All but a well-heeled minority and the Obamacare exempted will be facing mega-deductible health insurance in 2014, meaning they are effectively self-insured.
Something had to give to pay for the "10 essential health benefits" under Obamacare. Part is higher premiums and taxes, part is higher deductibles. Much higher deductibles.
If the intention was to get people to use fewer services by making them pay for them out of pocket, this is a home run. It can be for primary care, too. Back to that in a moment.
First, as a refresher, the 10 essentials are outpatient care, rehabilitative and habilitative services and devices, emergency room visits, hospitalization, lab tests, maternity and newborn care, preventative services and chronic disease care, prescription drugs, mental health and substance-abuse treatment, and pediatric services including vision and dental coverage.
This all sounds great, but with the projected 2014 average deductible as much as $4,000 per individual and $8,500 per family, most will never see their insurers pay a dime except for an annual visit and some inexpensive perks they probably will never use.
That means trouble for everyone from physicians to hospitals. It’s hard enough to get insurers to pay what they owe. Making deductible season year-round for newly burdened, cash-strapped people who already are hit hard with premium increases - those who are used to their insurers cutting a check in return for premium dollars and now have to cut their own checks - is a policy challenge and marketing opportunity.
The whole triple aim thing of better outcomes at lower cost with higher patient satisfaction is an unattainable fantasy for traditional practices, and serious business for those who have overcome their paralysis, confusion, and resistance to change in order to change the business of medical practice. These are the folks who have acted to preserve their clinical integrity and fiscal viability in a hostile environment.
They do it by cutting waste, duplication, unnecessary hospital admissions, and readmissions. They do it by managing, not just coordinating, care throughout the continuum and by stalling or reversing progression to greater complications for chronic-disease patients.
And, they do it without compromising care or service. They improve these things. And, they either capture a big portion of the savings, or keep it all.
So, the more, the merrier, because employing these strategies actually increases capacity.
That’s where the marketing opportunity comes full circle.
Marketing quality, cost, and service, or, empirically proven values, is the winning combination.
This strategy is otherwise as far from the retail staples of advertising sales, promotions, and discounts as Congress is from following the same rules as the rest of us.
Instead, communicating a commitment to eliminate waste, unnecessary tests, procedures, and hospitalizations for tens of millions of newly, catastrophically self-insured, is the winning message.
Cost is not price, by the way. It is the total spend required to treat a chronic, episodic, or acute encounter in a particular timeframe. Congress, CMS, and some private insurers may not get it, but your patients will. If they get great service, consistent, positive outcomes with an improved quality of life, and pay materially below community averages for those services and results, you will dominate your market with the best demographics - insured patients who are confident that they are getting what they need, and not paying for what they don’t. They are the ones who not only pay their bills, but who also refer their like-minded friends and families.
Like value-based reimbursement and pay-for-performance schemes, all you have to do is provide greater value, and the rewards find you.
The hard part is that you have to be a part of a medical community or neighborhood to make it all happen, and be on a common platform. Doing this does not mean surrendering your independence, just cooperating with your peers.
More common sense.