Blog Post

Is Overall Wellness in Trouble?

More high-deductible plans, more trouble engaging patients… and an early death to "Wellness?"
November 20, 2014
Anywhere from 60% to 80% of the health plans offered on the various health insurance exchanges during the open enrollment period that started Nov. 15 are expected to be high-deductible plans. These are, of course, the plans that offer low premiums but higher deductibles. The rates vary by state, type of plan and more, but the lowest-cost individual premiums on the federal exchange, according to HHS, are $69 a month. Although people may find themselves paying thousands in deductibles and out-of-pocket expenses before their plan ever starts to share the cost of care, that $69 is very attractive.
Good news for some. It’s good news for policy wonks and employers wanting Americans to share more – and be more aware – of their health care expenses. It’s also supposed to be another step toward a truly consumer-driven health care system in which people can, at last, choose their care by “quality” and price.
But it’s not such good news for plans and providers, who are finding the people with high deductible plans seem to be less willing to actually engage with health systems.  Their patient engagement efforts are struggling. The reason: people fear it will cost them part of their deductible every time they call.
A Struggle to Thrive?
High-deductible plans, in other words, have become a disincentive to use health care providers to manage their health. The media are dotted with stories about patients who delayed or avoided care to avoid out-of-pocket expenses. In 2010, even before the spike in people using high-deductible plans, 58% of Americans said cost had forced them either to delay or forego medical care during the prior year.
Meanwhile hospitals, physician groups, policy wonks and the plans themselves have launched expensive medical home and population management efforts –  best and most famously promoted by Kaiser’s much-admired “Thrive” campaign  –  precisely to get actively involved in helping patients stay well, treat minor illnesses before they become major, and keep people out of the hospital.
But almost half the “moderate income” buyers of the high-deductible plans already say their new out-of-pocket payments are “difficult to impossible to afford,” according to a new survey by the Commonwealth Fund. Sixty percent of the low-income buyers of these plans find their out-of-pocket expenses have become “difficult.”
Different kinds of communication. The assumption is that many of these people were previously uninsured. They are even less-prepared than the rest of us perplexed consumers to manage the confounding responsibilities of health insurance. The Kaiser Family Foundation (separate from the Kaiser “Thrive” company) recently found that 40% of the uninsured don’t know the definitions of, much less the differences between, “premium,” “deductible,” and “provider network.”
One of the results is a bunch of physician groups, hospitals and health plans that are struggling to engage these people (and, in many instances, collect the out-of-pocket bills still owed to them).
Until and unless policy changes, this is going to take considerably more sophisticated, evidence-based, better-targeted marketing and communications not only to protect providers, but keep wellness programs around the country.

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