Carlos Hernandez is vice president of Strategic Accounts at Acclaris.

Carlos Hernandez

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Consumer-driven healthcare has transformed from media buzzword to meaningful action, and there are a number of factors that have contributed to the transformation. The Affordable Care Act (ACC) is the latest health system change, but it’s the economics behind the healthcare universe that have finally turned the consumer-driven concept into a reality for benefits administrators, employers and consumers alike.  Specifically, ongoing growth in high-deductible health plans has caused a rush towards economic tools that offer funding options for benefits administrators, employers and employees.

	Changing Financial Options and Strategies

	In 2014, enrollment in high-deductible, consumer-directed health plans (CDHPs) 

 of all covered employees following a surge of new implementations.

 While the average employee does not typically meet his/her deductible, there is no argument that consumers continue to take on more and more of the financial responsibility. With so many healthcare dollars coming straight from the consumer’s pocket, it’s no surprise that they are seeking increasingly creative ways to finance the burden – with healthcare spending accounts becoming an integral part of the solution.

	Taking it one step further, regardless of the final financial mechanism, it is a safe bet that the vast majority of consumers are still confused. Across the board, providers need to focus on delivering the advice and educational support that consumers need to effectively use the account. Successful providers will find a way – be it email, 24/7 customer service, online tutorials, etc. – to play an advisory role for consumers and answer their ongoing questions. Educational tools will be what makes or breaks the success of healthcare solution providers as the market continues to change.

	True consumer-driven healthcare is all about economics. 

Employers predict that in 2015 their health benefit cost

 per employee will rise by 4.6 percent on average. This increase reflects changes they will make to reduce cost; if they made no changes to their current plans, the estimated cost would rise by an average of 7.1%.

 Consumers aren’t the only ones feeling the pain; employers are looking for creative alternatives to help fund the growing costs as well.

	The growth in Health Savings Accounts (a tax-free way to pay for healthcare services) is just one example of how consumers are not only taking a more active role in their healthcare, but also taking firmer control of healthcare dollars.  Likewise, Health Reimbursement Arrangements (commonly called Health Reimbursement Accounts) and Flexible Spending Accounts offer employers a flexible way to limit costs and offer greater freedom to consumers, fueling the rise in consumer-driven healthcare as a whole.

	NEXT: New pieces of the healthcare puzzle

	As a direct consequence of rising costs and new regulations, the fields of healthcare and banking have become interconnected. Likewise, technology is playing an increasingly important part. Private healthcare exchanges are growing steadily in popularity – they are being used by three percent of large employers, with 28% likely to make the shift within five years, according to the 

National Survey of Employer-Sponsored Health Plans.

	Online exchanges now reach beyond basic health plan choices and include choices like wellness and fitness programs. While e-commerce-style sites where consumers can compare options and choose the plan that’s right for them may seem relatively straightforward, it is increasingly important that healthcare funding options be incorporated directly into the exchange for a seamless and error-free user experience. The next generation of consumer-driven healthcare will be an exchange that offers not only the benefits packages, but also the funding and support tools to help consumers make the right choices. It is an opportunity that health plans, employers and benefits administrators will race to embrace, because the branding opportunity holds significant future value.

	Consider today’s typical consumers. They have previously relied on their employers to administer their benefits, but are now frequently entering an exchange to make their own health plan selection using a funding mechanism of their choice. By the time they choose a health plan and sort out funding mechanisms, they’ve likely had multiple points of interaction. Meanwhile, continually increasing deductibles and consumers facing more financial responsibility/payments than ever before have shifted some of the consumer interaction from insurance companies to account providers.

	In addition to the complex process of setting accounts up, the consumer is increasingly burdened with direct interaction with care providers. What was formerly automatic payment through employers to the health plan and automatic billing from providers to the insurer, is now a complex set of transactions with multiple points of interface. It is no wonder consumers are confused.

	The winner in the great race for consumer-driven healthcare will be the entity that can offer one point of interface and support for consumers to manage (and better understand) all aspects of their healthcare. Ever more educated consumers and savvy employers will drive the industry to provide one point of easy-to-understand resources and management for financing, payment, reimbursement and benefit administration so they can make smart decisions and manage all their healthcare-related needs in one place. 

	Whether that entity is an exchange, a bank, a health plan or even an employer portal is yet to be determined.  The industry has made great strides in reaching the consumer-driven healthcare nirvana. The next step is to take down the remaining walls that separate banks, insurers, employers and caregivers. Only then will one entity be able to deliver the full support, cost-containment and interface benefits needed to achieve the real promise of consumer-driven healthcare.

Carlos Hernandez is vice president of strategic accounts at 

	3 EBRI/Commonwealth Fund Consumerism in Health Care Survey, 2007; EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey, 2008-2013

Articles

Consumer-driven healthcare has transformed from media buzzword to meaningful action, but it’s the economics behind the healthcare universe that have finally turned the consumer-driven concept into a reality for benefits administrators, employers and consumers alike.

Carlos Hernandez

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