Decision Making In Consumer Directed Health Plans

"Choice Matters is the healthcare sector's guide to understanding and delivering the brand of consumer-centered care that is an imperative for the Zocdoc age. Drawing on the authors' diverse backgrounds in medicine, business, and public policy, this practically-oriented resource offers an on-the-ground introduction for clinicians and managers to better understand the differences between healthcare and other consumer-driven markets, what factors are most important for consumers in seeking care providers, how consumers make decisions about healthcare, the system-wide effects of increased consumer choice in healthcare, [and] the important distinction between patients and consumers"--

This book provides a balanced 360 degree view of consumer directed health care. It provides insight, analysis, and original research to help us see more clearly the important dimension in the future of American health care.

The IFIP series publishes state-of-the-art results in the sciences and technologies of information and communication Proceedings and post-proceedings of referred international conferences in computer science and interdisciplinary fields are featured. These results often precede journal publication and represent the most current research. The principal aim of the IFIP series is to encourage education and the dissemination and exchange of information about all aspects of computing.

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.

Insurance carriers, employers, and individuals are showing increasing interest in consumer-directed health plans (CDHP). CDHPs typically combine a high-deductible health plan with a health reimbursement arrangement (HRA) or health savings account (HSA). HRAs and HSAs are tax-advantaged accounts used to pay enrollees' health care expenses, and unused balances may accrue for future use, potentially giving enrollees an incentive to purchase health care more prudently. The plans also provide decision-support tools to help enrollees become more actively involved in making health care purchasing decisions. Because CDHPs are relatively new, there is interest in the extent of enrollment and in other aspects of the plans. GAO was asked to review the prevalence of CDHPs, how the associated accounts are funded and used, and the factors that may contribute to the growth or limit the appeal of these plans. GAO examined survey data on CDHP enrollment and interviewed or obtained data from employers, insurance carriers, individuals, financial institutions, and other

The Encyclopedia of Medical Decision Making presents state-of-the-art research and ready-to-use facts sorting out findings on medical decision making and their applications.