Quincy priester april 11 2012

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  • 1. Improving the NationsHealth: Making SureConsumers Can Play TheirRoleLynn QuincyApril 11, 2012 1
  • 2. Yes, THAT Consumer Reports 2
  • 3. The 2010 Affordable Care Act .it requires a whole new script
  • 4. Health Reform Implementation Timeline (selected reforms)
  • 5. Estimated Health Insurance Coverage in 2019 TotalNonelderlyPopulation=282MillionSOURCE: Congressional Budget Office, March 20, 2010
  • 6. Selected reforms are beingdebated by the Supreme Court In early March, heard oral arguments on: The constitutionality of the individual mandate; Whether the individual mandate can be severed from the remainder of the ACA; ACAs provisions concerning expansion of the Medicaid program; and Procedural questions regarding application of the Anti- Injunction Act to challenges against the ACA (stems from the Fourth Circuits ruling in September 2011). A decision is expected June 2012. 6
  • 7. But theres much more New Health Plan Transparency Summary of Benefits and Coverage form New public reporting on rates, customer satisfaction, denied claims, out-of-network provisions, etc New quality reporting New Provider Quality Transparency Value of employer provided coverage reported on W-2. Financial relationships among providers, suppliers, and manufacturers will be publicly disclosed Stronger appeal rights for consumers with self- insured employer coverage. 7
  • 8. Keep in mind The health reform laws true impact will be shaped by the decisions of consumers, employers, federal health officials and states. 8
  • 9. We have a UNIQUE opportunityto educate consumers so they can navigate health insurance and health care.
  • 10. Opportunity Arises from Tremendous consumer confusion about the law and poor health literacy and health insurance literacy New public data reporting can help in decision-making Consumers are looking for information especially Fall of 2013 Some funding exists for ACA outreach 10
  • 11. Lets get into the weeds Consumer testing in support of the development of the Summary of Benefits and Coverage form resulted in: Improvements to the form Better understanding of consumers difficulties understanding health insurance Spotlighted the dearth of consumer testing 11
  • 12. Three CU studies explored howconsumers shop for healthinsuranceStudy Examined: When: Locations: Mid-sized cities inPages 1-4 of new Sept-Oct 2010 IA, NH, CA, OHhealth insurancedisclosureCoverage Facts May 2011 MO, NYLabel (pages 5-6)Actuarial Value May 2011 CO, MDConceptsParticipants were evenly divided between men/women; uninsured/insured (non-group). A variety of education levels, ages (26-64), andrace/ethnic background, and prior familiarity with health insurance. 12
  • 13. Lesson #1:Abandon the imageof a carefulshopper capable ofweighing themyriad costs andbenefits of theirhealth insuranceoptions 13
  • 14. Lesson #2: Consumers DreadShopping for Health Insurance I think medical insurance is probably one of the hardest things for me that I shop for. And I think one of the hardest things is to figure out whats covered. -quote from report: Early Consumer Testing of New Health Insurance Disclosure Forms 14
  • 15. Lesson #3:Consumers Doubt the Value/Purpose of Health Insurance Many view health insurance as pre-paid health care, rather than insurance. If they dont expect to use much health care next year, doesnt seem like a good value.Note: there is different from the notion that Im young and invincible. Rests on a skewed notion of what insurance is. 15
  • 16. Implications Convey the value and purpose of insurance in a compelling way Expect to provide health insurance education using a multi-layered, just-in-time approach Showing what the plan would pay for a serious illness often altered these views 16
  • 17. Lesson #4:Consumers want a good valuebut cant calculate valueConsumers care about cost.But they dont want the lowest costplan, they want the best value planthey can afford.Notion of value is sophisticated: scope of services covered share of the cost paid by plan sometimes the quality of providers 18
  • 18. Lesson #5: Consumers areconfused by cost-sharing termsThis is the greatest area of confusion.They dont know the vocabulary: deductible,coinsurance, benefit maximum, allowed amount,out-of-pocket maximumThe underlying concepts are complex and they mustbe used together to estimate patient costs forservices (do copays count towards the deductible?the out-of-pocket maximum?) 19
  • 19. Sophisticated computation skills are required Is this a No pharmacy Yes expense? Have Have I met the I met the medical pharmacy deductible? deductible?No Yes Yes No Have I met the Pay fullPay full annual amountamount Out-of-pocket Max? No Yes Pay nothing Subject to any annual benefit limits? No Yes 20 More calcs M l
  • 20. Implications We are effectively asking consumers to shop blindfolded. It is like providing health plan detail in a foreign language. 21
  • 21. Which would you choose?Health Plan A or Health Plan BTerms: Terms: $4.000 $1,000 7 $5.000 22