Health Plan Comparison Tool

Transcription

1 Health Plan Comparison Tool by Consumers CHECKBOOK/Center for the Study of Services 1625 K Street, NW, Washington, DC SAVE (7283) PlanCompare@checkbook.org Presenter: Robert Krughoff, President 1

2 Purpose The purpose of this presentation is to describe and demonstrate a model health plan comparison tool. We are hoping to stimulate and challenge Exchanges in creating such a tool. I will describe a model that Exchanges can adapt for themselves, can take parts of, or can have us implement for them. A good tool is needed to Help consumers save money and get quality by making the best personal plan choice. Drive plans to be efficient and consumer-responsive. Give Exchanges extra leverage for health system improvement. 2

3 So Far, States Are Missing This Opportunity Focus of states so far has been on working with big IT contractors to build the eligibility, enrollment, and other mechanics of Exchanges not on giving consumers tools to make the market work. The tools states have created or are considering either are hopelessly complex for the user or may seem simple but will lead to the wrong answer. 3

4 Basis for Our Recommendations Our recommendations are based on our experience as a non-profit consumer organization supporting itself for 36 years by providing information that consumers value enough to purchase, online and in books and magazines, none of which carries any advertising The online resources and publications we offer include evaluations of service providers from auto repair shops to plumbers to various kinds of healthcare providers (doctors, hospitals, dentists, etc.) and insurers. Our online and print Guide to Health Plans for Federal Employees has for 33 years been purchased by individuals and has for more than a decade been purchased in bulk by dozens of agencies (HHS, Labor, IRS, U.S. Senate, Federal Reserve, many others) to help consumers make open-season choices. We also have much other experience doing research and analysis in the health care field e.g., have managed all of HHS s surveys of Medicare Advantage and Drug Plan members for Medicare.gov. 4

5 A Good Comparison Tool Should Give Users For each available plan, a dollar-amount estimate of average total yearly cost premium plus out-of-pocket for people with the user s age, family size, and other characteristics the insurance value of each plan. Estimates of the risks under each plan possible costs in good and very bad years and the odds of having such a year. An all-plan provider directory so that the user can quickly see which plans have his or her preferred doctors and other providers. Quality information on all providers in the community. Ratings of each plan s quality, and its health promotion programs, allowing the user to give personal weights to what matters most to the user. Design and user aids that make the tool easy to use and understand. Ability for family members, brokers, Navigators, the media, and others to extract or print out information to help consumers who want help. Ability to get the user to an excellent plan choice within five minutes, with flexibility for users to drill down, if they wish, for increasing detail. NO limiting/filtering of plan choices before the user has seen them. 5

6 Cost Comparison A valid, quick comparison of premium plus out-of-pocket cost is essential. We believe the correct way to do this is an insurance-value (or actuarial) approach to give the user an estimate of the average out-of-pocket costs for someone with the user s age, family size, and other characteristics. And also the costs in, and probability of having, low-usage and highusage years. Our recommended model makes these estimates using population expenditure data from AHRQ s Medical Expenditure Panel Survey and other sources. With these data, we can estimate for people like the user the probability of having various levels and types of health care usage in the coming year, calculate what the out-of-pocket costs for such usage would be under each plan s benefit structure, and average those costs. This approach is not what most currently available, or currently discussed, plan comparison tools do and that is a reason for serious concern. I will describe here the two approaches generally used and then include a slide with a greatly simplified illustration of how our insurance-value model works. 6

7 Benefit Description Model Most cost comparison tools just describe benefits deductibles, copays, out-of-pocket (OOP) limits, etc. This is what the Massachusetts Connector and Healthcare.gov do. This leaves the user the baffling task of figuring out the relative value of different benefit packages. Consumers can t figure out, for example Is a plan with a $200 deductible and $10,000 OOP limit better than A plan with a $1,000 deductible and $4,000 OOP limit And what about different co-payment levels, different coinsurance rates, differences in which charges are counted against the deductibles or against the OOP limit, etc. This is very confusing and does not provide a sufficient basis for consumers to choose plans. 7

8 Known-Usage Model A few tools apply what can be described as a known-usage cost calculator. These ask the user to predict how many doctor visits, prescriptions, etc. the user will have next year. This approach is appropriate when planning a contribution to a Flexible Spending Account, but not for choosing insurance. A known-usage model misleads by ignoring expenses for diseases, accidents, and other care needs that can t be predicted potentially large expenses that are a major reason for insurance. The insurance-value model we recommend can include adjustments for known usage a planned pregnancy or an expensive maintenance drug as part of the calculation but not as the entire calculation. 8

9 Insurance-Value Model Simplified Illustration Using a database of expenses of actual households, one can either calculate the OOP expenses under each plan for all households of a type and average them or, as in this simplified illustration, create a number of representative overall expense-level and expense-distribution profiles and probabilities and calculate a weighted average OOP expense estimate. Simplified illustration: for households with a 49-year-old husband and wife--for ABC Health Plan Level of total expense: $0 $1,000 $2,500 $5,000 $10,000 $25,000 $150,000 Probability of expense at this level 3% 16% 17% 16% 23% 21% 4% Components of expense: Hospital room and board $0 $0 $0 $1,200 $2,300 $6,000 $50,000 Other inpatient hospital $0 $0 $0 $1,200 $2,300 $6,000 $50,000 Surgical $0 $0 $0 $0 $2,000 $4,000 $25,000 Routine exams $0 $300 $300 $300 $300 $300 $300 Other medical $0 $400 $1,200 $1,300 $1,900 $4,700 $16,700 Prescription drugs $0 $300 $1,000 $1,000 $1,200 $4,000 $8,000 OOP member would pay in ABC Plan $0 $700 $1,120 $1,370 $1,870 $3,370 $9,000 OOP exp. times probability of this exp. $0 $112 $190 $219 $430 $708 $360 Estimated average OOP in ABC Plan for households like this (sum of row above): $2,020 Enrollee share of premium in ABC Plan: $2,500 Estimated total cost (premium plus OOP) for households like this: $4,520 (this is number shown on website) ABC health plan has $2,500 premium after any subsidy for this policyholder, $1,000 deductible, 10% coinsurance on all expenses after deductible, $8,000 OOP limit not counting deductible, routine exams fully covered.

