Michael Thompson: What we’re seeing is that, just like in the late 1990s—when we adjusted to what we didn’t like about managed care—we’re starting to have some repercussions with healthcare consumerism as well. What are some of the issues that you’re seeing that we need to rethink somewhat, and how would you start to address some of those issues?
Patricia Haines: Right away I think of healthcare literacy. We have a very educated population that I’m involved with personally, and if you went around and asked them to define their deductibles, their co-payments, or their out-of-pockets, I don’t think many of them would get a score of 100. And then once they start understanding that there’s cost involved for them, that evokes a fear. So if you’ve got any wage sensitivity or income sensitivity, and you package that with how they’re going to have skin in this game, that evokes some amount of fear. And so I think patients are increasingly afraid to go to the doctor for fear of what it will ultimately cost them.
Andrew Crighton, MD: And I think of the medical system too. So providers are geared more toward the consumers, and there is more of a shared decision making that’s being talked about and being pushed as doctors are talking to their patients. But then again, looking at things that were culturally appropriate or linguistically appropriate, we were big on that in the early 2000s. It’s gotten away from that a bit to more standardization, and so the patients—their wishes and beliefs—have to come back into the equation a lot more.
Bruce Sherman, MD: And to your point, Andy, I think that we have not learned the lessons that we perhaps necessarily needed to learn from when 401(k) plans were introduced relative to traditional pensions. And there has been a lag in individual engagement. I think the process has taken considerably longer than what we had all anticipated. To Pat’s comment, which I think is an intriguing one, to fill in some numbers, 9% of individuals were able to define explicitly the terms co-pay, premium, deductible, and out-of-pocket maximum. And I find it an interesting coincidence that 9% of the United States’s adult workforce is in healthcare.
But the point is that I think we have a naïve expectation that because we can provide this information, because we can provide what is effectively a more program-focused or an offering-focused effort toward consumerism, somehow people will engage. And I think that we have not taken into account individual priorities, perhaps leading to issues other than health. You mentioned linguistically and culturally appropriate terminology. So we have a bit of a ways to go.
Michael Thompson: I think it was well intentioned, right? I think there was an orientation that we didn’t necessarily want insurance companies to make all the decisions for our people. We wanted them to make value-based choices based on their own, but it turns out there’s a thousand moving parts. And even for people in the healthcare industry, if they can’t understand what a deductible and a co-pay is, how can they understand all the nuance of the care that’s being delivered? And how can they potentially even engage with a provider who of course has much more knowledge in the situation than they do? So those are some of the issues.