South Florida Hospital News
Friday October 23, 2020

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May 2006 - Volume 2 - Issue 11


At the Helm, Almost - A Shift toward a Patient-Centered Healthcare Decision Making Process

Few would buy a product – shoes, a TV, a car or a house – or a service – lawn mowing, a cab ride, an engine tune-up or a flight ticket - without knowing how much it would cost and developing a perception about the expected quality. Yet, "Healthcare is one of the few services or goods that Americans still buy without knowing beforehand what they'll have to pay," says Don Hardin, senior healthcare consultant with Mercer Human Resource Consulting.; an approach often resulting in a "price shock". Traditionally, patients had little will or need to know what their medical services actually cost. In the '80s and '90s, as managed care became increasingly popular, patients – who often paid the same copayment regardless of where or what for they received care - were indifferent about the fees insurers negotiated with providers.

The level of interest of the typical patient in the actual cost of medical services has changed significantly in recent years. With HMO’s and PPO’s faced with dramatically increasing medical costs, many insurers have adopted deductibles and coinsurance requirements that could amount into thousands of dollars. In addition, employers – in an attempt to control rising health insurance premiums - have begun encouraging employees to enter so-called consumer-driven plans, which usually mandate payments from a personal savings account until a deductible – usually, high - is met. Yet, according to Towers Perrin, an HR consulting firm, employers pay today 78% more and employees pay 64% more for health care than they did in 2000. Health-care expenses are expected to rise 8% in 2006 representing the first time in years that growth of healthcare expenses is not in double digits.

Managing the cost and quality of a person’s healthcare, therefore, increasingly becomes the person’s responsibility and progressively plays an important role in the person’s lifestyle and financial considerations. People are, thus, demanding reliable and useable healthcare information. Indeed, studies show that consumers are beginning to ask for more information. According to a Towers Perrin survey of 1,400 employees published in June 2005, 85% said they need more data and tools to make educated healthcare decisions. Another survey of 2,500 employees released by McKinsey & Co. in the same month found that 80% of those enrolled in consumer-driven plans were frustrated by the lack of information available on physician costs.

Web-based healthcare decision-support providers are quick to respond to this rapidly growing demand. Many commercial insurers – Blue Cross and Blue Shield of North Carolina, Humana and United Healthcare, to name a few - incorporate lifestyle assessment and healthcare decision-support tools, in varying degrees of details and usability, into their web portals. Among the independent players in this arena are WebMD and Yahoo!Health. WebMD’s health-care portal offers to employees, via agreements with the employers, a personal assessment where employees compare their medical risks of developing health problems - based on family and personal medical history, lifestyle, and other factors - with appropriate benchmarks. Through the WebMD service, employees also get an electronic health record that lists doctor visits, prescriptions, and out-of-pocket costs and "true costs" over the last three years. Subimo, a leader in this arena, provides detailed information on over 5,000 hospitals and over 100 common conditions and procedures, a comparison of hospitals based on user-defined criteria, key points to discuss with the doctor regarding a specific condition or procedure, the state of research for different conditions and available treatment options, etc.

Market conditions drive an increasingly growing number of patients to make their own healthcare decisions. The internet provides access to and a platform for powerful decision-making support tools now available to almost every patient. By embracing this shift of patient/customer behavior toward self-education and independent healthcare decision making, providers can increase public exposure and promote transparency, credibility and consumer confidence. This, in turn, could improve market share and profitability, promote better health and help control healthcare costs.

Ofer Amit is a partner and Chief Executive Officer of RehabXperience, LLC, an outpatient physical therapy center in Sunrise, Florida. He can be reached at (954) 741-2221.
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