10 Right and Wrong Ways to Simplify Among the experts who are suggesting how to design plan comparison tools, some of the suggestions on how to make it simple for consumers are misguided. An example is the UX 2014 project, which a number of states are involved in. The recommendations from some experts are that the Exchanges Limit the number of participating plans. Show no more than three or four plans at a time. Ask the user screening questions up front Will you consider an HMO, what s the highest deductible you will consider, will you consider a plan that doesn t include your doctor? Problem is that consumers don t even get to see plans that they might prefer and that might save them thousands of dollars. A good tool will simplify without limiting choices. 10

11 A demonstration of the plan comparison tool Consumers CHECKBOOK has developed follows. More detail on our recommendations, a video demonstration of our model tool illustrating these features, RFP specifications states could use to procure a tool with the desirable features, and other resources on this subject can be found at 11

12 CHECKBOOK/CSS Plan Comparison Tool Welcome Screen with Introductory Video

13 About You The majority of the information gathered in this user profile page can be passed through to the CHECKBOOK/CSS comparison tool as hidden variables from the Identity Verification/Eligibility components of an Exchange or from an employer outside an Exchange. In that way, the user will see a dramatically simplified version of this page.

14 Audio Tips Short audio explanations are available on nearly all information points. Additionally, the user may choose to have an Audio Guide where many of the audio advice elements are automated to correspond with the user s progress. Text is always provided alongside audio or video components to maximize accessibility.

15 Doctor Directory An Exchange-wide doctor directory is presented so the user can enter the names of any current doctors, select from the drop-down list, and know in which plans their doctors participate. Doctor Chooser Help is provided to find doctors recognized on a variety of quality considerations should the user need to find a doctor recognized for quality.

16 Choose a Doctor Quality Doctor selection page Selected Doctor Doctor chosen from Exchange-wide directory.

17 Summary Ratings Results Displaying Plans ranked by (1) Cost for Someone Like You Combined Total Cost including Yearly Premium less any government assistance or subsidy plus Health-care Costs YOU Pay. Can also be sorted by (2) Most You Could Pay in a Year, (3) Overall Quality Score, (4) Doctor Result (are your preferred doctors in plan), (5) Plan Type. Visual cues point to most important information.

18 Video Explanations - Use our specially prepared videos to help explain certain critical considerations on the main Summary results page. Adjunct text improves accessibility.

19 Accessible Explanations - Nearly every information point has a handy pop-up text explanation available.

20 Sort By Your Preference Display plans ranked from low to high or high to low, depending on your preferences, on any of our information columns. Here we see Most You Could Pay in a Year sorted from high to low, revealing some important warnings and considerations.

21 Enhanced Cost Information - Allows the user to see rankings of plans on cost in Good, Bad, Average, and Extremely Bad years and shows the likelihood of Having a Good or Bad year for families like yours.

22 Personalized Quality Score Quick access to the ability to weight quality measures that are important to the user.

23 Personalized Quality Rating - Allows the user to weight a variety of quality measures on what s important to them and recalculate a new set of Quality star scores for the plans.

24 Personalized Quality Rating - Allows the user to weight a variety of quality measures on what s important to them and recalculate a new set of Quality star scores for the plans.

25 Personalized Quality Rating Underlying information on top-level quality measures, for those who wish to look at specific questions and scores. Includes information on customer experience, disputed claims rates, and adherence to best practices in diabetes care, heart disease, cancer, back pain, and more.

26 Personalized Quality Rating - Allows the user to weight a variety of quality measures on what s important to them and recalculate a new set of Quality star scores for the plans

27 Deductibles/Copays/etc - Provides information on plan deductibles, copays, coinsurance, and contributions to health savings accounts.

28 Dental - Multiple layers of information on both health plan dental coverages and stand-alone dental plan coverages. Summary Dental Costs if your dental care usage were None, Low, Average, and High. Includes listing of the Maximum Benefit amount. Key Benefits Child and adult preventive and restorative coverages and more. Detailed Benefits Coverages by procedure.

29 Filters and Customization Tools - Narrow your choices with filters and preference tools once you ve seen the variety of costs and quality available to you.

30 Side-by-Side Comparison: Compare data in multiple ways. Use columnar comparison under the table tabs, as shown on earlier screens, or create a side-by-side report on all coverage details and costs for up to four selected plans.

31 Create a Custom Print Report Particularly helpful to assisters like family members, navigators, and others is the ability to create a custom print report on the chosen plan comparisons, showing cost and quality comparisons and including useful advice on plan selection.

32 We Wrote the Book: Walton Francis and CHECKBOOK/CSS have literally written the book on health Insurance, providing an in-depth look at how the system works, what it all means, and how the consumer should best go about making their choices. This example if for Federal employees but similar advice can be given within a state Exchange environment or a private employer environment.

33 CHECKBOOK/CSS Plan Comparison Tool For more CHECKBOOK/CSS information on helping consumers and employers choose the health plans that best meet their needs and preferences, visit