Consumer Oriented Strategies For Improving Health Benefit Design

Responding to persistently rising health care costs and continuing concerns about the quality of health care, many health insurance purchasers have become interested in consumer-oriented strategies to improve health plan design that hold the promise of reducing health care costs and improving quality. While a number of specific activities fall within the general umbrella of consumer-oriented strategies, most of the recent developments in this area can be classified in three categories. Consumer directed health plans (CDHPs) are health insurance plans that use high deductibles coupled with personal health spending accounts to increase consumer accountability for health care spending. Tiered networks are health benefit structures that group providers into tiers based on their costs or quality, and reward consumers with favorable prices if they choose providers in higher quality or lower cost tiers. These strategies, which place greater financial responsibility on consumers for health care decision-making, can also be accompanied by initiatives to provide consumers with better information about the cost and quality of health care, including, for example, information about the quality of health care providers, to enable them to make more informed decisions. While these three strategies have been increasingly discussed, there remains little consensus about their likely impacts on the health care system or how purchasers can most effectively use these strategies, either alone or in combination, to achieve the goals of reducing costs and improving quality. Over the past several years, several studies and reviews have been published that appear to offer some insight into how consumer-oriented strategies can affect the provision of care, costs, and outcomes. However, many of these studies have examined narrow ranges of consumer oriented strategies and often do so in a very tightly focused setting such as a single employer. A synthesis of the existing literature may be able to provide valuable information about the potential for consumer-oriented strategies to bring about beneficial outcomes in health care. Discussion concerning the relative newness of the topic and the possibility of limited scope of literature prompted the decision to conduct an initial exploratory analysis and draft a feasibility report, with the goal of developing a foundation for further evidence review work in this area. AHRQ further determined that this initial analysis should address three issues. First, a conceptual framework should be developed that identifies important factors determining the impacts of consumer-oriented strategies, within which questions about the impacts of consumer oriented strategies on health care utilization, costs, and quality can be addressed. Second, a review of published, peer-reviewed literature on CDHPs should be conducted. Several guiding questions were identified: What are prevalence rates and expected trends for CDHPs? What is the evidence on the effect of CDHPs on quality improvement or lack of improvement? What is the evidence that CDHPs affect utilization of health care services, including doctors visits, ER visits, medications, and diagnostic tests? Is there evidence to determine whether effects on utilization are necessary vs. unnecessary services? What is the evidence that CDHPs discourage access to appropriate care? Is there evidence that effects of CDHPs on utilization vary depending on the underlying health status, income or education of individuals? What is the evidence that CDHPs reduce health care expenditures? Third, preliminary evidence should be gathered about the ability of the literature on tiered networks and provider quality collection and dissemination to support further productive evidence review.

An informed argument for reworking the broken market†‘based U.S. healthcare system by making cost and quality more transparent The United States has the most expensive healthcare system in the world. While policy makers have argued over who is at fault for this, the system has been quietly moving toward high†‘deductible insurance plans that require patients to pay large amounts out of pocket before insurance kicks in. The idea behind this shift is that patients will become better consumers of healthcare when forced to pay for their medical expenses. Laying bare the perils of the current situation, Peter A. Ubel—a physician and behavioral scientist—notes that even when patients have time to shop around, healthcare costs remain largely opaque, difficult to access, and hard to compare. Arguing for a middle path between a market†‘based and a completely free system, Ubel envisions more transparent, smarter healthcare plans that tie the prices of treatments to the value they provide so that people can afford to receive the care they deserve.

Covering a wide range of issues, the 22 cases included in Case Studies in Canadian Health Policy and Management constitute an exceptional resource for bringing real-life policy questions into the classroom. Based on actual events, the cases have been developed with input from mid-career professionals with strong field experience and extensively tested in Raisa B. Deber’s graduate case study seminar at the University of Toronto. Each case features both a substantive health policy issue and a selection of key concepts and methods appropriate to examining public policy, public health, and health care management issues. In each case, the authors provide a summary of the case and the related policy issues, a description of events, suggested questions for discussion, supporting information, and both works cited and further reading. Suitable for graduate and undergraduate classrooms in programs in a variety of fields, Case Studies in Canadian Health Policy and Management is an exceptional educational resource. This second edition features all new cases, as well as adding an introductory chapter that provides a framework and tools for health policy analysis in Canada.

There is currently heightened interest in optimizing health care through the generation of new knowledge on the effectiveness of health care services. The United States must substantially strengthen its capacity for assessing evidence on what is known and not known about "what works" in health care. Even the most sophisticated clinicians and consumers struggle to learn which care is appropriate and under what circumstances. Knowing What Works in Health Care looks at the three fundamental health care issues in the United States-setting priorities for evidence assessment, assessing evidence (systematic review), and developing evidence-based clinical practice guidelines-and how each of these contributes to the end goal of effective, practical health care systems. This book provides an overall vision and roadmap for improving how the nation uses scientific evidence to identify the most effective clinical services. Knowing What Works in Health Care gives private and public sector firms, consumers, health care professionals, benefit administrators, and others the authoritative, independent information required for making essential informed health care decisions.

This book examines the nature of service design and service thinking in healthcare and hospital management. By adopting both a service-based provider perspective and a consumer-oriented perspective, the book highlights various healthcare services, methods and tools that are desirable for customers and effective for healthcare providers. In addition, readers will learn about new research directions, as well as strategies and innovations to develop service solutions that are affordable, sustainable, and consumer-oriented. Lastly, the book discusses policy options to improve the service delivery process and customer satisfaction in the healthcare and hospital sector. The contributors cover various aspects and fields of application of service design and service thinking, including service design processes, tools and methods; service blueprints and service delivery; creation and implementation of services; interaction design and user experience; design of service touchpoints and service interfaces; service excellence and service innovation. The book will appeal to all scholars and practitioners in the hospital and healthcare sector who are interested in organizational development, service business model innovation, customer involvement and perceptions, and service experience.

The Theory at a Glance: A Guide for Health Promotion Practice (Second Edition) describes influential theories of health-related behaviors, processes of shaping behavior, and the effects of community and environmental factors on behavior. It complements existing resources that offer tools, techniques, and model programs for practice. Theory at a Glance makes health behavior theory accessible and provides tools to solve problems and assess the effectiveness of health promotion programs. For nearly a decade, public health and health care practitioners have consulted the original version of Theory at a Glance for guidance on using theories about human behavior to inform program planning, implementation, and evaluation. Theory at a Glance can be used as a stand-alone handbook, as part of in-house staff development programs, or in conjunction with theory texts and continuing education workshops.