Published in the Huffington Post on January 17, 2017
I recently decided to buy a space heater as a gift for a relative who’s always cold. I took myself over to Bed, Bath & Beyond, coupon in hand (pro tip: they never expire!). What greeted me was an overwhelming array of options; I had no idea we needed so many choices when it comes to space heater features.
A salesman quickly helped me narrow it down to two models from one manufacturer. The most amazing thing was how much relevant comparative information was readily available about them: heating abilities, number of settings, timers and shut-off systems, digital displays, anti-tip and other safety features, power consumption, hidden anti-trip cords, etc. I could even scan a code on my smart phone that would instantly take me to online reviews of the products. Most of all, the price of each one was printed in big, bold letters.
I eventually ran out of time and decided to buy the less expensive one. They seemed to perform the same; the costlier one just had a nicer display. (I don’t think this relative reads my blogs, but in case she does: Sorry for cheaping out and I hope you love the one you got.)
Contrast this experience with making a health care decision. Without question, the health care choices you make—when and where to get care, how much to pay for it—are vastly more consequential than buying a space heater. It isn’t overheated rhetoric to say the choices we make about our health care could have life and death implications.
Yet, choosing health care can feel like you got left in a dark room, spun around three times to disorient you, and then had a blindfold put on just for good measure. Unlike Bed, Bath & Beyond, you probably don’t have a “salesman/navigator” to assist in the process and help narrow your options; you can’t easily get comparative information about quality and performance; and good luck trying to find and compare the prices. (You probably don’t get the never-expire coupon either, but so it goes.)
It is obvious that we need to ensure that timely information about health care prices and quality is available, accurate, and understandable. In this era of high-deductible plans, consumers are increasingly paying more out of pocket for their health care and are looking for value. (I’ve written before about the difference between a “consumer” and a “patient”—it is more than semantics.) How much longer will consumers accept a black box of health care prices? Can you imagine walking in to Bed, Bath & Beyond and not being told how much the space heater costs until you’ve already left the store, and you can’t return it for a refund or a discount?
We are making some progress. Some insurance companies are offering tools that make price and quality information available to their members. Both the availability and quality of these tools vary. Consumer Reports recently rated online health care cost and quality tools in New York and nationally, and found that 12 of New York’s health plans make these cost estimator tools available; the other 9 major plans do not. Some tools are better than others. The information provided may sometimes be out of date; for example, a provider may no longer accept a particular type of health insurance, even if it’s listed on the doctor’s or insurance plan’s website. Sometimes the information is incomplete; for example, it’s not clear how much of a listed price will be out of pocket vs. covered by insurance. Some tools are simply easier to navigate and use than others.
Consumer Reports makes solid recommendations for how health plans can learn from the best-in-class tools. Health plans should ensure that their websites meet high standards for usability, functionality, scope, and reliability. Because there is little relationship between cost and quality (just like with space heaters, the more expensive one isn’t necessarily better), quality information should always be made available alongside price information, and sites should offer clear information that helps consumers understand the value of the care delivered. Consumer Reports also suggests that health plans provide similar information to their covered providers, to facilitate more communication between patients and their doctors about high-value care and to inform decisions about specialist referrals and laboratory services.
While plans work to improve their tools, consumers need to learn some new habits too. Numerous studieshave demonstrated that even when these tools do exist, consumers don’t necessarily know about or use them. Consumer Reports noted that only 12.5% of the consumers included in its study had previously used cost estimator tools on their insurance plan’s website. Insurers, employers, consumer organizations, health care navigators, and health care providers could all step up to raise awareness by sharing information about the availability of cost estimator tools and encouraging consumers to use them.
There are also policy opportunities in New York State. What if all insurers were required to provide information about cost and quality in order to operate in New York State and that information had to meet certain standards? The State could also move in this direction. As New York implements its all-payer database, it should provide direct consumer access to provider-level information about price, quality, and value through a single website. New Hampshire and Maine already do this and so should New York.
I was being cheeky—sort of—by pining away about Bed, Bath & Beyond. Of course I realize that health care is more complicated than other goods and services we purchase. It isn’t as easy or accurate to make side-by-side comparisons of performance and prices. You don’t have to risk-adjust space heaters. I know that health care isn’t a space heater, or a computer, or a car, or any of the other analogies we like to make to point out how backwards our health care system is compared with other industries. But we should also stop using that complexity as an excuse to remain in the dark ages. The information I had available when buying a space heater was like night versus day compared to the lack of information and empowerment that health care consumers face all the time. Consumers will eventually vote with their feet; providers and plans who get that and become more attuned to the demands of their consumers are going to emerge on top.