For decades, the health insurance industry has worked, mostly unsuccessfully, to slow the pace of increasing cost. The complexity of our medical delivery system makes the task daunting, given complex care delivery models, misaligned incentives and payment methods, the pace of technological advances, and society’s preference for broad provider network access. In recent years, cost containment initiatives have focused largely on advancing consumerism to buck the trend, nudging individuals to be more responsible for navigating the market, and providing tools intended to help them do so.
Some consumer tools have had immediate impact; others are and will continue to be slow to contribute to controlling cost. Telemedicine, for example, holds promise across multiple specialties, but applications that simply ease access to primary care services and provide consumer convenience may not really reduce system cost. Cost transparency tools theoretically align well with consumer driven health plans, but the underlying maze of health delivery and provider reimbursement arrangements challenges the near term value these tools offer for many procedures or conditions. In summary, there are no silver bullets and the health system as structured today cannot pivot effectively.
But there are some strategies that can immediately influence cost trends. Providing consumers with access to a health plan selection decision support tool is one approach to proactively manage cost now. Studies indicate most consumers choose health plans poorly; random selection would be as effective — or even more so.1, 2 Without support, consumers tend to overbuy coverage, stretching to purchase the “richest” coverage plan they can afford. A good tool helps consumers quantify expected out-of-pocket costs (e.g. copays and deductibles) for each plan option, giving the individual a complete picture of likely costs for each plan.
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