mm), uterine cancer (757,000),

 

For Healthcare Costs, Geography is Destiny

Where you live in America determines what you might pay for healthcare. In this health economic scenario, as Napoleon is rumored to have said, “geography is destiny.” If you’re searching for low-cost health care, Ohio may just be your state of choice. The map illustrates these health care disparities across the U.S. in 2015, when the price of a single service could vary by more than 200% between one state and another: say, Alaska versus Arizona, or Wisconsin compared to Florida. Even within states, like Ohio, the average price of a pregnancy ultrasound in Cleveland ran nearly three times that received in

 

What Retail Financial Services Can Teach Healthcare

“Banks and insurance companies that cannot keep pace will find their customers, busy pursuing flawless service models and smart solutions, have moved on without them and they are stranded on the wrong side of the digital divide — from which there will be no return,” according to a report on The Future of Retail Financial Services from Cognizant, Marketforce, and Pegasystems. You could substitute “healthcare providers” for “banks and insurance companies,” because traditional health industry stakeholders are equally behind the consumer demand for digital convenience. This report has important insights relevant to health providers, health plans and suppliers (especially for

 

What the SCOTUS ACA ruling means for health consumers

Now that the Affordable Care Act is settled, in the eyes of the U.S. Supreme Court, what does the 6-3 ruling mean for health/care consumers living in America? I wrote the response to that question on the site of Intuit’s American Tax & Financial Center here. The top-line is that people living in Michigan, where the Federal government is running the health insurance exchange for Michiganders, and people living in New York, where the state is running the exchange, are considered equal under the ACA’s health insurance premium subsidies: health plan shoppers, whether resident New Yorkers or Michiganders, can qualify for

 

It’s still the prices, stupid – health care costs drive consumerism

“It’s the prices, stupid,” wrote Uwe Reinhardt, Gerald F. Anderson and colleagues in the May 2003 issue of Health Affairs. Exactly twelve years later, three reports out in the first week of June 2015 illustrate that salient observation that is central to the U.S. healthcare macroeconomy. Avalere reports that spending on prescription drugs increased over 13% in 2014, with half of the growth attributable to new product launches over the past two years. Spending on pharmaceuticals has grown to 13% of overall health spending, and the growth of that spending between 2013-14 was the fastest since 2001. In light of

 

Health care costs for a family of four in the U.S. reach $24,671 in 2015

The cost of a PPO for a family of four in America hits $24,671 in 2015, growing 6.3% over 2014’s cost. The growth in health care costs will be driven by high specialty prescription drug costs. The 6.3% growth rate in health costs is a stark increase compared with the twelve month April 2014-March 2015 decline in the Consumer Price Index of -0.1%. Welcome to the 2015 Milliman Medical Index, subtitled “Will the typical American family of four be driving a ‘Cadillac plan’ by 2018?” The MMI gauges the average cost of an employer-sponsored preferred provider organization (PPO) health plan and includes all

 

Consumers seek retail convenience in healthcare financing and payment

Health care consumers face a fragmented and complicated payment landscape after receiving services from hospitals and doctors, and paying for insurance coverage. People want to “view their bills, make a few clicks, pay…and be done,” according to Jamie Kresberg, product manager at Citi Retail Services, a unit of Citibank. He’s quoted in Money Matters: Billing and payment for a New Health Economy from PwC’s Health Research Institute. The healthcare service segment most consumers are satisfied with when it comes to billing and payment is pharmacies, who score well on convenience, affordability, reliability, and seamless transactions – with only transparency being

 

Banks — a new entrant in the health/care landscape

TD Bank gifted free Fitbit activity trackers to new customers signing up for savings accounts in the 2015 New Year. John Hancock is discounting life insurance premiums for clients who track steps and take on preventive care strategies. And Banco Sabadell in Spain, along with Westpac in New Zealand and Standard Chartered in the United Kingdom are all piloting wearable technology for consumer financial management. Financial wellness is an integral part of peoples’ overall health, so financial services companies are putting their collective corporate feet into the health/care market. Banks and consumer investment companies are new entrants in health/care as

