Health Care Should Be Treated as an Investment

Regardless of your stance on the future of healthcare, one thing most of us can agree on is that we need to think of healthcare as an investment for payers, providers, and patients. While a focus on profit certainly should not be the primary driver, money does matter because we have to pay for health care somehow. Just as with any business, the numbers need to add up in order for it to remain financially solvent. What we’re seeing now is that everyone is pointing fingers at each other:

  • Doctors charge too much
  • Drug prices are skyrocketing
  • Insurers hike their premiums every chance they get
  • Lower income individuals misuse the ER and ambulatory services
  • Patients don’t take care of themselves which drives up their medical costs

There’s plenty of blame to go around, but not enough accountability and certainly not enough action taken to resolve these issues. As we all know, payers and providers already look at health care as an investment because they operate as a business. They can see the impact of their decisions on the bottom line. But what about their patients? Do they really understand their contribution to the equation?

The Patient’s Responsibility

When we think of health as an investment for individuals, we may think of the premiums they pay, their deductibles, copay, coinsurance, and max out of pocket. But it goes beyond that. Looking at the life of a patient, we see many factors that contribute to their overall medical costs. Let’s take a closer look at these risk factors and how they should be addressed:

WBIH Risk Factors

How to Incentivize Good Behavior

Education, technology, and a support system are amazing tools to help patients make good decisions about their health. People who are proactive in utilizing preventative care and are disciplined with diet and exercise should be incentivized with lower premiums and other perks. They should also be empowered through the use of technology and integrated wellness programs. It’s in the best interest of insurers to put these tools in the hands of their members. Incentives such as lower premiums, rebates, and rewards can be a powerful motivator to help patients prioritize their health.

  • Gym Memberships: many health insurance companies have begun reimbursing their members for part or all of their gym membership costs if they check in at their gym a certain number of times per week. This is a wonderful incentive and an innovative solution for those who do not exercise because they can’t afford the gym membership.
  • Diet & Exercise Trackers: We’re already seeing the use of FitBit technology and other wellness programs to track diet and exercise via smart devices, but they should be easily integrated with the patient’s medical care and nutrition plan. For example, BlueCross BlueShield of Tennessee just announced that they’ve integrated their wellness portal’s AlwaysOn™ mobile app with Apple Watches so members can sync their Apple Health data and track their progress on diet and exercise plans. Read More >>
  • Premium Rebates: The use of the above programs/technology and subsequent attainment of weight loss or other prescribed health goals could be verified at regular check-ups and incentivized through premium rebates, much like a Safe Driver discount for auto insurance.

Time to Crack Down?

But what do we do if patients choose not to participate in their health care? What should be done when people continue to maintain a poor diet, resist exercise, abuse drugs and alcohol, and exhibit irresponsible behaviors such as diabetics not managing their sickness with the prescribed medications? Should they be penalized to discourage such behavior and help offset the increased medical costs they’ll likely incur? Many health insurance companies already charge higher premiums for smokers, generally 15-20% higher than for non-smokers. Under Obamacare, qualified health plans can charge up to 50% higher premiums for smokers. Should we use that model for other preventable conditions?

What do you think? Should the health insurance system play good cop or bad cop? Maybe a little of both? We need to get healthcare costs under control one way or another and as Benjamin Franklin once said, “an ounce of prevention is worth a pound of cure.”

Dottie Robinson
HCIM Executive Adviser

About HCIM

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered expert consulting services and robotic automation tools for small to mid-sized healthcare payer and managed care organizations. Our concierge consulting services include everything from core claims system procurement to go live, including configuration, migration, upgrades, reporting, benefits and fee schedules, user training, and project resourcing. We also offer strategic consulting in the areas of value based payments, population health, medical management, medical loss analysis and recovery, care management, provider contract modeling, data analytics, and business process reengineering/analysis.