Why are we asking patients to change health care⁉️

From so-called consumer driven health care, to the mythical transparency of Massachusetts health care prices and on to reference pricing; health plans, especially employer plans, see the solution to health care costs in trimming individual fees along with the ability for patients to navigate the maze of health care; shop for the best deal and thereby save money.

In Massachusetts insurance companies that we are told must compete to lower health care costs must now reveal the fees negotiated with providers to their customers … and competitors. At the same time health plans are imposing higher cost-sharing on patients who receive health care out-of-network.

Patients are expected to pick the highest quality, lowest cost doctor and hospital. Never mind that when you pick your doctor you by default pick your hospital where the doctor has privileges. Ignore the fact “quality measures” are largely patient evaluations.

Are you kidding me⁉️

The big dollars are in serious illness and hospitalization. The big dollars are spent on people least able and least inclined to be thinking first about the price of their next procedure … and rightly so.

These efforts, to the extent they save any money, are doing little more than shift costs to patients who are caught in the middle.

At the same time many large employers are getting out of the health benefits business by dumping their workers and retirees on private exchanges to essentially fend for themselves often with limited dollars; more choices, more confusion and less advocacy on their behalf… But employers save money‼️

As I have said before, the practice of insurance companies setting up their own networks and own fees is nuts. Every plan should pay the same fee for the same service based on collective negotiations with providers in a geographic area. Let insurance companies compete on service and efficiency. Let providers compete based on efficiency and quality. Let patients choose any provider knowing in advance their potential out-of-pocket cost. Provide bonus payments above the negotiated fee to groups of providers with the best outcomes and quality measures (including utilization patterns) without regard to fees thereby minimize incentives to under or over treat.

There are too many moving parts in the system, too many variables presented to patients and we are making it worse by the day.