Did you pick the right health insurance plan?

Selecting a health insurance plan can cause considerable angst for a consumer and his/her family. Insurance plans are complex and there is a wide variety available on the market. Let’s try to simplify the decision making process. There are basically four areas that the consumer needs to assess for each plan offering;

1. The deductible.

2. The co-payment.

3. The co-insurance.

4. Out-of-pocket spending limits.

The complexity of plan choice arises in part from wide variation among plans across these four features that determine how health costs are shared between the insurer and consumer. And so consumers are faced with a dizzying number of permutations when trying to balance these four areas.

Lack of health literacy also plays a part in the process. A study done in 2013 found that only 14% of consumers could answer four simple multiple choice questions regarding the definition of these four cost sharing features. Also when presented with a simplified plan, most respondents were unable to accurately estimate the cost of their medical services. To confuse things further employees need to know if the plan covers their medications (formulary status) and whether their physicians are in or out of network.

The Affordable Care Act (ACA) organized plans were segregated into four ‘metal’ tiers – platinum, gold, silver and bronze. One investigation of hypothetical plan choices with plan menus designed to mimic those of the exchanges found that metal labels, rather than facilitating better decisions, worsened choices compared with generic labels (eg, plan A, plan B, plan C). This study also found that alternative plan labels that encouraged consumers to forecast how much care they anticipated needing did have a modestly beneficial effect, suggesting that participants may have misinterpreted metal labels as signals of quality, or the breadth of services covered, rather than the degree of cost sharing.

To make a financially efficient choice, employees, most of whom lack extensive prior experience with insurance, have to carefully consider the complicated relationship between plan cost, cost sharing, and their expected health risk. So what can be done to help employees navigate through these complex scenarios? I would like to suggest some possible solutions;

1. Provide decision aids. These may be scenario based examples or so called “people like me” illustrations.

2. The utilization of consumer historical data (claims, pharmacy etc) to help predict future costs should be encouraged. Prescriptive analytics tools can now help perform this task.

3. A more aggressive approach may be the use of plan “defaults” or restricted menus tailored to each consumer.

4. A more long term solution would be to simplify health insurance – period. Insurance products free of the complex features that consumers are least able to understand, such as deductibles and co-insurance,would more likely help consumers make informed decisions regarding plan choice and utilization.

Offering multiple plans seems like a good idea – the typical ACA enrollee is offered an average of 47 plans. One would hope that this large number of choices would help the consumer find an appropriate plan and may stimulate competition among insurers, leading to improvements in plan price and quality. However, these benefits are unlikely to emerge if consumers are not given the right tools and education.

To sign up for a free demo of the tools on offer at Obeo Health please click here.

10 Things you need to know about Compliance in a Healthcare Setting

In this world of instant access to social media, the issue of privacy has expanded into new territories. Data is no longer locked down. It is shared through multiple offices, providers, hospitals, and specialists. This new environment carries increase risk and consequence. Here are ten things to consider about organizational compliance:

1.Privacy policies are too easy to break. All it takes is one frustrating patient and a louder than normal conversation of “venting” between employees. Always be aware of your surroundings, patient care areas, waiting rooms, and other high traffic centers. Some of the most dangerous violations can come from the most innocent intentions.

2. Be wary of gifts. The normal week in a medical office contains a flow of vendors with samples and presentations. They will often attempt to sweeten the dealings with food or other offerings. This practice can extend to patients that mean well. Accepting gifts can land an employee and office on rough legal waters. Know where the line lies and keep the overzealous salesmen in check.

3. File reports. A patient falls getting out of bed. An employee stays an extra hour to help finish a large project. A lunch break is cut short for a meeting. All of these must be reflected in filed reports and accurate time counts. The consequences of falsifying records are much larger than the documentation and scrutiny from management. If legal proceedings occur down the line, you’ll want your files in order.

4. Legal Cooperation. The subpoena may come from different sources but, the minute it arrives, be ready to hold relevant records and provide all needed information. Stop the flow of paperwork until you are prepared to respond and keep to your developed process. It will smooth out any headaches.

5. Keep Current Training. It may be year one or year fifty, either way be sure to keep up with your training courses. OSHA requires yearly sessions in regard to employee and patient safety, along with other relevant issues. When an emergency happens, you’ll know the training works as it is handled in a professional manor.

6. Sharing passwords- In a nod to the first entry on this list, security is highly important for any practice. One day someone may call out sick or a new hire will start without login information. With the pressure and speed of daily operations, this may temp fellow employees to share login information or, even worse, keep them displayed on notes around workstations. Keep access keys secure at all times and let the new employee wait to get their own digital identification in the system.

7. Dangerous Friends- One day the phone will ring and it will be a favorite aunt or grandfather wondering about their test results. The matriarch of the family may have been admitted after a stroke and, for an hour, relatives from out of state are burning up the phone lines begging for information. Be sure the limits are known and posted throughout any areas of medical records and patient contact. Friends and family of patients mean well and can get frustrated at a lack of answers but, staying vigilant will only help your practice and show the empathy for the patient that you value and their loved ones should respect.

8. Protect Yourself- Physical security is just as important as data security. Have PPD ready and available when needed. Know what issues patients present when they arrive and whether or not they should be in an isolation room. The moment ignored often becomes lost time and illness (consider the recent Ebola outbreak). If you work evening hours, be aware of your surroundings in parking areas and other dark environments.

9. Protect Your Claims- “But I swear, it was a car accident.” Be sure to document everything that patient says and presents in terms of their condition. How often have they requested pain medications this month? Do visual symptoms match up with clinical findings? Insurance fraud is a common occurrence. Enact all possible measures to prevent this from happening in your practice and, when in doubt, document in detail.

10. Be Prepared- The audits will come. The Joint Commission will make announced and unannounced appearances. State and local inspectors will show up and your practice must be ready. Keep all parts up to code and stay on top of changes within the survey process. Nothing can derail patient service, profit, and satisfaction like a failing inspection. It is common sense and the quickest headline to make the news when an office fails for something that was an easy fix.

This list is only ten of many issues of compliance that are present on a daily basis. Do your best in all areas and you will find an increase of patient and employee satisfaction, a smoother workflow, higher profits and success.