 

The blurring landscape of digital health: the Health 2.0 team puts it in focus

They’re the team that built a brand with the phrase “Health 2.0” before the world barely recognized v 1.0 in healthcare. This week, those folks that brought you the Health 2.0 Conference unveiled the Market Intel database of over 3,000 companies, trying to make sense out of a very blurry and fast-morphing market landscape. I spoke with Matthew Holt and Kim Krueger of Health 2.0 earlier this week to discuss just what’s in this mine of information, and what they intend to do with it. In full disclosure, I have been a colleague and friend of Matthew Holt since his

 

Americans are spending $1 in $5 on health care

People in the U.S. are spending over 20.6% of their income on health care, according to data published by the U.S. Department of Commerce on March 2, 2015. This is up from 15% of personal income in 1990. Note the slope of this curve, moving up the X-Y axes from southwest to northwest. Now note the slope of the curves in the second chart, which illustrates consumer spending on other household goods and services: cars, housing, clothing, education, groceries, and eating outside of the home. Spending on these home budget line items remained relatively flat over the 25 year period 1990-2015,

 

$1 in $5 will go to health care in 2023 – the new health engagement is health cost engagement

National health spending will comprise 19.3% of U.S. gross domestic product in 2023, nearly $1 in $5 of all American spending. This statistic includes the expenditure categories for health spending as defined by the Centers for Medicare and Medicaid Services (CMS), Office of the Actuary. The number includes hospital care, personal health care, professional services (physicians and other professionals), home health, long term care, retail sales of prescription drugs and durable medical equipment, and investment in capital equipment, among other line items. The forecast was published in Health Affairs article, National Health Expenditure Projections, 2013-23: Faster Growth Expected With Expanded

 

We are all self-insured until we get sick – especially if we are women

During my conversation with a prominent pharma industry analyst yesterday, he observed, “As a consumer, you are self-insured until you get sick.” My brain then flashed back to a graph from the 2013 Employer Health Benefits Survey conducted annually by the Kaiser Family Foundation (KFF). The chart is shown here. It illustrates the upward line indicating that in 2013, 4 in 5 workers were enrolled in a health plan that included an annual deductible. That’s the “self-insurance” part of the observation my astute conversationalist noted. Simply put, when you are enrolled in a high-deductible health plan, You, The Consumer, are responsible for

 

The Season of Healthcare Transparency – Chaos, then Creation, Part 5

The consumer demand side for healthcare transparency is hungry for the light to shine on health care costs, quality and information that’s relevant and meaningful to the individual. The supply side is fast-growing, with websites and portals, government-sponsored projects, commercial-driven start-ups, and numerous mobile apps. These tools endeavor to: Help people find and access services Schedule appointments Compare peer consumers’ reviews for those providers Calculate and prepare for out-of-pocket co-payments deriving from their health plan Negotiate prices with providers Pay for the services, and Reconcile the payment with a high-deductible health plan or health savings account. On the demand side, consumers

 

The Season of Healthcare Transparency – Consumer Payments and Tools, Part 4

“The surge in HDHP enrollment is causing patients to become consumers of healthcare,” begins a report documenting the rise of patients making more payments to health providers. Patients’ payments to providers have increased 72% since 2011. And, 78% of providers mail paper statements to patients to collect what they’re owed. “HDHPs” are high-deductible health plans, the growing thing in health insurance for consumers now faced with paying for health care first out-of-pocket before their health plan coverage kicks in. And those health consumers’ expectations for convenience in payment methods is causing dissatisfaction, negatively affecting these individuals and their health providers’

 

The Season of Healthcare Transparency – HFMA’s Price Transparency Manifesto – Part 1

As Big Payors continue to shift more costs onto health consumers in the U.S., the importance of and need for transparency grows. 39% of large employers offered consumer-directed health plans (CDHPs) in 2013, and by 2016, 64% of large employers plan to offer CDHPs.  These plans require members to pay first-dollar, out-of-pocket, to reach the agreed deductible, and at the same time manage a health savings account (HSA). In the past several weeks, many reports have published on the subject and several tools to promote consumer engagement in health finance have made announcements. This week of posts provides an update on

