By David Fletcher, MPH
Vice President of Innovations, Streamline Health, Inc.
It’s not often that you sense a sea change in a large industry through a single event, but a few weeks ago, I experienced exactly that with regard to healthcare. I was just picking up eardrops at my local pharmacy. My ear hurt from an infection. It had been an issue for five weeks, starting with hearing loss and wax impaction. I was ready for medication. Then my pharmacist said, “That will be $177.00”. My face dropped. It was the shock of an HDHP newbie and it was the moment I realized how profoundly healthcare is changing.
My new high deductible health plan (HDHP) permits me to put pre-tax dollars from my paycheck into a healthcare spending account (HSA). I have to pay for most expenses up to $3000 but I keep what I don’t spend, year after year. Now more than ever before, I had financial “skin in the game” regarding my healthcare costs, and it had an immediate impact on my perspective regarding medical necessity. Having an earache is bad, but spending $177 for eardrops, using my money?! I don’t think so. I chose to leave those eardrops at the pharmacy and endure the pain. My bet was that I would notice if this infection were to get really bad but at that moment, I figured I could take more pain and hope for intrinsic healing without medical intervention. I was lucky. The infection cleared in two weeks and I saved the dollars.
An HDHP is patient engagement for the checkbook. It feels like my money. If I save it, I keep it. I’m a new recruit in the mission to control healthcare costs in the US and I’m embracing it. The HSA directly engages the consumer in the evaluation of costs—normal for most other industries. In addition to taking chances on my treatment by refusing the expensive eardrops, I also successfully contested $150 of the $450 in doctor office visit fees. With my previous health insurance, I was largely shielded from the expenses involved with my care because, even though the costs were being incurred, I wasn’t so directly responsible for them. With the increased visibility, I suddenly saw not just the costs differently, I reconsidered the respective value of the related procedures and therapies as well.
With this new perspective, I considered the possible impact on how healthcare is delivered and supported via technology. Many HIT vendors provide denial management workflows for providers, but maybe we should think about the consumer and the difficult conversations that are now occurring between doctors and patients. With price sensitivity, providers are likely experiencing a new line of cost-related questions and concerns prior to care delivery. “Uh, before you do anything, I’m super engaged with my HSA and billing. Can you let me know what you intend to do before you do it and provide approximate charge information? If you’re OK with that, can you let me tell you what I think you should and should not do?” How do patients pose the questions— and providers answer them—without turning care visits into a factory-like procedure? Maybe a charge guide for consumers would be useful. Something like an app where you tell it your doctor’s name, your insurance and that you’re being seen for an ear infection and it gives you a working bill that includes all the work that the doctor might do, prior to the charges being incurred. This type of charge estimation would be more flexible than pre-authorization, and it would be the basis of the discussions needed to address the patient’s newfound interest in the cost side of their care.
Maybe I should pitch the development of such technology to my CEO because the game is changing in healthcare, and these changes will require new tools to accommodate the new rules of engagement.