When it comes to healthcare policy under the Trump administration, much is up in the air—especially for consumers.
For those who have health insurance through the federal and state marketplaces, there is uncertainty about how long their coverage will remain in place and whether subsidies will continue. Likewise, people who acquired Medicaid coverage under the Affordable Care Act (ACA) expansion can’t be sure how long their eligibility will last. And for anyone concerned about high out-of-pocket expenses or surprise medical bills, the question is whether the focus on the ACA will detract from attention to these important issues.
As political battles play out in upcoming months, hospitals, physicians, and health plans should realize the importance of staying focused on consumer needs. Despite disruptions that may occur as a result of events in Washington, healthcare stakeholders need to avoid bickering, complaining, and finger-pointing, or they risk unintentionally politicizing themselves and eroding consumer trust.
What Matters to Consumers
Maintaining consumer trust is vital not only under the fee-for-service model but also as accountable care organizations (ACOs) and other alternative payment models (APMs) take hold. Understandably, consumers aren’t interested in APMs from the standpoint of how they affect providers and health plans. a
For consumers, contracts, incentives, and spending targets are irrelevant. What matters instead is that providers coordinate care to ensure the different specialists involved in a care episode talk with each other; that all caregivers have access to their patients’ medical records; and that the financial experience is convenient, straightforward, and accurate with respect to benefit coverage.
To the extent that APMs can deliver in these areas, consumers likely would accept and even embrace them. But early experience with ACOs shows that consumers may not be ready to appreciate the value of coordinated care; not having had it in the past, consumers may not fully grasp what they’ve been missing or even be able to imagine that things could be different.
For example, Medicare beneficiaries believe that being in an ACO would lock them in and limit choice, according to Philip Oravetz, MD, director of accountable care for Ochsner Health System. “We haven’t done a good enough job of educating patients about the value of coordinated care,” he told HFMA News in September. “You’re not giving up choice, you’re getting improved quality, you’re getting improved value. We haven’t delivered that message well.” b
What Oravetz is saying makes sense. Think about it—if health care were like any other industry, you’d see TV commercials during college bowl games highlighting the benefits for patients of data flow among providers, and showcasing conversations between multiple specialists and the patient—making it all sound really cool. But in health care, we can be overly sensitive to physicians’ reactions and worried about running afoul of fraud and abuse laws, so messages like these are rarely the focus of advertising campaigns.
Overcoming Trust Barriers
Why wouldn’t consumers be skeptical of new arrangements like ACOs? The size and composition of provider networks, especially in the age of narrow networks, has become a hot-button issue for consumers today. And in the past, new payment models (HMO, PPO, POS, EPO, etc.) have typically layered on requirements or limited patients’ choice of providers rather than adding value for them. So we don’t have a solid foundation of trust to build on. It wouldn’t be easy to gain consumer trust and promote engagement with APMs under the best of circumstances, let alone at a time when disruption in the industry could detract from our message.
We have our work cut out for us. What we say on the public stage, what we tell consumers, and how well we listen to them matters more than ever. Let’s make 2017 the year we rededicate ourselves to putting the people we serve first.
Joseph J. Fifer, FHFMA, CPA, is president and CEO, HFMA. Follow Joe Fifer on Twitter @HFMAfifer.
a. “Talking About Health Care Payment Reform with U.S. Consumers: Key Communications Findings from Focus Groups,” Robert Wood Johnson Foundation, April 2011.
b. Daly, R., “More Discussion Needed on Patient Engagement, Slavitt Says,” HFMA News, Sept. 29, 2016.