CDHPs Doomed Without Physician Support

Les Masterson, for HealthLeaders Media, November 12, 2008

Reaching out and engaging members of consumer-driven health plans (CDHPs) may help slightly, but if health insurers really want to make a dent on costs and quality they need to reach out to providers.

Case in point: A recent study called Are Primary Care Physicians Ready to Practice in a Consumer-Driven Environment? showed that most primary care physicians don't understand CDHPs and medical savings accounts, can't advise patients financially about procedures outside of their practices, and don't trust quality-of-care information on health insurers' Web sites.

"I think it's an open question about what role the doctors should play in these plans," says Craig Evan Pollack, MD, MHS, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania in Philadelphia and co-author of the study.

Less than half of 528 physicians surveyed said they are ready to discuss medical budgets with patients. About four out of 10 surveyed said they had "low knowledge of CDHP cost sharing" and about one-third said they had "low knowledge of how medical savings accounts function."

The survey also found that physicians are comfortable advising patients on the costs of office visits, medications, and laboratory tests, but they were less comfortable educating patients about the financial impacts of procedures outside of their practices, including specialist visits and hospitalizations.

In another sobering finding, less than one in 10 physicians surveyed trust quality-of-care information on health insurers' Web sites. Sites that compare quality and costs are seen as an important component of CDHPs because they allow consumers to make educated decisions. Without doctors' support though, health plans can't expect these sites to become part of point-of-care discussions between physicians and patients.

These findings should concern health plan leaders. Here's why:

  • Patients trust their doctors more than health plans and employers. Payers can promote the cost-effectiveness, choice, and quality of CDHPs, but consumer-driven plans are doomed if the most important player in healthcare (the doctor) is not an active participant.
  • Point-of-care decision-making is a key component to containing costs and choosing the most cost-effective care. If a doctor is not ready to advise a patient about care and cost options, health plans can't expect the best options are being chosen.

"I think the transparency of price information is something that I know insurers are actively working on and I think it's going to be increasingly important under these plans to have that information at the point of service," says Pollack.

Sander Domaszewicz, principal at Mercer in Newport Beach, CA, says physicians delivering the message of healthcare finances holds promise. For instance, physicians can recommend less costly alternatives, such as x-rays rather than MRIs when appropriate. Without physician participation, health plans can expect only marginal cost reductions, says Domaszewicz.

Part of the problem is that physicians are already swamped. If given the choice between whether to stay abreast on medicine or financial planning, the doctor is going to choose the former every time. Plus, for doctors who want to understand their patients' health plan options, there are simply too many plans to keep track.

What's a doc to do?

There are technological solutions, including point-of-care kiosks that provide information about patient out-of-pocket costs. A recent white paper published by Fifth Third Bank in Cincinnati listed two products that physicians believe will help:

  • A price calculator that predicts expected health plan reimbursement and subtracts that amount from the expected total billed amount and then estimates the patient's payment responsibility. The calculation also factors in copays and deductibles to estimate the patients' total financial responsibility.
  • Tools that forecast a patient's propensity to pay their bill, such as building it on a credit score or key elements of credit reports.

Meanwhile, the researchers in Pollack's study suggested health plans and employers educate physicians about deductibles, cost sharing, and medical savings accounts.

Those suggestions coupled with the Fifth Third Bank white paper's wish list are steps in the right direction. There is mistrust on both sides, but if health plans expect CDHPs to succeed they need physicians onboard. That goes beyond a quarterly newsletter about healthcare finances and a greater emphasis on continuous education and technology solutions.

Getting the physicians involved is the only way CDHPs will ultimately live up to their potential.

Les Masterson is senior editor of Health Plan Insider. He can be reached at
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