 

Health costs in retirement: the standard of living

On their list of top financial worries, 1 in 2 Americans is most concerned about not having enough money for retirement, not being able to pay medical costs if they get sick, and not being able to maintain a desired standard of living. Gallup’s annual Economy and Personal Finance poll, conducted in early April 2014, finds that even in the wake of a healthier economy, people feel health-finance insecure. While ability to pay medical bills ranked #2 on the list of 9 fiscal worries, the proportion of Americans with this concern fell from a high of 62% in 2012 to

 

FICO scores for health – chatting with a #BigData pioneer

I had the pleasure of spending quality time brainstorming with Mikki Nasch, co-founder of AchieveMint, yesterday. Mikki worked on the early days of building the FICO score with Fair Isaac, so has been involved in Big Data well before it became the well-#hashtagged buzzword it is today. In our conversation, we talked about the history of FICO and how it took about a decade for consumers to understand it, accept it, and use it as a tool for bettering their credit ratings. When a FICO score was below an acceptable threshold to a lender – say, for a new car

 

Patients play a starring role at #HIMSS14 – Best In Show

Even before stepping into the Orlando Convention Center on Sunday 23 February 2014, my clairvoyant powers know the forecast of the Best in Show: the growing role of patients in health care, reflected in both the education session at the annual 2014 meeting of HIMSS as well as the product/service mix being proffered on the convention show floor. As a member of HIMSS Connected Patient Committee, I know first-hand the conscious effort and energy that the organization has committed to getting real about patients’-peoples’-caregivers’ central role in health care. The organization was built on providers and technology. When I first

 

Employers will strongly focus on costs in health benefit plans for 2014; so must consumers

Employers who sponsor health insurance in America are at a fork on a cloudy road: they know that they’re in the midst of changes happening in the U.S. health system. Except for one certainty: that health care costs too much. So employers’ plans for health benefits in 2014 strongly focus on getting a return-on-investment from health spending in an uncertain climate, according to Deloitte’s 2013 Survey of U.S. Employers. Key findings are that: Employers will grow their use of workers’ cost-sharing, continuing to shift more financial responsibility onto employees They will expand other tactics they believe will help address cost

 

There’s fear of health care costs in peoples’ retirement visions

While working people in the U.S. are feeling better about the nation’s economy, Americans aren’t putting much money into savings for retirement. The reasons for this are many, but above all is what Mercer calls “the specter of health care costs in retirement” in the Mercer Workplace Survey for 2013. In addition to peoples’ concerns about future health care costs, reasons for not putting money away for the future include flat personal income, slow economic growth and financial literacy challenges around how much 401(k) savings can be tax-deferred. On the slow economic growth perception, Mercer found that, on the upside, people

 

Health costs up, credit down: health consumers face tightening credit markets in the face of rising medical costs

People who received health care in the U.S. between the second quarters of 2012 and 2013 faced 38% higher out-of-pocket costs, growing from $1,862 to $2,568 in just one year. These were payments for common procedures like joint replacements, Caesarean sections, and normal births. At the same time, consumers’ access to revolving credit lines fell by $1,000 over the twelve months. (Credit lines here include bank-issued credit cards, store credit cards, and home equity loans). The TransUnion Healthcare Report from TransUnion, the credit information company, paints a picture of tightening money for all consumers in the face of rising household

 

Moneytalk: why doctors and patients should talk about health finances

  Money and health are two things most people don’t like to talk about. But if people and their doctors spoke more about health and finance, outcomes (both fiscal and physical) could improve. In late October 2013, Best Practices for Communicating with Patients on Financial Matters were published by the Healthcare Financial Management Association (HFMA). Michael Leavitt, former head of the Department of Health and Human Services, led the year-long development effort on behalf of HFMA, with input from patient advocates, the American Hospital Association, America’s Health Insurance Plans, the American Academy of Family Physicians and the National Patient Advocate Foundation, along

