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May 30, 2023

Bridge Out: A road sign you really never want to see. Its appearance in your path means that there has been a failure and that you have to find a new way of getting where you want to go. The rise of consumer-driven health plans indicates that the era of managed care failed to control the increased cost and demand for care and that many things about the way we receive healthcare in the US.

In late August 2006, Wellpoint, one of the nation’s biggest healthcare insurance providers, has gone on record stating that in 2007 they will the first insurer to have consumer-driven health plans in all states and for all types of people (from major employers to small groups to individual plans).

“Our customers who choose these consumer-driven products will have new opportunities to lead healthier lives because of this first-of-its-kind national offering,” Wellpoint CEO, Larry Glassock

The press release also goes on to share:

“we’re empowering consumers through unique and robust online tools and incentives that encourage and reward them for choosing to live healthier lifestyles… Consumers who choose Lumenos will be eligible for extensive preventive care and personal health coaching, as well as smoking cessation and weight management programs. In addition, most consumers will receive financial rewards for completing various wellness programs.

WOW! That sounds great, right?!?!?! Well, I always read these things and think about what my parents and my in-laws know about healthcare/ health policy and what they would think.

So for those of you who are not familiar with this new type of health plan, their implementation will produce significant changes in how care is reimbursed. Consumer-driven health plans are designed to shift some of the financial decision-making and responsibility to the individuals who consume healthcare services. Health savings accounts and high deductibles are key cbdhintcom to this new type of health plan. The thought behind all of this is to allow patients to determine how best to spend their healthcare dollars.

If you buy into traditional economic theory as applicable to the healthcare industry, this is not a bad way of trying to control skyrocketing costs. Since the price of services has a direct impact on demand for services, in theory , this type of plan has the potential to reduce duplication of services and unnecessary utilization of higher levels (more expensive) of care. In very simple terms, if patients are required to share some of the financial responsibility of their care, then they are more likely to choose the cheapest, most effective care.