Consumers will face increasing pressure to comparison-shop for the best value, but they lack easy access to information on price that could help with informed decisions, Goltz says.
Quality data has been more readily available to consumers than cost data, she says.
Employers continue to drive benefit changes that require households to take on more of the financial burden of medical care.
Among roughly 500 employers surveyed by the National Business Group on Health and Towers Watson this spring, workers' healthcare costs increased 40% over five years. Meanwhile, employers' costs during the same period climbed more slowly at 34%. Modern Healthcare's 2011 Healthcare Purchasing Power Survey, which looks at health spending by major U.S. employers, found workers continue to see benefits that shift more of the financial responsibility for healthcare to households.
Consumers are left with less to spend on rent or major purchases such as cars or college, says Helen Darling, president and CEO of the NBGH. “It's eating away at the family standard of living and what people have to live on.”
Employers are pushing for more price information for consumers and seeking ways to encourage workers to be more price-sensitive.
Nearly one-third of the employers surveyed by the NBGH and Towers Watson said plans to give workers healthcare service unit price information were under consideration for 2013. And 19% of employers said they planned to offer different levels of coverage, or tiers, based on the value or cost of services in 2013. That's compared with 15% that already are doing so this year.
Health plans commonly tier coverage for pharmaceuticals, Darling says, with more coverage for generics and less for brand-name medications. Now health plans have started to tier physician coverage to encourage patients to visit primary-care doctors instead of specialists when possible. The same is true for unnecessary emergency room visits, she says.
The trend toward more price-sensitive health benefits is expected to accelerate.
Darling says she also expects more employers to adopt plans that offer patients a lump sum of money for treatment and more price information about treatment options. Households will be left to make the choice how best to spend their money—and will be required to foot the bill when treatment costs exceed their benefit.
“We don't see much of that yet,” she says. “We think we'll see more of that.”
Yet information for consumers is “more available than it used to be, but it's not available enough,” Darling says.
Goltz of the Pacific Business Group on Health agrees.
The California not-for-profit released a scorecard of health plan consumer price information based on research by comparison shoppers. Some health plans lacked tools to compare physician prices, and shoppers found that others had a limited list of conditions for which prices were available. And only 1 of 6 major insurers provided relative prices for various treatment options.
For example, health plans could provide prices for alternatives to a costly—and often unnecessary—MRI for back pain, Goltz says.
Without such options, consumers risk the “greased chute of medical intervention,” she says.
The marketplace isn't the only arena where efforts are under way to get a better handle on how to identify high-value healthcare.
The Healthcare Financial Management Association, a professional development association of the industry's actuaries, accountants, treasury and finance professionals, launched an effort with 17 hospitals and health systems last year to help the industry respond to the heightened interest from payers about providers who can deliver on cost as well as quality.
“Hospitals and health systems may well want to initiate the process of developing meaningful quality and cost of care metrics instead of waiting to have such metrics imposed on them through government regulation or employer and health plan demands,” according to the HFMA's inaugural value report, Value in Health Care: Current State and Future Directions.
Metrics will help providers predict future financial results and could help win business for those providers “able to speak clearly and convincingly to patients and other purchasers” on cost and quality data, according to report. And metrics developed by providers could be influential as national standards develop.