Orchestrating Your Consumer-Directed Health Plan

A take-charge personality and willingness to do homework are plusses

FRIDAY, March 31, 2006 (HealthDay News) -- You probably know people who drive a hard bargain when they buy a new car. They go online to check pricing and read reviews about the latest models. They solicit multiple quotes before narrowing their list of alternatives. And, in the end, they drive off the lot with a quality vehicle at a reasonable price.

If you're that kind of shopper, you'll likely do well in one of the new "consumer-directed health plans" that health insurers and employers are touting. These plans typically impose high annual deductibles to encourage people to take more financial responsibility for their medical care. Some plans come with a health savings account (HSA) that can build up to become a tidy nest egg over time if you don't spend those funds every year.

Proponents of the consumer-directed approach say when people pick up more of the tab for routine care and elective tests and procedures, they'll shop around for the best providers and prices and avoid inappropriate and unnecessary care. That, in turn, should tamp down overall health-care costs, or so the thinking goes.

But to make appropriate cost-and-quality decisions, patients need really good information, said Melinda Beeuwkes Buntin, a health economist with the RAND Corp. in Arlington, Va. "In many cases," she added, "they need information from a physician or from a health insurance plan that hasn't traditionally been released."

Just getting providers to quote the prices they'll charge you can be a challenge.

"It seems like a simple thing," Buntin acknowledged, "but that information is not readily available. And, anecdotally," she added, "I've been told stories of people in such plans literally trying to call a couple of doctors and ask them their fees for various services and not being able to get an answer."

They'll have push a little harder to get that information, Buntin said, "if they want to be spending their health account dollars wisely, or as wisely as they can."

That being said, most of the new consumer-directed plans are built atop existing preferred provider organization (PPO) networks, she explained. So people may decide to go to an in-network provider to get the rate that that provider has negotiated with the insurer.

Even after selecting a provider, consumers must continue to ask questions, said Devon M. Herrick, a senior fellow at the National Center for Policy Analysis in Dallas, who started an HSA in June.

Asking questions, he explained, can help avoid unnecessary expenses, from costly diagnostic tests that may not be needed to brand-name drugs for which cheaper generics are available.

Patients in consumer-directed health plans also need the gumption to keep track of which out-of-pocket expenses count toward their deductible, Buntin cautioned. What counts toward the deductible may not necessarily match what the person spends out-of-pocket.

Of course, consumer-directed health plans may not be for everyone.

"If you don't have the time or the energy, if you don't want to talk to your doctor about money, if you want to be within (a managed care plan that offers) integrated health care, if you don't want to be someone in charge of your own care coordination and hand off between doctors, these are all reasons to be wary about it," Buntin said.

As for Herrick, the next time he sees a physician, he'll make sure he's getting a good deal. "I'm going to let them know I have a health savings account," he said. "I'm going to let them know I have a high deductible."

More information

Visit the California HealthCare Foundation for RAND's latest report on consumer-directed health plans.

Read this Next
About UsOur ProductsCustom SolutionsHow it’s SoldOur ResultsDeliveryContact UsBlogPrivacy PolicyFAQ