Consumer decision support - proteus duxbury

© PA Knowledge Limited 2015 1

NEXT LEVEL CONSUMER SUPPORT TOOLS

Implementing decision support beyond

network and price choice

Proteus Duxbury

July 16 2015


Buying health insurance is hard!


While a majority of Americans understand key health insurance concepts and terms, over a quarter of them are unable to answer even four questions correctly

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Understanding of Insurance Terms and Concepts

A recent survey by the Kaiser Family Foundation (KFF)

found that over 50% of those surveyed were able to answer

seven out of the ten questions asked

• Only 4% of those surveyed were able to answer all

questions asked

• Double that number were not able to get even one

correct answer

Out of the ten questions asked, six were considered to be

fairly easy to answer and at least 67% answered these

correctly

Source: KFF Survey

http://kff.org/health-reform/poll-finding/assessing-americans-familiarity-with-health-insurance-terms-and-concepts/


Some of the simpler questions relating to frequency of premium payments and definitions of deductibles were easily answered by respondents to the KFF survey; however a deeper understanding of how healthcare payments works is still elusive

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Understanding of Key Healthcare Insurance Terms and Factors

Don’t know Wrong Answer Correct Answer

While knowledge of the key concepts and terms are quite good, most people are unable to replicate the calculation of

out-of-pocket expenses suggesting that a deeper understanding still eludes them

Source: KPC Analysis

Source: KFF Survey



Those who are insured are more likely to understand the concepts than the non-insured; younger people are less likely to be exposed to health insurance terms; Male respondents and college graduates are more likely to be better informed

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College Grads Some College High School or Less

Source for all graphs: KFF Survey Note: Low Scorers – 0-4 Correct Answers, Moderate Scorers 5-6 Correct Answers and High Scorers – Above 7 Correct Answers



The ACA is not well understood by consumers

Source: www.healthlawhelper.org


Only 50% of consumers are enrolling direct through web channels

Connect for health Colorado, 2015


Very few consumers are selecting lower deductible health plans

Even though these may be financially

better choices.

For example CSR is only available with

Silver plans and above.

Connect for health Colorado, 2015


The challenges faced by marketplaces in the US have implications that are driving opportunity

Need to be financially

sustainable with less

capital

Making the right plan

choice is tough and non-

web support costs are

high

The cost of healthcare is

rising but revenues are

decreasing

M

A

R

K

E

T

P

L

A

C

E

Online support tools

Plan selection tools

Greater transparency

Care management

Private / public partnership

Pressures Implications


Consumers make sub-optimal choices leading to dissatisfied customers

Consumers take shortcuts to simplify complex purchasing decisions

Vulnerable individuals most likely to take shortcuts

People’s decision-making is malleable – we must

aid people in making trade-offs

Information overload takes place quickly

– must be doable in less than 10 minutes *

Cheapest

is best

Top of list

is best Gold is

good

* Source: Ted von Glahn, 2014


Premium is still the #1 factor when deciding on a plan

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Factors influencing the choice of healthcare plans

Overall

Currently in a non-group plan

Uninsured

Healthcare providers need to keep in mind the non-financial factors that influence choice of healthcare forms although

of course the financial aspects dominate the choice

Source: Factors Influencing Health Plan Choice among the Marketplace Target Population on the Eve of Health Reform

Source: KPC Analysis

http://hrms.urban.org/briefs/hrms_decision_factors.html





Variables become more important as people age

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Factors influencing the choice of healthcare plans – by Age

Overall18-3031-4950-64







Trade offs that are acceptable to people favouring lower premiums suggest that people are more willing to trade non-financial advantages for lower premiums

Factors that can be traded off against lower

premiums

% of respondents

Limits on covered services 43.5%

Limited drug coverage 42.3%

Restricted access to specialist care 39.2%

Limited choice of healthcare providers 34.4%

Unwilling to accept any trade offs 27.2%

Higher co-payment/co-insurance 26.3%

Higher deductible 25.1%

Higher annual “out-of-pocket spending limit” 24.7%







Online avatars are being used to help consumers navigate the online experience more seamlessly


Best of breed out of pocket calculators are helping consumers select the right plan

Picwell claims:

• 90% success rate at guiding consumers to choose a plan

for their individual needs

• Helping consumers reduce their total healthcare spending

by close to 20%

• Helping individuals save up to $1,300 per year.


… and drawing on big data to provide targeted analytics


Treatment cost calculators and advanced provider search tools are helping consumers utilize their healthcare $’s efficiently


… and providing cost transparency


The All Payer Claims Database contains valuable transparency data


Smart phone usage has become ubiquitous over the last 10 years


Maturing consumer digital services is a progression

Learn Transact Manage

Static content

Basic plan browsing

Provider search

Eligibility

Enrolment

Account management

Transparency tools

Health management

Social


Direct enrollment APIs can open up new channels and allow other intermediaries to share the cost of engaging the consumer

Source: hCentive, 2014

Documents

Consumer decision support - proteus duxbury