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| Wayne A. Sensor |
It’s no surprise to anyone that health care costs are spiraling out of control. In fact, estimates indicate they could consume 17 percent of our gross domestic product next year. This trend will place a great strain on the U.S. economy and could change the face of the country’s health care system in sudden, dramatic and profound ways. And Americans are not likely to welcome those changes.
Rising health care costs are driving more and more Americans to live without health insurance, either because the businesses they work for can no longer provide it or they themselves can no longer afford the premiums, deductibles and co-pays that employers are passing on to them. Health care costs are choking America’s economic engine. When car manufacturers pay more per car for their employees’ health care than the steel that goes into the vehicles, we have reached a critical juncture.
To think that there is a silver-bullet solution is to fool ourselves, but to think that there is no solution at all is to fail ourselves. Giving consumers more say in and more control of their health care may well be the closest thing to a silver bullet we will find to address the challenges facing our nation’s health care--and our nation’s health.
Patient as Driver
If the health care industry can help patients take the wheel--in other words, truly engage them as consumers in their own health care--they will make better decisions for themselves and their families. Today, too few people spend time researching what kind of health insurance policy to choose, what hospital to go to, or which physician they see.
Health care is clearly the “last frontier” for American consumers in that there is no other good or service they buy without knowing its cost or how good it is. As consumer-driven health care plans gain traction, consumers are increasingly demanding information that is more meaningful and transparent, and rightfully so. We are entering the consumer’s generation of health care. We must surround consumers with the information they need to complete the value equation: price plus quality equals value.
Alegent Health believes that proactively offering this information to consumers will empower them to take more control over their health, make good decisions, and ultimately improve the health of surrounding communities and lower the overall cost of health care.
Alegent Health began proactively releasing quality information in September 2005 and devised a composite scoring system that simplified information for consumers and provided benchmarks to compare scores with leading regional and world-class health care providers.
The quality data are updated monthly online, and a full-page ad is periodically placed in local newspapers. Using the composite scoring methodology, performance in the care of heart attacks, heart failure and pneumonia is shared. Each of Alegent Health’s hospitals and the overall system scores are compared with a regional average.
Meaningful Costs
Even as Alegent Health has changed the dynamic of the health care quality discussion by publicly reporting key performance measures, it has also been developing solutions that address the second part of the value equation: the need for understandable and relevant information about health care costs.
In January 2007, Alegent Health introduced My Cost, a patent-pending online tool that provides individual consumers with information they need, based on their health plan or personal financial situation, to more precisely determine their specific cost, along with their out-of-pocket responsibility, for a variety of common medical tests and procedures. Uninsured consumers also have access to a list of self-pay prices for frequently purchased services as well as information on financial assistance programs.
Our approach is somewhat different from that which many of our colleagues have taken. Instead of using a “list price” or “average cost,” which are irrelevant to consumers given the multitude of insurance plans and government reimbursement formulas that determine the actual cost to a consumer, we provide the consumer with the ability to find out how much they will actually pay.
If the health care industry truly wants patients to become good consumers, then it needs to find more innovative ways to engage them and deliver care. A look at any industry that has put consumers in charge will show that they constantly create new products, new services, and new conveniences, all designed to meet the needs of the customer. Health care should be no different.
As more employers choose to offer consumer-driven health plans, which place more of the financial responsibility on consumers to pay for their health care, we will see consumerism take control.
Alegent Health and the health care industry have started down many of the right paths--quality reporting, transparency, better cost data and greater consumer involvement. We need to keep up the good work on all of these fronts, and we must do a great deal more to ensure that patients, stakeholders, policy makers and regulators understand what we’re doing, why we’re doing it and what they can do to help.
Wayne A. Sensor is CEO of Alegent Health, Omaha, Neb.
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This article first appeared on June 6, 2007 in HHN's Magazine online site.
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