Bye Bye HMO, Hello Consumer Driven Health Plans According to Forbes
HSA, Consumer driven plans which puts the patients in charge of costs is becoming a more common plan as seen in our offices. Basically, according to Forbes, HMO’s have failed to control health care costs (for anyone watching the broken promises made to us when these plans began to proliferate in the 1990’s) many employers are converting their employees to consumer driven plans.
Basically, these are mostly PPO plans where patients can self direct rather than rely solely on their primary doctors referral. The difference is that the PPO keeps their costs in line while the patient now has to see what things cost. The idea is that if consumers balk at the cost of care, market forces will bring down the cost of care. Consumers are given a certain amount of money in an account by their employer they can spend before they hit their high deductible. Once they hit the deductible, they will either pay a percent of a co payment.
The problem with this is that although some high cost procedures and tests will be questioned, the PPO supposedly negotiates the fees (They do not, they dictate them which will cause many doctors to leave the networks if the fees are too low). Some of the fees are still egregious. What is more alarming, is that some MRI centers have their insurance fee being over $600 while offering cash patients the ability to get the same test done for $299. Here is an example where the insurance fee is much higher than what they will gladly charge you if you never give them an insurance card. Could part of the problem be insurance carriers and they way they work; you bet? This is the same logic as the private surgicenter who is allowed to charge you $1300 for the hour of your procedure, while the doctor gets way less and the anesthesiologist is well paid as well, however less than the facility. On the other hand, the hospital based surgicenter will have a negotiated rate of $2500 for the same hour with the doctors being paid similarly.
How is a consumer supposed to work with this or make sense of any of it, especially since most specialists in the current broken paradigm take little responsibility other than looking at your part, rather than you? This is a huge cost driver in the system and without an alternative, most consumers are lost.
In the world of chiropractic, where we live, we are primary care doctors who address most problems with an eye on you, rather than your parts. Our fees are posted, and are fair and affordable for most people with no real surprises. Unfortunately, some insurers have dictated very low fees, when compared to other types of providers, which has forced us to withdraw from those plans. The good news is that under consumer driven plans, even if the reimbursement is lower for out of network, you are still funded to visit us by the employer and since in many cases, we can resolve the problem with fewer tests and usually for a much lower net cost, more people are seeing value in the chiropractic paradigm than ever before.
Consumer plans are here to say, however in the medical world, the only way to truly reform the business of health care into health care, it needs to be defunded and market forces need to stop propping up those overpriced and under delivering entities in health care that have delivered services with little accountability for results. Unless insurance goes away, we may never see a true market based system in place. A good start would be to have all providers offer a price list. Most providers at this time will not tell you what something costs and will allow the insurer to dictate the cost once the bill comes. This is hardly the way to place the consumer at the helm of their health care costs. On the other hand, a price alone cannot give you the consumer a sense of the value of the service you are receiving.
In our office, we are not the least expensive, and some who shop price only will likely never visit our office. Those who value thoroughness, great advice and effective care on the other hand would not think twice. A problem we resolve in 9 visits costs less than the lower priced office who is less comprehensive, less effective and takes 22 visits to resolve with a lesser outcome, even though they charge less per visit. Quality cannot be measured by price alone.
Other consumers are using sites such as yelp to help figure out who they want to use. One bad review whether reserved or not can harm a doctor on the Internet, even if they are a good doctor. Our office had many reviews on Yelp, only to be taken down their their “filter”, which is biased to anyone who advertises with Yelp. We had a number of glowing reviews that were removed and filtered by them, with no negative reviews. This is one area consumers must be cautious using, since on line reviews for doctors is not as popular as they are or as frequently used as the ones for your local restaurant.
The consumer needs to be more in control, however with the current broken system, and much misinformation in the internet, and the insurance companies ways of doing business, consumer plans are likely to be another form of rationing.
Read the Forbes article here
HMOs Decline, Consumer Plans Rise As Health Insurance Option
The health maintenance organization (HMO), once billed as a savior of medical insurance that would reign in medical costs by restricting choices and pushing patients to low-cost primary care, is deteriorating as an option for U.S. consumers.
A new study by Aon Hewitt (AON) is the latest sign that so-called “consumer directed health plans” — high deductible medical insurance usually tied to a health savings account that allows enrollees to set aside money through a tax-deferred arrangement — have overtaken HMOs as an option offered by major employers.
Preferred provider organizations, or PPOs, are still the most popular health plans offered by employers. PPOs allow their enrollees to go outside of the health plan’s network but at a higher cost to the health plan subscriber.
Aon Hewitt’s survey shows 58 percent of nearly 2,000 U.S. employers offered a consumer-directed health plan in 2011, compared to 41 percent in 2010. Meanwhile, 38 percent offered an HMO in 2011 compared to 41 percent in 2010.