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Preparing for an Influx of High-Deductible Patients


The healthcare industry is seeing a dramatic rise in the number of individuals covered by high-deductible health plans and even greater increases are expected in the years ahead.

The healthcare industry is seeing a dramatic increase in the number of individuals covered by high-deductible health plans. The number more than doubled between 2006 and 2013, and even greater increases are expected in the years ahead as high deductibles become an increasingly popular feature in plan design, says Robin Gelburd, president of FAIR Health.

How will this affect practices, large or small?

“I wouldn’t characterize it as either good or bad,” Gelburd says. “What I would underscore is the importance of both the patient and the physician community to be fully educated on the implications of a high-deductible health plan, and how it can best be managed. And there are ways physicians can help patients navigate those plans more efficiently.”

Working together

Gelburd says there are ways in which the physician practice can bring value to the patient experience and strengthen the patient relationship by being forthcoming about information that will help consumers with high-deductible health plans. For example, it will be helpful for consumers to know if their physicians are in network or out of network.

“Physicians should be very transparent in what their fee schedule is, so that they could help the consumer properly plan for the administration of their deductible,” Gelburd says.

Likewise, if a physician is in network for that consumer’s plan, but is going to be doing a procedure that may implicate out-of-network physicians—for example, some type of a diagnostic colonoscopy involving pathology or anesthesiology—it would be helpful to communicate to the consumer what that out-of-network exposure might be so he or she can properly prepare and plan for those expenditures.

“There’s a lot of stress involved with managing healthcare costs,” Gelburd says. “Physicians can reduce that stress for the patient by being very clear, because a patient who is sort of surprised by their ultimate bill is not a satisfied consumer.”

Physicians could also be helpful in educating consumers about preventive services, because some are covered even before a patient meets the deductible, she says. If there are certain services a physician practice offers that would be characterized preventive and, potentially, covered prior to the deductible being met, that would be a conversation that’s worth having.

“I think there’s a growing sensitivity on the part of the physician community about the increasing cost-sharing responsibility of the patient; and toward that end, helping the consumers try to manage that,” Gelburd says.

Cost conversations

One way to avoid unexpected out-of-pocket costs for patients is by introducing price into the dialogue from the start, according to Gelburd. But first, she says, it’s important for physicians to delve into market data and ensure their fees are in alignment with their market. Doing so can be a very healthy exercise.

“The media certainly has been shining a spotlight on the whole notion of how healthcare fees are developed,” she explains. “I think it’s very important for a physician practice to evaluate its fee schedule. Robust market data can help ensure that its fee schedule is defensible and is appropriate, and to really be able to stand behind that fee schedule as they begin to have these conversations with consumers.”

Gelburd suggests beginning these cost conversations by talking with patients about what their medication regimen should be or by educating patients by raising the issue of preventive services. Doing so opens the door for physicians to segue into a discussion about costs.

“The more that physicians sort of introduce these topics, the more that patients appreciate the recognition on the part of the physician that there is increasing obligation that’s being placed on consumers based on shifting reimbursement models,” she says.

Garnering the skills

The Healthcare Financial Management Association recently issued a report focused on transparency, and placed significant responsibility on providers to educate patients on costs associated with medical care. But, are physicians equipped with the skills to adequately engage in these conversations?

Gelburd acknowledges physicians are focused on the clinical aspects of their services—as they should be. As such, FAIR Health has developed its own homegrown curriculum available to the physician community. At its website physicians can download educational materials at no charge and place them in waiting rooms. Those materials can help jump-start conversations regarding costs and payment arrangements.

“[Payment arrangement] conversations are starting—negotiating certain fees, or creating installment plans to accommodate the needs of certain patients,” Gelburd says. “Those conversations are definitely happening, and, I think, are very much appreciated.”

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