Choosing a doctor, hospital, health insurance plan, or a course of medical treatment can be among the most daunting and critical decisions that consumers make. Most consumers and patients make these decisions without proper information or support – a situation that can lead to higher costs, lower quality, and care outcomes that don’t match individuals’ goals and preferences, according to our new report “Transparency in Health Care: A Priority Roadmap for Consumer Engagement.”
Among the report’s findings and recommendations are the following:
Consumers generally don’t understand that they may face multiple treatment options for a given condition that may or may not match their own preferences. They’re also typically unaware that health care costs can vary widely for the same service, often with little or no correlation to quality. To address these issues, NEHI’s report calls for a broad public awareness campaign on health care choices and consequences. It also recommends steps to spur “shared decision-making” between patients and providers, including extending some liability protections to physicians who engage their patients in a careful process of jointly considering various treatment options.
There are multiple tools to help guide consumers through their decision-making, such as choosing a physician or a health plan, but these tools are not uniformly available or useful. Even when they are, consumers are typically unaware that these tools exist, don’t use them, or find them difficult to understand. Most consumers want cost, quality, and treatment information that is highly personalized to their condition, insurance coverage, and preferences, and delivered at the time they have to make decisions. NEHI’s report calls for simpler tools focused on consumer information priorities, better marketing of tools to consumers, and increased availability of tools across all populations at key decision points.
Amid current trends in health insurance, such as the growth of narrow provider networks, restrictions on coverage for prescription drugs, and the rise in deductibles and other consumer cost-sharing, the wrong decision in selecting a health plan or provider can have costly consequences for consumers. NEHI recommends that policy-makers pass laws that hold plans and providers accountable for the accuracy of the data that they publish in provider directories and other materials, and that protect consumers from the financial consequences from acting on bad data. Public and private tool developers should build on lessons learned from the tools that support consumer choice among plans on the Affordable Care Act exchanges. Laws and regulations also should support the development of tools that allow consumers to determine their specific cost-sharing responsibility based on negotiated payment rates between plans and providers.
You can read the full list of NEHI's nine recommendations in the Executive Summary of the report.