Provider/Patient Dynamic Changes as Result of High Deductible Plans

by  Wyn Staheli, Director of Content - innoviHealth
May 3rd, 2016

The doctor/patient dynamic is changing. Patients now take a much more active role in making healthcare choices. They will ask if there are less costly tests or procedures. Some of this change results from the implementation of the Patient Protection and Affordable Care Act (PPACA). Since the implementation of the PPACA, the number of high-deductible plans has dramatically increased. In fact, according to a study by Kaiser Health, only 4% of employees work for firms which offer traditional insurance plans. That's pretty significant and plays an important roll in billing, but why does that change doctor/patient communication?

The answer is that as patients are now responsible for more up-front costs with these new Consumer Directed Health Plans (CHDP), they have become cost-conscious. Since they are going to be paying significantly more out-of-pocket, they want to make sure that they are getting their money's worth. This results in more questions that healthcare providers may be unprepared to answer, such as, "How much are these lab tests and pills going to cost?"

Providers now need to understand not only treatment costs, but also be able to provide less-expensive alternatives for the patient. In the past, a provider would simply say the patient needed an MRI and that MRI was scheduled and performed right away. Now, a patient may ask if an MRI is really even necessary or ask there are less expensive alternatives. Even in situations where the provider states that a procedure or service is absolutely necessary, the risk of non-compliance is now much higher than it used to be.

This doesn't mean that providers need to become trained in the art of high-pressure sales. However, they do need to be fully versed in evidence-based best practices and be willing to take a more conservative approach to patient care as their role shifts in this new paradigm.