 

The new era of consumer health risk management: employers “migrate” risk

The current role of health insurance at work is that it’s the “benefits” part of “compensation and benefits.” Soon, benefits will simply be integrated into “compensation and compensation.” That is, employers will be transferring risk to employees for health care. This will translate into growing defined contribution and cost-shifting to employees. Health care sponsorship by employers is changing quite quickly, according to the 2013 Aon Hewitt Health Care Survey published in October 2013. Aon found that companies are shifting to individualized consumer-focused approaches that emphasize wellness and “health ownership” by workers to bolster behavior change and, ultimately, outcomes. The most

 

A new medical side-effect: out-of-pocket health care costs

When we say the phrase “side effects,” what do we think of? The FDA says that “all medicines have benefits and risks. The risks of medicines are the chances that something unwanted or unexpected could happen to you when you use them. Risks could be less serious things, such as an upset stomach, or more serious things, such as liver damage.” There’s a new risk in town in health care, and it’s the equivalent of an upset stomach when it comes to a co-pay for a branded on-formulary drug, or liver damage if it involves a coinsurance percent of “retail”

 

Whither price transparency in health care? The supply side may be growing faster than consumer demand

Online shopping for health care can drive costs down, according to research conducted by HealthSparq, a company that works with health insurance companies to channel health cost information to plan members (that is, consumers). Healthsparq partnered with one of the company’s health insurance company clients to conduct this study, which demonstrated that, over two years, consumers who used an online treatment cost estimator saved money on care for hernia conditions, digestive conditions, and women’s health issues. It’s early days for health care price transparency in health care, but HealthSparq’s findings demonstrate positive evidence that when consumers are offered a tool

 

Consumers don’t get as much satisfaction with high-deductible health plans

Since the advent of the so-called consumer-directed health care era in the mid-2000s, there’s been a love-gap between health plan members of traditional plans, living in Health Plan World 1.0, and people enrolled in newer consumer-driven plans – high-deductible health plans (HDHPs) and consumer-directed health plans (CDHPs). That gap in plan satisfaction continues, according to the Employee Benefits Research Institute (EBRI)’s poll of Americans’ consumer engagement in health care. The survey was conducted with the Commonwealth Fund. As the bar chart illustrates, some 62% of members in traditional plans were satisfied (very or extremely) with their health insurance in 2012.

 

HSAs for Dummies: improving health insurance literacy

Most Americans don’t understand what a health savings account (HSA) is – including people who are enrolled in the plans. While health literacy is generally acknowledged to be a public health challenge in America, health insurance literacy is not well recognized. Yet in the emerging consumer-directed health plan era of U.S. health care, peoples’ lack of understanding of health financial accounts will get in the way of people who really need care seeking care at the right time. This leads to greater health spending later when the consumer-patient can develop a health condition that could have been prevented (say, pre-diabetes

 

Americans’ health insurance illiteracy epidemic – simpler is better

Consumers misunderstand health insurance, according to new research published in the Journal of Health Economics this week. The study was done by a multidisciplinary, diverse team of researchers led by one of my favorite health economists, George Loewenstein from Carnegie Mellon, complemented by colleagues from Humana, University of Pennsylvania, Stanford, and Yale, among other research institutions. Most people do not understand how traditional health plans work: the kind that have been available on the market for over a decade. See the chart, which summarizes top-line findings: nearly all consumers believe they understand what maximum out-of-pocket costs are, but only one-half do.

