Some companies are bucking the trend and finding ways to increase utilization of price transparency tools, especially among employees with costly health conditions.


March 30—More than one-third of high-cost patients have given up trying to figure out what they should pay for medical services and are just waiting for the bill to arrive, a new survey found.

The annual survey by Aon Hewitt delved into the use of healthcare services by 2,500 consumers with health insurance through a range of employers.

The survey found that fewer high-utilizers are looking up any costs before they receive a procedure. The disengagement by high-cost patients was most extreme among people in their 20s, 44 percent of whom say they have given up looking at costs. Also, only 40 percent know where to go to figure out the cost of a health service, which was seven percentage points lower than the survey found last year.

“In that group they are really exhausted,” Joann Hall Swenson, a partner at Aon Hewitt, said in an interview.

Such patients said they want coaching in navigating the healthcare industry because they lack the time to “be an engaged patient,” she said.

“We’re not seeing a major decline, but we are seeing shifts toward lower [levels of] consumer behaviors,” Swenson said.

Such disengagement comes amid a shift toward high-deductible health plans (HDHPs), which are putting more responsibility for the cost of care on consumers. But the burnout didn’t shock some who are focused on healthcare consumerism.

“It’s not surprising to me because the folks consuming the most care are probably the most inclined to throw up their hands and say, ‘This is so complicated, I’m going to spend a boatload of money no matter what,’” Anne Marie Aponte, senior vice president of operations at Accolade, said in an interview.

Shift to HDHPs

The ongoing shift to HDHPs includes 29 percent of workers who are covered by employer-sponsored plans with a savings option (known as consumer-directed health plans, or CDHPs), according to the latest Kaiser Family Foundation employer survey.

A recent example of that shift happened at General Mills, where 81 percent of employees selected a CDHP with a health savings account when that arrangement was first offered in 2017. Ron Drayton, director of Global Benefits for General Mills, credited the popularity of such plans to the company‘s communication of the advantages that those plans offer to patients.

Meanwhile, JPMorgan Chase implemented a full-replacement HDHP and integrated wellness program in 2012. 

Still, increasing costs are affecting consumers. One in five Aon Hewitt survey respondents said that high healthcare costs led them to decline other coverage, such as dental or vision coverage; stop taking prescriptions; or avoid care.

Preferred Approaches

Surveyed consumers said their engagement would improve if offered “high-impact decision-making tools,” personalized reporting, and clear direction.

“Aggressively promote high-touch advocacy and concierge services,” Swenson said. “People want that human touch; we hear that over and over again from our survey.”

Such service is exemplified in Accolade’s health assistants program, which assigns individuals to each beneficiary to provide details on  healthcare and benefit options and to answer questions on billing, benefits, insurance, and financial barriers to care. They also aim to get to know the individual enrollee’s characteristics, their families, and specific challenges outside health care.

“Logistical issues they may have—whether it’s transportation, whether it’s financial—all of those other things that are part of a person’s being and don’t obviously seem like variables that might impact how they utilize health care but that we’ve known are huge influencers,” Aponte said.

Swenson also noted that insurers and—to a lesser extent—employers have found difficulty in getting those covered by their insurance to use cost-saving tools. But enrollees are more likely to use tools from third parties, especially providers.

Swenson urged employers to go back to basics on health insurance terms, develop mobile tools accessible on smart phones, and “hyper-personalize” information utilizing individuals’ data.

Adam Glauberg, director of Global Health Services in the Americas for Johnson & Johnson, said the company has offered digital health-coaching tools for at least 12 years but this year was able to increase employee utilization by 500 percent after integrating tools into a mobile app.

“That’s when it starts getting really exciting that we’re reducing that barrier to entry and getting people there really easily,” Glauberg said at the annual meeting of the National Business Group on Health (NBGH).

Glauberg credited the broad engagement on the health app to a concerted effort to push employees to download the app during meetings held as part of the regular course of business.

“Once you get people into these great tools, they stick around and they like them and they use them,” Glauberg said. “It’s getting them in there that’s the hard part.”

As part of a broader health push, the company aims for 100,000 of its employees to use digital health tools by 2020.

The shift to apps from websites also has benefited employers with more diverse workforces, such as Wal-Mart, where 25 percent of employees have used a cost-and-quality app from Castlight Health.

“If you’ve got a computer in front of you all day, it’s a different situation than the associates out in the store,” Lisa Woods, senior director for Health Care Benefits at Wal-Mart, said at the NBGH meeting.

The company, which has 1.2 million people covered by its health plan, credited an 8.6 percent spending reduction stemming to Castlight’s concentrated use among Wal-Mart workers with the most medical costs.

The high utilization rate was credited in part to the integration of the sign-up process for Castlight into the open-enrollment process for employees’ annual benefits. Woods said that change boosted the sign-up rate from 9 percent of employees to 40 percent.

Such utilization may get employees to consider a second opinion to “Dr. Google” when they have a healthcare need.

“Our hope is that we can get to a point where they think of our app first,” Woods said.

Full results from Aon Hewitt’s consumer mindset survey are scheduled for release in April. 


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, March 30, 2017