The leading advocate for Northeast Ohio hospitals. HEALTHCARE CONSUMERISM AND THE GROWING IMPORTANCE OF PATIENT DECISION MAKING

Defining Consumerism Consumerism The free choice of consumers dictates the economic structure of society Healthcare Consumerism The free choice of consumers shapes what services patients buy, the providers they select and insurers that they choose.

The Rise of Consumerism Growing Trend of Patient Engagement Rising Costs Inconsistent Quality Quest for High Value Care

Impediments to Consumerism Price Concerns –Third-party payers muddy price considerations –Complexity of healthcare pricing –Limited access to pricing information –Uncertainty about which services will actually be purchased Insurance market –Employers select carriers leaving individual consumers with little control –Many individuals can not afford plans on the individual market

Consumer-Directed Health Plans High-deductible health plans with savings options IRS requirements –Minimum deductible $1,200 indiv., $2,400 family –Maximum deductible & out-of-pocket expenses do not exceed $5,950 indiv., $11,900 family Savings options available –Health Savings Accounts –Health Reimbursement Arrangements

Prevalence of HDHPs

HDHP Outcomes Slowed cost growth Reduction in use of efficacious services Reduction in preventive care Undue Financial burden for those with chronic conditions

Health Reform Provisions that Promote Consumerism 1.Health Insurance Exchanges 2.Certain Insurance Market Regulations 3.New Transparency Requirements

Health Insurance Exchanges Building block of ACA Creates more competition in small group and individual insurance market Serve as marketplace for purchasing insurance Potential economic impact: $200 billion between 2010 and 2019

Insurance Market Regulations Adverse selection- When an insurance risk pool has a disproportionate number of unhealthy enrollees Common in small group & individual market ACA Regulations –Individual Mandate –Insurers must enroll all individuals in a single pool –Insurers must enroll all small group in a single pool

Transparency Requirements Hospitals must list charges for items and services by MS-DRG annually Physician Quality Reporting (PQR) Extended Other Requirements Already in Place: –Ohio State Law: Hospitals must report average charge of 60 most common inpatient procedures –Ohio State Law: Hospitals must publically post price disclosure list –Hospital Compare

Patient Engagement

Patient Decision Aids Decision support materials that supplement physician visits On-line or paper-based Improve patient knowledge of options, enhance realistic expectations & reduce frustration Aid physicians in cultural shift toward greater patient input Reduce need for lengthy consultations Greater use encouraged as a provision of ACA

Suggestions for Stakeholders Become engaged in the decisions that influence your healthcare Encourage additional public information on healthcare price and quality Educate consumers about ACA provision that eliminates cost sharing for preventive services Support regulations that mitigate insurance market shortcomings such as adverse selection Urge policymakers to appropriate funds for patient decisions aids