Most people are getting their health insurance through their employer. That has been changing slowly, but with healthcare reform, many more people will be left to select their own plans without the pre-selection and help from their employer. What used to be a choice among 3-5 plans is soon to become a selection from dozens of health insurance companies each offering a dozen plans to choose from. And selecting an insurance plan is not like getting car insurance; family makeup, prior health issues, future healthcare needs, and affordability – they all matter. In other words, it’s very personal.
As in other insurance industries, there will be a number of options to help consumers, such as agents and brokers. Cost is one of the most important criteria, but the problem of predicting the impact of plan choices on out-of-pocket costs is much harder, since selecting a plan is such a personal choice. Our needs and therefore expenses also change over time, as we go through different life stages.
As in many industries, there is a lot of data one can harness to help with these decisions. One benefit we see emerging is the availability of personal power tools (similar to financial planning tools) that allow for detailed modeling of an individual or family’s situation. These tools predict likely health care needs and allow one to compare the detailed expenses given different insurance plans. Starting a family? Entering your fifties, with its slew of clinically advised exams? Dealing with the ups and downs of a chronic condition? Those factors can all be taken into account to provide detailed plan options and price comparisons to help choose the optimal health plan.
We can’t expect most people to create these models themselves. Even brokers will be hard-pressed to spend the effort, and privacy concerns will be another barrier. Instead, the model will be created semi-automatically from demographics, claims history, and clinical rules. The tools also allow variable input of factors like your family history, current health and financial circumstances, and planned future events (child birth, elective surgery) while leveraging benchmark data from thousands of people with similar circumstances. Such comprehensive tools are not far away.
For example, Xerox is offering such a tool through its ACS Care and Quality Solutions practice, which today is deployed through employers during open enrollment. An individual or family can save hundreds, or even thousands of dollars in premiums and out-of-pocket costs every year through an informed decision-making process based on the data that applies to their unique situation. In the future, we want to make this even easier on consumers, e.g., automatically analyzing information in PHRs to determine the family history and future needs. By simplifying complex and comprehensive data and providing a seamless process for consumers, navigating the myriad of available healthcare coverage options becomes effortless.
Consumers will be the major decision makers in health care purchases in the not too distant future. It’s obvious that there is a lot of power in data, and we can bring powerful tools to bear in this new era of consumerism. With all the focus on health information and insurance exchanges, what are you doing to address these consumers?
Markus Fromherz is chief innovation officer, Healthcare, ACS, A Xerox Company.