Health Insurance Exchanges Will Transform Health care. Magically ...

By Ann Mond Johnson

NPR ran a story recently about how some retailers are retooling efforts to appeal to consumers in light of increased competition, particularly from online vendors.

Many are striving to be more ?customer friendly?; Kohl?s department store was mentioned for adopting a ?no questions asked? return policy with the idea that customer loyalty could be enhanced as the retailer made itself easier to do business with.

Comparisons between health care and retail abound, and while we say it is ideal for the consumer experience to be the same in both industries, in fact they are much different. The gap between the two industries was well-illustrated in this video of a shopper in a grocery store. We see them at the counter having their items rung up. But they aren?t told the prices and when they are given the receipt at the end, they?re told the final amount due may actually differ from what they see on the receipt.

Let?s take the analogy a step further: what if the customer expected the same ?no questions asked? return policy from Kohl?s? Or a money back guarantee? In health care, only recently has the federal government taken steps to impose financial penalties in instances of poor care (which is the health care system?s equivalent of a ?return policy? from providers).

When our team was at Subimo we initially focused on cost and quality (outcomes) information on hospitals. It was clear that ? for the same procedures ? there were both low cost and high quality providers as well as high cost and poor quality providers. Our efforts with transparency were designed to help people sort through the information so they could make more informed decisions and understand what quality outcomes might mean to them. We knew there was much variation in outcomes with certain procedures (e.g. aortic aneurysm repair) and less variation with others (e.g. normal vaginal delivery). Helping people understand when a poor outcome was more likely to occur helped them with their decisions (and presumably made them better shoppers).

And now our team is providing the latest expression of consumerism in health ? private exchanges and online shopping platforms that are designed to help consumers wisely spend their benefit dollars while addressing cost considerations of employers. Private exchanges that provide personalized benefits for consumers and transparency around the price of insurance as well as the employer?s contribution continue to sustain my optimism when it comes to the goal of making health care more oriented towards consumers. I truly believe that transparency and personalization will not just expand but will become touchstones as consumers learn to navigate the health care system, from choosing insurance to finding providers, products and services.

Even with my optimism and with all the market buzz about exchanges, I can?t help but be reminded of disconnects between health care and retail shopping, especially when the differences surface regularly and are so easily remedied. Case in point: Hurricane Sandy caused a longer stay than anticipated on the East Coast, leading to a shortage of prescription medications. I first called our pharmacy benefit manager, asking for a one week supply of meds to be filled at a local Virginia pharmacy. They told me to call the insurance company. Our doctor called the Virginia pharmacy who then called our insurance company for an ?override?. The override was approved for five of six prescriptions but declined for the sixth. Why? The patient lives in an area (Chicago) that was not affected by the hurricane. Even though the patient was in Virginia, and not in Chicago. Even though the other five prescriptions were approved. No amount of dialogue could change the insurance company?s decision and the void of logic and common sense (not to mention customer service) was astonishing. I can?t imagine a service person at Nordstrom?s not anticipating this and working proactively on their client?s behalf, especially if they worked at the doctor?s office.

So while I am heartened by how consumer-driven health care has become ? retail clinics, quality rankings as examples ? I?m reminded that we are only as consumer-centric as our weakest link(s). For every example I have, I know that there are many more. There are plenty of weak links throughout the healthcare system. Like Kohl?s, each of us can look at the top things that make our business difficult for people to deal with. With often only modest effort, we can make changes to significantly improve the consumer experience, lower frustration and minimize confusion.

While technology and financial realities accelerate consumer-oriented innovation like insurance exchanges, I am mindful that the entire industry has to ensure that every facet of the business reflects the same level of consumer orientation. We each need to fix our weakest links if we want to see innovation deliver on its promise.

Ann Mond Johnson is the chairman of board of managers of?ConnectedHealth, LLC.

Source: http://thehealthcareblog.com/blog/2012/12/08/health-insurance-exchanges-will-transform-health-care-magically-increase-transparency-improve-access-and-maybe-even-lower-costs-but-only-if-we-get-it-right/

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