Presumed Requirements for Success | Consumer-Driven Health Care

Consumer-driven health care must engage and inform the individual on the issues of health care costs by providing information on health care costs, quality, and outcomes, so that individuals can escape the notion that more expensive health care is better care. Consumer-driven health care relies on several presumptions necessary for its success:

• The individual will shop and use health care more carefully when he or she has a greater financial "investment" in that care—and shares in the savings from that shopping and use.
• Once the individual has the health information on the most efficient and least intrusive methods of treatment, no matter who is paying the bill, the patient will choose the least invasive treatment from the highest quality provider with the best outcomes history.
• Accurate quality measures and information sources are being developed and available which make this choice easier.
• These improved sources of information and better health care quality measures are readily available and accessible today through health information technology systems and continue to evolve.

To achieve these goals, proponents of consumer-driven health care believe the employer through the health plan must:

• educate employees as to the true cost of medical services and their role in managing health care spending,
• hold the employee more responsible for medical purchase decisions through innovative plan designs with built-in incentives,
• provide clinical and financial information to enable employees to be true health care consumers, and
• provide proactive clinical management and coaching to optimize provider efficiencies and courses of treatment.

Proponents of consumer-driven health care believe as health care consumers become more financially responsible for the real cost of health care services, both demand and total health care spending will stabilize—and perhaps even decrease.