A New Consumer-Centric Approach to Healthcare

As healthcare costs continue to rise, employers and plan sponsors are continually being pressed to find solutions. The healthcare industry is unlike any other when it comes to buying goods and services. The challenge in healthcare is the end user (patient) has traditionally been blinded to the true cost of services. This is largely due to health insurance being the primary mechanism for covering the costs of healthcare services.

When an individual has a procedure or is prescribed a medication they pay a copay/coinsurance that is typically a fraction of the total cost of care. This prevents patients from having an easy way to be a “consumer” and make informed financial decisions when it comes to receiving healthcare services.

This has led to a multitude of solutions aimed at assisting the patient in becoming a consumer. The two most prominent solutions are high-deductible health plans (HDHP) and healthcare transparency tools. Although these solutions may allow patients to understand the cost of healthcare they do not help navigate them down the most cost-effective path.

Healthcare benefits, and more specifically pharmacy benefits, are complex with several ways to access care at varying costs. A recent study conducted by the Harris Poll found that although employees feel knowledgeable about enrolling in health insurance they lack the ability to best utilize it. The poll provided an insightful look into the employee perspective of health insurance benefits:

The results of the poll beg the question, “How can we expect patients to be “consumers” of healthcare when they do not fully understand it?”.

We can assist a movement to healthcare consumerism by not only providing transparency but also being directive in which path leads to the most cost-effective care. It is the combination of the two (transparency and navigation) that will lead to lower healthcare spend for employers. The SmithRx Connect program aims to meet this challenge by leveraging transparency to identify the best path and then using patient advocates to direct patients through the process. The result is a reduction in pharmacy spending that benefits both the patient and their employer. As we continue to search for solutions that lower healthcare costs we should be using the term “directive consumerism” to describe the missing piece.