Health Care Literacy, Who’s Responsible?

Friday, September 02, 2011

As organizations have continued to struggle with health care inflation, many employers have now turned to some form of high deductible health care plan (HDHP), also referred to as “consumer driven health care plan” or more simply “CDHP”. The premise is that if the employee is personally at risk for the first $1,000 to $5,000 of their health care expenses, they will exercise prudent judgment in the consumption of health care services. This prudence extends to a maintaining a healthy lifestyle including preventive health care, smoke cessation, exercise, weight and dietary management. While there are many individuals who are knowledgeable about health care related issues, others lack such information or even access to the basic health and wellness facts. Who should bear the responsibility of raising the health care literacy level of employees and their family members?

The National Action Plan to Improve Health Literacy, published by the U.S. Department of Health and Human Services in 2010, identifies many parties in interest, including health care professionals, public officials, insurance carriers, as well as employers. However, the role of employees, the consumers of health care, is restricted to being more of a passive recipient of health literacy information. While the plan encourages “… employees to take advantage of continuing education …” to raise their level of health literacy, it fails to provide clear incentives to motivate employees to become better consumers of health care. Without some form of financial incentives, employees are unlikely to be motivated to take action either in the consumption of health care or their personal lifestyles.

For many employees, the higher deductibles of consumer driven health care plans are offset by the lower monthly premiums and other features designed to steer employees to CDHP’s. Furthermore, some employers provide seed and matching contributions for employees who enroll in CDHP’s and a companion Healthcare Savings Accounts.

Generally, high deductible consumer driven health care plans have annual deductibles of a minimum of $1,200 for Employee Only coverage, while Employee and Family deductibles will be $2,400. Currently, the maximum annual out-of-pocket expenses are $5,950 and $11,900 for Employee Only and Employee and Family coverage respectively. In addition, the annual contributions for Healthcare Savings Accounts are at $3,050 for an individual and $6,150 for a Family.

With an individual at risk for several thousands of dollars in health care expenses, it becomes imperative that individuals have access to both the cost and quality measures of health care procedures and their outcomes. Unfortunately, the availability of such measures is still highly restrictive thus preventing most from being able to comparison shop within their community. This lack of cost and quality transparency means that many, if not most medical consumers have little or no understanding of what a specific medical procedure costs or the outcome history of their medical provider. Certainly, there are a number of internet sites which allow patients to rate doctors, hospitals, dentists, and other healthcare professionals. Most of these sites available to the general public are not vetted and provide no independent measure of the quality of the outcomes, such as the number of procedures done and the success or failure rate.

The Leapfrog Group runs “a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded.” Unfortunately, the major shortfall of such organizations is that they are voluntary.

So who bears the responsibility of employee health care literacy?   Why, the employee of course.