Healthcare Reform Stakeholders Summit, Fall 2015 - Episode 7

Providing the Right Incentive to Effect Change

Employers are trying to get more creative in the kinds of benefits packages they offer, but new regulations set up by the Affordable Care Act makes it difficult. One of the reasons for the changing market is the proliferation of plans with high deductibles, explained Leah Binder. As of yet, it’s unclear whether high deductibles are changing the market for the better or worse, she added.

However, one changing aspect of the health insurance market that Austin Frakt, PhD, views as a negative is the increased options in the marketplace. There is emerging evidence from the insurance marketplaces, and already established evidence from Medicare Part D and Medicare Advantage, that consumers are confused. This is especially a concern in the marketplaces where many consumers have never had insurance before.

“So when they go and they see a choice of 40 plans, different premiums, different deductibles across different time periods, different kinds of providers, copayments, and so forth, it’s enormously confusing,” he said. “They don’t know what their own costs or what the costs are going to be.”

Matt Salo directed the conversation toward provider risk in the new shared savings model. In Medicaid, he said, doctors are unsure how they can be held accountable for what happens outside the walls of their office if they do everything right inside it. But while providers cannot influence the behaviors of patients outside of their office, it’s only because they’ve never been given a financial incentive to do so before.

Binder pointed out that even though all the pieces are being put in place to change the way care is delivered, does not guarantee success.

“A handful of purchasers have been very interested in the ACO model and have actually started working directly with these ACOs to sort of work through some of these transition issues, because it doesn’t happen overnight,” she said. “Just because you say, ‘here’s the incentive on the table,’ everybody doesn’t suddenly change their behavior overnight.”