M-RCBG Senior Fellow-Led Study Group: Deborah Gordon
Session 1: October 17, 4:00-5:30 M-RCBG Conference Room (B-503)
Session 2: November 15, 4:00-5:30 M-RCBG Conference Room (B-503)
Health care consumerism has become all the rage.
Financial responsibility for health care purchasing in the United States has shifted substantially to consumers over the past few decades. American families are paying 28 cents of every health care dollar spent between out-of-pocket costs for care and insurance1; increasingly, Americans with employer-sponsored insurance have deductibles of $1,000 or more2.
And the industry has noticed. Venture capital has flooded into digital health start-ups. To enable shopping behavior, price transparency tools and benefit market places have emerged. And large companies across the health care sector have spent significant resources trying to improve their engagement with consumers.
So why haven’t Americans turned into savvy health care consumers?
Despite industry efforts and investments, consumer adoption has remained low. Just building shopping platforms has not created thriving consumer markets and shifting costs to individuals has not effectively transformed them into shoppers. Even those consumers who want to shop may not find easy answers. Health care providers are not equipped to provide prices, despite transparency provisions in the ACA and numerous state laws3. Health service pricing is convoluted and intricately negotiated, varying by provider, service, and insurance type. Transparency tools themselves are pricey, and incomplete. Where prices are available, consumers may not use them4. Further, price transparency alone may not achieve its aim. Price, like less tangible features, does not always drive logical responses.
Barriers to health care shopping abound. To leverage that purchasing power to reshape health care into a consumer-grade industry, it is critical to understand what drives consumer behavior – the mindsets, beliefs, and perceptions that influence health care decision-making. Why people do not shop for health care and what would it take to enable true shopping behavior are the central questions of this research.
In this study group, we will review emerging consumer data, collected with a range of methodologies, and discuss implications for policy and business practice.
Why haven’t Americans turned into savvy health care consumers, despite increasing financial responsibility and incentives to do so? Barriers to health care consumerism abound, but so too might opportunities to improve consumer empowerment in health care purchasing.
In this study group, we will pick up the conversation and discuss initial findings and emerging themes from our research on health care consumerism, including:
- widely varying consumer definitions of quality and value
- the role of health care providers in enabling or discouraging consumerism
- how issues of cost may affect treatment decisions
- how negotiating strategies may affect treatment decisions and patient financial responsibility
- how insurance plan design affects behavior
- where in the health care system might we see more traditional shopping behaviors and why
- what can deeper exploration of pharmaceuticals, mental health services, and dental care as case studies illuminate about the opportunities and pitfalls of health care consumerism
Additionally, what are the policy implications emerging from the research? As we are in the midst of 2018 open enrollment for the Affordable Care Act, what should we be focusing on right now as millions of Americans shop for their health insurance?
Whether you’ve been part of this conversation or new to it, join in the discussion about barriers and drivers of American health care consumerism.
Deborah Gordon is a seasoned health care executive and a thought leader in health care consumerism. She currently advises entrepreneurial ventures and other companies on consumer strategies, engagement, and marketing in health care. Deb was formerly CEO of Voxent, a national technology firm supporting reproductive health providers with custom electronic health record and analytics tools and a national data warehouse. Deb had previously held health insurance leadership roles, notably as Chief Marketing and External Affairs Officer at Network Health, a Massachusetts health plan now part of Tufts Health Plan and ranked NCQA’s #1 Medicaid plan nationally. Under Deb’s leadership, Network Health received hundreds of awards, including Health Leaders Magazine’s Top Leadership Team award. She helped the plan double its membership under Massachusetts health reform, expand product assortment, and transition to the ACA. Deb was recognized as a 2011 Boston Business Journal “40 Under 40” honoree, an award highlighting Boston’s most influential business and civic leaders. In 2013, Deb was named an Eisenhower Fellow, a non-partisan program chaired by retired General Colin Powell that fosters the exchange of information, ideas, and perspectives among global leaders. On her fellowship, Deb traveled to Australia, New Zealand, and Singapore to explore the role of consumers in high-performing health systems. She has served on Harvard University’s Advisory Committee on Shareholder Responsibility, as a Board member in MIT’s Delta V start-up accelerator, and as a mentor in Boston University’s Business Health Sector program. She has served on the Editorial Advisory Board for Fierce Health Payer and as Fierce Healthcare’s Innovation Awards’ head judge, and on Marketing Health Services’ Editorial Board, the Advisory Group for Massachusetts’ Choosing Wisely campaign, and several nonprofit Boards. Deb earned a B.A. in Bioethics from Brown University and an MBA with distinction from Harvard Business School. As a Senior Fellow, Deb will research health care shopping and how to improve functioning of consumer markets in health care. As a Senior Fellow, her research is entitled Beyond Health Care Transparency: Applying Marketing Principles to Improve the Functioning of Consumer Health Care Markets. Her faculty sponsor is Joseph Newhouse, John D. MacArthur Professor of Health Policy and Management at Harvard Kennedy School. Email: firstname.lastname@example.org
1. Paying Out-of-Pocket: The Healthcare Spending of 2 Million US Families. JP Morgan Chase & Co. Institute. Sept 2017
2. Kaiser Family Foundation (2015)
3. Anthony B., Haller S. Healthcare Prices for Common Procedures are Hard for Consumers to Obtain. Pioneer Institute Policy Brief
4. