The cost-control promise of consumer-directed health plans depends on plan members making medically appropriate, cost-conscious decisions when seeking care.
Resources to enable that kind of decision making have been limited, but tools are being developed to help consumers find and choose quality providers and compare costs before receiving services.
An Employee Benefit Research Institute (EBRI) survey found that consumer-directed plan members reported higher engagement in cost-conscious behaviors, such as seeking cost and quality information outside their health plan, considering cost when making care decisions, and asking doctors about less costly prescription options.
Where can consumers find reliable cost and quality information on doctors, hospitals and other providers?
Federal and independent hospital comparison tools let users compare hospitals on patient experience, outcomes and process-of-care measures; many of these tools also allow filtering by specific medical conditions. Independent groups publish hospital safety comparisons and summaries of patient-safety practices.
The firm change:healthcare publishes a Healthcare Transparency Index that analyzes medical claims to identify opportunities for consumer savings across medical categories, including prescription drugs, dental care and office visits.
The index has shown that prescription drugs often offer among the largest opportunities for savings, with both generic and brand prices varying by pharmacy and by location within pharmacy chains.
Consumers need clear information about the costs of treatment options, patient experience results, and quality measures. Simple comparison charts, worksheets, and interactive tools make it easier to choose the right care at the right price.
For more on estimating out-of-pocket costs and comparing providers, see Understanding Health Care Costs and Insurance Options.
To learn how different plan types and coverage rules affect your choices, consider resources such as Understanding the Affordable Coverage Act and Health Insurance.
If you want help reviewing options, you can talk to an agent about plan features and cost-saving tools.
Frequently Asked Questions
How can I compare hospital quality?
Use official hospital comparison tools and independent safety ratings to review patient experience, outcomes and procedure-specific measures.
Where can I find price information for a specific service?
Look for transparency reports and indexes that analyze claims data, and check prices across pharmacies and provider offices when possible.
Do consumer-directed plans always save money?
Not always; savings depend on choosing lower-cost, appropriate care and using available tools to compare quality and price before receiving services.
What should I ask my doctor about prescription costs?
Ask whether a generic is appropriate, about therapeutic alternatives, and whether there are lower-cost pharmacies or dispensing options.