How High-Deductibles are Changing the Payer-Provider Relationship

Now that patients are assuming greater financial responsibility for their healthcare, payers and providers must collaborate to educate patients and reduce barriers to care.

JJ: High-deductible plans, because they place greater financial responsibility on consumers, serve as a good way to increase patient engagement. The experience to date shows that patients with high deductible plans tend to reduce utilization across the full range of care from preventive and elective care to more urgent care. Payers and providers should focus on improving patients' understanding of when and where to access care based on their condition.

Also, cost, quality and other relevant consumer information should be presented clearly, in a user-friendly way, and early in the care process. Increasingly, payers and providers are making this kind of information more accessible by posting quality measures online, providing payment estimators or price calculators, third-party cost comparison apps and other online tools. That trend will continue to grow.

JJ: One word: data. Payers and providers have significant and growing data sets on their shared consumer — the patient. Payers in many cases may have access to broader data that can provide a comprehensive view of a patient's care.

On the other hand, the proliferation of electronic health records has provided many health systems with much deeper data on the care they provide to the patient. The sharing, and ultimately the integration of the shared data, will help drive a wide range of improvements, from consumer engagement to improved outcomes to lower cost. Payers and providers have a common interest in promoting wellness and managing population health, so how that data gets shared will be important. There will likely be many questions to address: where does the data reside, what format is it in, what can be shared and, from a technology point of view, can it be shared in a way that's useful? These discussions may be relatively new for some payers and providers but it's important to begin them.

JJ: The trend of higher bad debt due to high deductibles is unfortunately already underway. There are many steps health systems can take, such as enhancing the front end of the revenue cycle, so that the conversation about the patient's financial responsibility occurs in a meaningful way very early on. Providers should also develop flexible financing alternatives that provide options for patients to receive the care they need and fulfill their financial responsibilities. Analytics should prove to be another useful tool in identifying and mitigating risks.

Jeff Jones has more than 26 years of healthcare consulting experience in strategy, operations improvement and information technology implementation. Jeff leads strategic markets for Huron Healthcare.

To discuss your organization's strategic challenges, contact Jeff at [email protected] or 503.347.0554.