 

Money and health, migraines and sleep: how stress directly impacts health and wealth

There’s an issue that doctors and patients don’t discuss that’s among the most important contributors to ill health: it’s money, and it’s something Alexandra Drane calls an “Unmentionable.” Alex, Founder, Chief Visionary, and Board Chair at Eliza Corporation, coined Unmentionables as those aspects of daily living which everyone deals with, but few like to talk about: like sex (whether too much, too little), drugs (abusing), drinking (too much), toileting problems (such as incontinence or pooping problems), sleep trouble, and caring for others (not ourselves so much). These daily life challenges can negatively impact health, with financial stress being one of

 

The promise of ObamaCare isn’t comforting Americans worrying about money and health in 2013

In June 2013, even though news about the economy and jobs is more positive and ObamaCare’s promise of health insurance for the uninsured will soon kick in, most Americans are concerned about (1) money and (2) the costs of health care. The Kaiser Health Tracking poll of June 2013 paints an America worried about personal finances and health, and pretty clueless about health reform – in particular, the advent of health insurance exchanges. Among the 25% of people who have seen media coverage about the Affordable Care Act (alternatively referred to broadly as “health reform” or specifically as “ObamaCare”), 3

 

Health consumers, meet the medical bank

Health consumers, meet a new player in your health care world: the bank. Financial services companies will play a growing role in U.S. health care as patients morph into health care consumers responsible for making more money-based decisions about their health care. This shift could make paying for health care just like paying other bills in the consumer retail market. And that’s a new role for health providers – doctors and hospitals – to fill. The Impact of Growing Patient Financial Responsibility on Healthcare Providers, prepared for Citi Enterprise Payments by Boundary Information Group, discusses what the impact of consumers’ payments in

 

As Account-Based Health Plans Grow, Will Americans Save More in Health Accounts?

The only type of health plan whose membership grew in 2012 was the consumer-directed health plan (CDHP), according to a survey from Mercer, the benefits advisors. Two-thirds of large employers expect to offer CDHPs by 2018, five years from now. 40% of all employers (small and large) anticipate offering a CDHP in five years. The growth in CDHPs going forward will be increasingly motivated by the impending “Cadillac tax” that will be levied on companies that currently offer relatively rich health benefits. Furthermore, Mercer foresees that employers will also expand wellness and health management programs with the goal of reducing health

 

Consumer-directed health isn’t always so healthy

Giving health consumers more skin in the game doesn’t always lead to them making sound health decisions. Over four years in consumer-directed health plans, enrollees used one-quarter fewer visits to doctors every year and filled one fewer prescription drugs. CDHP members also received fewer recommended cancer screenings, and visited the emergency room more often. These rational health consumer theory-busting findings were published in the June 2013 issue of the Health Affairs article, Consumer-Directed Health Plans Reduce The Long-Term Use of Outpatient Physician Visits And Prescription Drugs by Paul Fronstin of the Employee Benefit Research Institute and colleagues from IBM and RxEconomics,

 

Wellness at work – Virgin tells it all

Health, happiness and engagement among employees are closely-linked and drive productivity in the workplace. But there’s a gap between the kind of wellness services employers offer workers to bolster health, and the programs that people actually want. The current state of employer wellness programs is described in a survey conducted by Virgin HealthMiles and Workforce, The Business of Healthy Employees: A Survey of Workplace Health Priorities, published in June 2013. There’s a gap between what workers want for wellness and what employers are offering. Most-demanded by workers are health on-site food choices desired by 79% of employees; but, only 33%

 

The importance of being banked for getting health insurance

While having money in the bank is always a prescription for feeling well, having a bank account is a precursor to getting health insurance under the Affordable Care Act. That fact could prevent millions of people who are eligible for health insurance premium subsidies under health reform from enrolling in a health plan. The issue of banking the un-banked in health is a little talked-about detail that, if overlooked, will scuttle the best-laid plans for health reform. That’s because if people enroll in health insurance, their monthly premiums will need to be debited from a bank account. So, without a

 

Nearly 1 in 2 women delayed health care in the past year due to costs – the economic impact on a woman’s physical, emotional, and fiscal health

Nearly 1 in 2 women put off seeking health care because the cost was too high. The kinds of services delayed included visits to the doctor, medical procedures, and filling prescription medications. The fourth annual T.A.L.K. Survey was released this week by the National Women’s Health Resource Center (NWHRC), focusing on the declining economy and its impact on women and three dimensions of their health — physical, emotional, and fiscal. 40% of women say that their health has worsened in the past five years due to increasing stress and gaining weight, according to the survey. One of the most interesting