Navigating Healthcare: It's Time to Embrace the Role of Healthcare Consumer

I once attended a conference of provider organizations in Chicago where a senior leader of Centers for Medicare and Medicaid Services (CMS)presented an interesting case study on the Amish community. When needing medical services, the Amish paid less than most and received quicker treatment. The reason? They negotiated fees, paid in cash, and were willing to seek treatment elsewhere if the negotiations didn’t meet their acceptable price.

This revelation piqued my curiosity, so I decided to investigate further. When I returned to work at a large provider group, I reached out to the revenue cycle department and requested to see our rate sheets, including the cash prices. As described in the conference case study, our "non-published" rate sheets had cash rates significantly below any major insurance carrier’s negotiated price.

In the past, as consumers of healthcare, most people didn't pay much attention to what the providers were paid because their health insurance covered most expenses. However, the consumer cost for health insurance premiums and medical services have increased. As a result of those increases, many consumers have opted to enroll in High Deductible Health Plans (HDHPs).  

The HDHP plan is where the consumer pays providers directly from their Health Savings Account (HSA) for most services. The money in the HSA belongs to the consumer and stays with the consumer even if there is a change of job or health insurance company. Many people even have multiple HSA accounts, which can be cumbersome to manage.

This shift to HDHPs is transforming most of us into true consumers of healthcare.

If an individual’s HSA account balance reaches zero, they end up paying for healthcare directly from their personal bank account or through credit cards.

So, with this new responsibility in hand, why do so many of us often fail to act like informed consumers when it comes to healthcare? Unlike when purchasing other goods or services, most people don't shop around for the best prices, compare quality ratings, or even talk to the provider before agreeing to receive a service.

It's time to change our approach.

Just like with any other significant purchase, being a healthcare consumer requires diligence and proactive decision-making. Here area few reasons why it's crucial to embrace the role of a healthcare consumer:

1. Cost Savings: By researching and comparing prices, individuals can identify cost-effective options without sacrificing the quality of care. Negotiating prices can often lead to significant savings, as seen in the Amish case study.

2. Transparency: Becoming an engaged healthcare consumer encourages providers to be more transparent about their prices and services, fostering a more competitive market.

3. Empowerment: Taking charge of their healthcare decisions empowers individuals to choose providers and treatments that align with their preferences and needs.

4. Improved Quality: Consumer-driven demand for quality services encourages providers to prioritize patient satisfaction and outcomes.

5. Better Health Outcomes: When individuals actively participate in their healthcare decisions, they can be more likely to follow through with treatments and preventive measures, leading to better overall health outcomes.

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Achieve a win-win scenario for your well-being and financial health.

By becoming informed and proactive healthcare consumers, each person can positively impact their health and finances. Individuals should be ready to ask questions, explore options, and seek out the best deals for their healthcare needs. It's essential to remember that financial resources and well-being are at stake, so taking charge and making the most out of both is crucial.

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Mark Stamper is the Vice President of Commercial Products at Opyn Market^®. Having spent 20+ years in the healthcare industry, he is passionate about empowering consumers to take charge and feel good about their healthcare decisions, for the first time.

You can reach him at mstamper@myopyn.com.

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Keep an eye out for the upcoming post in the Navigating Healthcare Series, where we'll unveil valuable insights on becoming adept healthcare consumers. Discover essential tips and the array of tools and information available to help individuals make informed healthcare decisions.

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