Analysis Shows Patient-Centered Benefit Models Lower Costs
Patient-centered benefit designs may be beneficial for health care reform, as it can lower health care costs while simultaneously improving delivery, according to New information published in The New England Journal of Medicine (NEJM).
Peter V. Lee, JD, executive director, Covered California, the state’s insurance exchange, and one of the authors of the article, explained that Covered California utilizes a similar model, which has proven successful and valuable for consumers since 2014. It requires plans to adopt patient-centered benefit designs that allow consumers at every metal tier (cost-sharing split between insurer and enrollee) to visit their primary care physician without the cost being subject to a deductible.
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The authors stated that current health care systems need to improve delivery of care while decreasing costs through provider-focused and consumer-focused reform initiatives that directly conflict with one another. For instance, provider-focused initiatives encourage hospitals, doctors, and other providers to coordinate and improve care to lower costs but the consumer-focused approach discourages individuals from meeting with their providers because of high cost-sharing.
Previous studies have shown that since 2006, the number of Americans who have employer-sponsored coverage with deductibles >$1000 has escalated from 10% to 46%. A lot of those high deductible plans require patients to fully meet their deductible before receiving any coverage for primary care.
“Patients and consumers pay attention to financial incentives,” said co-author Elliot Fisher, MD, MPH. “They will buy less health care if you make them pay for some of it. The challenge is how you design some of those incentives because they are very blunt.”—Alessia D’Anna
Reference:
Fisher ES, Lee PV. Toward lower costs and better care— averting a collision between consumer- and provider-focused reforms. NEJM. March 10, 2016.
