From 3M Health Information Systems
What is most important to patients: convenience, cost or quality?
Does a patient prioritize convenience, cost or quality when it comes to taking care of his or her health? Do patients approach different conditions the same way—a sprained ankle, back pain, diabetes management, cancer treatment or joint replacement? Most importantly, do patients really have the ability to make a choice based on convenience, cost and quality, or is someone else making this decision for them?
Consumer behavior in the retail market may offer some clues. One recent survey of consumers found that when purchasing retail products, two-thirds prioritized quality. Cost was slightly more important than convenience, however, half of women reported that they consider cost first.
Purchasers of individual health insurance as well as Medicare enrollees are increasingly being asked to trade choice for cost in the form of narrow networks that offer lower premiums. Nationally, 29 percent of new Medicare enrollees chose Medicare Advantage plans in 2016 compared to 22 percent in 2010.
Narrow networks were used by 40 percent of Medicaid plans across 14 states from 2010-2015. While the trend towards using narrow networks in Medicaid seemed to be reversing, a 2018 proposal by the Centers for Medicare and Medicaid (CMS) to remove the requirement that states use time and distance standards to ensure network adequacy would likely limit access to providers.
Employers have been less willing to limit access to providers. The HMO backlash of the 1990s still lingers with many employers. Only 5 percent of large firms and 7 percent of small firms offer a narrow network plan to their employees. However, when narrow networks are labeled as high performance networks (HPNs), and providers are selected based on quality and not just cost, nearly 44 percent of employees express a willingness to trade choice for cost.
Convenience, measured as the distance a patient must travel to see a doctor or specialist, can be an issue with narrow networks. Broad networks often have up to 70 percent of local providers participating, while narrow networks have less than 30 percent participation and some less than 10 percent participation among local providers. This means that patients in rural areas may have to travel longer distances to get the care they need. This is particularly a problem for those managing chronic conditions that need ongoing and frequent care.
Narrow networks limit choice in primary care, as well as specialty care. However, there are often many more primary care physicians practicing in a region compared to specialists. Additionally, patients often choose participation in a network based on their primary care physician’s inclusion. What happens when someone develops a serious or catastrophic illness that requires a specialist? Cardiothoracic surgeons, neurosurgeons and oncologists are specialists that may be in short supply in some Medicare Advantage networks.
Since quality and cost are often more important to patients than convenience, some employers are incentivizing their employees to use a center of excellence (COE) for the treatment of potentially costly conditions, even if it means traveling hundreds of miles for evaluation and treatment. Specialists at these COEs are incentivized to provide the most appropriate care. Surgery is offered as a last resort.
Finding the right specialist can be a challenge. The lack of comparative data, an unbiased advocate, and pricing and network transparency leaves patients feeling vulnerable and confused. CMS has launched Physician Compare, which is intended to offer quality comparisons, but is often little more than a searchable database of physicians that participate in Medicare. Some companies have tried to match the patient with the right specialist using a blend of data science and patient advocacy.
Ultimately, patients prioritize quality more than cost and convenience when it comes to their health care. Networks that are limited to the best physicians can help lead patients to the right care, but these networks must be based on quality and not cost. Quality is not only getting the best treatment, but also getting the most appropriate treatment, which means foregoing treatment that is unnecessary, excessive, premature or potentially harmful. Networks that are geographically extensive and based on providing patients with the most appropriate care may limit patient choice, but they will guide patients in making the best decisions.
Steve Delaronde is director of consulting for Payer and Population Health Services at 3M Health Information Systems.