The Healthcare System need to be Used More Thoughtfully and Efficiently by All

Employers are desperately looking for ways to cut costs and to keep their employees on the payroll, as they are financially drained. People have never been so concerned about good healthcare benefits than today. Therefore, this is the time when all have to put some effort and break the healthcare cost curve for employers. Employers without financially draining themselves wish to offer quality benefits.

People are now motivated to make the best healthcare decision, especially with the fear of exposure to COVID-19. Today all need to thoughtfully and efficiently use the healthcare system. This pandemic has come in a time of active healthcare consumerism and has led to the positive and lasting impacts on cost and quality. However, this is only possible when health insurance carriers can appreciate and support consumer motivation.

Health insurance needs to be designed in a better way and it needs to be done immediately. The time has arrived when health insurance that was designed around doctors, hospitals, and drugs need to be moved to a condition-based health plan design. This will create a fine balance between people’s health insurance and the manner in which they use healthcare. A robust infrastructure needs to be created through which people can avail of top-quality care and lower cost medical procedures to resolve their health issues. If it is done, then everyone is sure to benefit.

To truly support active consumerism there are four essential tenets for health insurance design:

Health insurance should be personalized – Everyone’s healthcare needs are not the same and yet traditional health insurance plans grouped consumers down to a set path. All policyholders are given a list of in-network providers and they are supposed to pay the price that the insurance company has negotiated. The irony is that policyholders are not aware of the cost until they avail healthcare and receive the bill for the same. Policyholders simply receive the treatment recommended by their doctor without knowing all the treatment options available and without being able to compare costs. Policyholders don’t have the apt information so that they confidently take the right decision while purchasing the plan. However, this needs to be changed. Based on data and technology, the healthcare sector needs to provide a personalized and flexible solution to consumers by providing people the tools through which they can make the informed and right decision regarding their health plan. Insurance carriers should learn details about their consumers like their motivations, build context and about their healthcare need through artificial intelligence and machine learning

Health plans to offer condition-based coverage – People shopping for health insurance not just look for doctors, hospitals, and drugs but they want coverage for their own specific condition. Health insurance plans supporting active consumerism will unfold the entire treatment options along with clear prices. Due to the spread of the COVID-19 pandemic, the entire healthcare sector has come together for a condition-based approach. Health insurance carriers not just need to offer a condition-based approach for COVID-19 but for every single condition because now the consumers will shop for a health plan in this manner only.

Remove Unnecessary Affordability Barriers – Unnecessary affordability barriers such as co-insurance and deductibles need to be removed now. Simply because a deductible for chronic conditions or infectious disease is simply not a good idea, because many people who face high deductibles generally skip or postpone receiving healthcare. Employer-sponsored health plans generally have deductibles so that people smartly shop for health plans and will try to control the healthcare cost, if they have to pay 100% of their treatment costs from their pocket. But it becomes hard for people to shop without knowing about the prices. It becomes harder for them to shop when they are unable to fund 100% of their healthcare until the deductible kicks in. Thus, people need to know the upfront cost of healthcare so that they can accordingly shop and save money. Being aware of the healthcare cost in advance, people can make a well-informed decision that works for their specific circumstances.

Effective and efficient choices should be incentivized – While shopping for health insurance people require reliable and real-time information that will help them make better decisions. The clarity on the price of the health plans will help people take more effective and efficient options. Today people are unaware that there are effective as well as ineffective treatment paths for every condition. Based on the clinical evidence, the healthcare sector needs to put the financial incentives in place to support behavior change. Consumers should pay less for treatments and providers that will likely keep them well. An effective and efficient choice in this regard can be telemedicine, which is now becoming common and more accessible. Now both doctors and patients are realizing the virtual care benefits, because it is scalable, convenient and costs less. Therefore, health plans need to be designed to incentivize telemedicine in a much significant manner.

Set a Well-defined Path – Now is the time for the healthcare sector to build something new and create a platform that allows consumers to avail of the care they need. Through the platform, the consumers should be delivered choice and value at every step and the healthcare sector needs to shift their attention from patients to active participants and from treating illness to maintaining health. In this regard, employers can have a positive impact on their employee health that will further allow them to spend better on their healthcare. A time has come for the healthcare sector to stand up and play a different and unique role.

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