Opinion: Speed Bump Ahead on the Consumer Health Autobahn?


Seven years into the 21st century, consumer-directed health plans are a lot like automobiles were at this point of the 20th century, suggests PricewaterhouseCoopers consultant David Harris. Early adopters of the horseless carriage tended to get into a lot of accidents.

It was hard to tell if massive pile-ups are on the horizon with the posh Wynn Las Vegas resort, a symbol of bold confidence, serving as host for the annual meeting of America’s Health Insurance Plans (AHIP) last week. But that’s exactly what seems to be happening with high-deductible health insurance, health savings accounts (HSA), and personal health records.

Blame a distinct lack of transparency in healthcare, plus quite a bit of misunderstanding by just about everyone involved, from consumers to providers to banks to employers to health insurers themselves.

Providers don’t quite know how to bill patients with high-deductible plans since many insured services won’t come with a co-payment. A growing number of banks are offering HSAs, but often without specially trained customer-service representatives. (My own HSA didn’t initially come with a debit card. I was writing checks at the pharmacy for more than a year!)

Patients — er, consumers, in the current vernacular — still don’t know what health services really cost, so it’s hard to be informed shoppers. And many employers view consumer-directed plans as a way to reduce corporate spending on healthcare.

With PricewaterhouseCoopers forecasting that a third of privately insured Americans will be on consumer-directed health plans by 2011, be on the lookout for a lot of pile-ups.

“If it becomes a lever for cost shifting, we’re going to see some opposition,” said Mike Tarino, chief executive of DefinityHealth, the CDHP subsidiary of UnitedhealthGroup.

“I don’t think it’s about cost shifting as much as it’s about education,” Harris responded.

If so, that’s where health-IT comes in.

A quick scan of the exhibit hall showed that everyone’s offering some form of personal health record (PHR) to help make health information portable and accessible. A few stops in the educational sessions suggested otherwise.

AvMed Health Plan, a not-for-profit insurer in Florida, has about 200,000 members. Exactly 34 have signed up for an “electronic clipboard” for filling out patient history at the doctor’s office, said Marcela Phillips, AvMed’s director of support systems. “The utilization is pretty dismal.”

Other PHR providers report similar, disappointing results so far.

“The infrastructure hasn’t been built to handle transparency and the shift to consumerism,” said Rob Panepinto, president of customer-relationship management company Connextions (Orlando, Fla.).

“Consumers are confused,” added Jeff Gruen, chief medical officer of Revolution Health. “There’s little or no innovation in terms of how you get consumers involved.” That Washington, D.C.-based company, founded — and bankrolled — by Steve Case of AOL fame, counted 2.1 million unique visits to its home page in just its second month of public operation.

“Consumers really do have power,” Gruen said. “[But] individual consumers have no power.”

Clearly, both the health insurance industry and the health-IT segment believe in the power of free markets. But the former is running scared, or at least somewhat wary, from the prospects of “universal” coverage in some states and, notably, the impending release of Sicko, Michael Moore’s cinematic indictment of the U.S. healthcare industry.

A rumor that Moore might disrupt the AHIP meeting with some sort of publicity stunt never materialized. Instead, the only Hollywood figure we got was California Gov. Arnold Schwarzenegger, whose bland closing keynote address suggested he was making a courtesy call to an industry that stands to benefit from the Governor’s proposal for universal coverage in California that favors private plans over a government-run system.

Not surprisingly, Arnold made no mention of electronic health records.

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