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Doing the Right Thing For Employers and Members

MANAGED CARE September 2007. © MediMedia USA
Editor's Memo

Doing the Right Thing For Employers and Members

John Marcille
MANAGED CARE September 2007. ©MediMedia USA

John Marcille

High-deductible plans are taking off; 2008 will be the breakthrough year. Or, they are a disappointment, a fizzle, a nonstarter. Yes, over the past few months there have been headlines that go both ways. I have no crystal ball, and I have no data that would encourage me to make either prediction. What I do know is that insurers are adaptable, and they will offer whatever the market demands.

Payers — companies that buy health care and/or health insurance for their employees, are demanding relief from escalating costs. I demanded relief from my home heating oil supplier the other day and she laughed at me.

Insurers don't have the luxury of laughing at customers, but they have to deliver good products that will do what the customer wants, even if it isn't what the customer initially thinks he wants. I don't take my car to the shop and say that I hear a roar and you should fix the muffler. I say I hear a roar and what can you do about it? In my experience it's always been the muffler, but it could be something else.

Similarly, with health care, high deductibles save the payer money, but for him to prescribe them (replace the muffler) specifically and without exception may be unwise, which leads us to this month's cover story on the latest developments in the debate over whether high copayments lead not only to a reduction in unneeded or optional care but also to a reduction in necessary care, resulting in worse outcomes and overall higher costs.

Plans owe it to payers and patients (if not to the imaging centers that do all those MRIs) to get the evidence and try to ensure that the customers design their health benefit so as encourage what they really want: the right care (what's needed) at the right time (to keep a condition from worsening) at the right place (a provider that does a good job at a fair price).