Health care transparency as more than an amenity

Would you purchase a new phone without knowing its data plan? For almost everybody, the answer is an obvious “no.” We simply cannot make a good choice if we don’t know how much coverage the phone will offer, or how much money it will end up costing us.

Unfortunately, this type of blind decision is exactly the sort that many could face when purchasing a plan in the new health insurance marketplaces — assuming Healthcare.gov will remedy the basic functionality issues that have dogged it in the weeks since launch.

Beginning January 1, 2014, everyone will be required by law to have health insurance; the marketplaces will help consumers find and purchase new plans. But what happens then? Are there easily available doctor appointments covered by these plans, or will patients come up empty-handed when seeking care? Is an insurer’s online directory up-to-date or wildly inaccurate? Which plans have better customer service and which have none?

As patients, it’s vital to know the level of care access an insurance policy will actually provide. Without this basic consumer information, your brand new insurance card is like a mystery phone. All you can do is carry it in your pocket and hope that it gives you the coverage you need, when you need it, at a price you can manage. In reality, it may fail you when you need it most.

This is the opacity American patients have become accustomed to, and it is deeply problematic. Healthcare is perhaps the most important service we consume — but as consumers, we are far less well-informed than when we shop for travel, leisure, electronics, cuisine, etc.

Unfortunately, insurance plans differ enormously in the accessibility of care that they provide. In independent research my company conducted to create Care Access Grades listed on HealthMarketplace.com, we found that some insurance directories are relatively accurate, while some have an abhorrently low 20 percent accuracy quotient. We also found that doctor availability is over 1000 times better in some health plans than in others.

The consequences for patients and for the healthcare system are not trivial. Consider the patients who cannot find a doctor in time to treat problems early. They frequently end up in overcrowded emergency rooms, where health outcomes are worse and treatment is four times as expensive. These inefficiencies and poor results are so commonplace they escape notice.

The risk of making a poor coverage choice is especially great for currently-uninsured Americans who will soon purchase ACA-mandated policies; many of these shoppers will unwittingly end up in “narrow networks.” These plans carry small groups of carefully selected providers, making it incredibly important that patients can assess their availability before purchasing. According to a recent, unpublished McKinsey and Company study (described by the Healthcare Financial Management Association), nearly half of new ACA plans will be of the narrow network type. Even savvy ACA healthcare consumers are left simply hoping that their insurer does not railroad them into a plan with invisible defects.

It is high time that we recognize transparency as more than an amenity; it is an essential aspect of a functional healthcare system, and we are suffering in its absence. Both the private and public sectors have an incumbent responsibility to foster it in their own domains.

That means we need to bring robust, verified, data-driven performance indicators (like closed-loop consumer feedback and doctor availability) to the insurance shopping experience. Conversely, we need to see patient feedback as an asset and an opportunity, rather than as a liability. We must realize that the “data plan” is just as important for patients as the “phone” itself.

Moving toward transparency will require widespread and varied effort from insurers, providers, hospitals, and healthcare IT entrepreneurs, but the end goal is simple and shared: create an environment in which patients have the information they need to make responsible decisions.

If we fail, we risk contributing to the inefficiencies and inadequacies of the healthcare system we all know today. If we succeed, we can look forward to more consumer empowerment — and better, more efficient healthcare — for everybody.

Oliver Kharraz is chief operating officer and founder, ZocDoc. He blogs at The Doctor Blog.

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  • Dr. Drake Ramoray

    It’s important for the doctors to know this as well. Some insurance carriers have provisions to change what they pay docs without notifying them or not providing up to date rate information when requested.

    “Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego, and at the University of California San Diego Hospital, isn’t joining the exchange.

    Franklin said last summer she “got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying less. They did not tell me how much less. You had to agree or disagree. So, of course, I said no.””

    http://washingtonexaminer.com/article/2540272#.UqLPd42Zl8I.twitter

  • southerndoc1

    “Are there easily available doctor appointments covered by these plans, or will patients come up empty-handed when seeking care? Is an insurer’s online directory up-to-date or wildly inaccurate? Which plans have better customer service and which have none?”

    And exactly how is this different from the behavior of health insurers before the passage of the ACA? Sounds like the same old song and dance to me . . .

    • Jess

      I agree, there’s never been very much in the way of transparency as far as health insurance goes. But one of the selling points of the PPACA was that it would lower costs by increasing competition among insurers for new clients, that the exchanges would feature an unprecedented amount of transparency, that we’d all be able to see laid out plain as day what the features of each policy was and we’d be able to compare them and choose the best one. And this was going to lead insurers to compete among themselves to be that “best one” that we’d want to choose.

      Instead, billions of dollars later, the PPACA offers us no better, and arguably worse, than the pre-PPACA. So what was the point?

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