Health care consumers, who have been helping to pay rising costs through increased health plan premiums, copayments and deductibles for several years, could see a financial boost by 2012 as a result of action at the end of last year by the federal government.
The Obama administration has issued new federal rules that require health insurance companies to spend a prescribed minimum of revenue on medical care. For some companies, it will mean less profit, lower executive compensation and limits on marketing and overhead expenses.
Although some states, including California, already have such requirements, the federal mandate, spurred by the new national health care law, includes some new provisions most states don’t address — such as rebates. Insurers failing to meet the threshold of spending at least 80% of premium revenue on medical care will have to pay rebates to consumers starting in 2012. HHS Secretary Kathleen Sebelius estimated that up to nine million people could get rebates worth up to $1.4 billion.
A related concept is value-based purchasing, which could reward consumers for helping insurers save money.
CalPERS and Anthem Blue Cross are introducing an innovative program this month that will establish a payment threshold for some medical procedures and services. The “value-based purchasing” system will establish a basic price for specific elective procedures and services and give members a list of facilities that will provide the service or procedure for that amount or less. If CalPERS members choose to patronize hospitals or medical organizations that charge more, the member will be expected to pay the difference.
For example, Anthem Blue Cross has determined that it should not be spending — and will not spend — more than $30,000 for a total knee replacement. If a CalPERS Anthem member chooses to have a knee replaced in a facility that charges more than $30,000, the member pays the difference. If a member chooses to have a knee replaced at a facility that charges $15,000, Anthem saves $15,000.
If value-based purchasing spreads, as many predict it will, would a logical next step be to reward consumers for choosing the low-priced alternative? Should the insured patient, or perhaps the employer who provides the insurance, share in profit earned by a patient’s informed decision?
We asked experts from several corners of the health care world — insurers, consumer advocates, employers and employer groups — to weigh in.
We got responses from: