Health Policy

Will Your Health Plan Tell You That It Can Save Your Life?

By MICHAEL MILLENSON

At kitchen tables everywhere, ordinary Americans have been grappling with the arcane language of deductibles and co-pays as they’ve struggled to select a health insurance plan during “open enrollment” season.

Unfortunately, critical information that could literally spell the difference between life and death is conspicuously absent from the glossy brochures and eye-catching websites.

Which plan will arrange a consultation with top-tier oncologists if I’m diagnosed with a complex cancer? Which might alert my doctor that I urgently need heart bypass surgery? And which plan will tell me important information such as doctor-specific breast cancer screening rates?

According to Matt Eyles, president and chief executive officer of America’s Health Insurance Plans (AHIP), insurers over the last decade have made a “dramatic shift” to focus more on consumers.  That shift, however, has yet to include giving members the kind of detailed information available to corporate human resources managers and benefits consultants (one of my past jobs).

What’s at stake could be seen at a recent AHIP-sponsored meeting in Chicago on consumerism. Rajeev Ronaki, chief digital officer for Anthem, Inc., explained how the giant insurer is using artificial intelligence to predict a long list of medical conditions, including the need for heart bypass surgery. Information on individual patients is passed on to clinicians.

“The future of care delivery will see physicians, scientists and consumers alike empowered with the most accurate clinical information in real time,” Ronaki declared.

That may be the future, but it’s not the present for the one in eight Americans that Anthem serves today in its various plans, most affiliated with Blue Cross and Blue Shield. Anthem members have to rely on the limited information available in a new mobile app with the gender-vague name of “Sydney” that’s blandly touted as “smart” and “personal.”

As for obtaining a sophisticated cancer consult, an oncologist working with 2nd.MD, which contracts with the top 20 cancer centers in America for virtual consults, related how a man who was diagnosed with advanced cancer had a grim diagnosis offering perhaps a few months to live. But after the consultant, Dr. Charles Balch, directed him to an advanced cancer center, the man showed “an almost complete response” to immunotherapy, Balch said.

Do you know if your health plan offers that kind of service? Who would even think to ask before enrolling?

Meanwhile, as a consultant I’ve seen the detailed information about individual hospitals and doctors that’s available to some insurers. While a few plans do a good job of sharing meaningful data, most settle for limited information posted in a dusty corner of their website. 

Given health insurers’ negative image – in one national poll, just 16 percent of respondents believed insurers put people over profits –why don’t health plans highlight these kinds of valuable services? Here’s where consumerism confronts unpleasant realities.

Take cancer consults. While a world-class second opinion may save money in the long run, if everyone who thinks they’re a cancer risk joins your plan, that “adverse selection” among the enrolled population could boost medical expenses. 

When it comes to publicizing the use of algorithms to predict illness, the adverse selection problem is complicated by the additional issue of public trust. Even though early intervention can save money, will members believe that a company that gained national notoriety for denying claims for emergency room visits – as Anthem did – has their best interests at heart when it comes to their heart? Other plans have similar trust issues.

And speaking of trust, can members trust that their health plan will risk the ire of doctors and hospitals by publicizing usable data showing that some perform much better than others? 

The way to overcome these issues, I believe, is for powerful national employer groups such as the Federal Employees Health Benefit Program to demand detailed disclosures by health plans to consumers. That puts all plans on an equal footing. Plans should answer carefully defined questions in three areas: What will you do to keep me well? What information will you give me about doctors and hospitals? And what resources do you offer in case of serious illness?

It’s important that insurers’ pay members’ bills without bogus bureaucratic barriers. But it’s even more important to give prospective plan members full and complete information about services that might one day save their life.

Michael L. Millenson is president of Health Quality Advisors LLC and adjunct associate professor of medicine at Northwestern University Feinberg School of Medicine. This article originally appeared on Forbes here.

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PeterSameer KhanVinceKuraitis Recent comment authors
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Peter
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Peter

Eat well, exercise, are the best predictors – no algorithm necessary.

Sameer Khan
Member

Leafy and dark vegetables such as spinach, broccoli, and kale – some are also rich in magnesium which helps muscle relaxation;
Meat – fish, poultry, beef liver, and red meats are good sources of the vitamin B complex. Due to the lack of these ingredients in their nutrition, vegetarians and vegans need to take vitamin B supplements;
Eggs and dairy – cheese and yoghurt in particular;
Grains – brown rice and millet;
Nuts and seeds – especially sunflower seeds;
Legumes such as green soybeans, lentils, chickpeas and kidney beans.

VinceKuraitis
Member

Important issue.

Health insurers will look at this through an economic lens. Do they have a financial incentive to bring relevant information to the attention of patients?

In some (many?) cases the answer will be “no”. Improving a patient’s health or saving a life often will result in increased short-term health care costs to the plan. A typical member stays with a health plan for about 3 years, so the economic incentive and ROI just isn’t there.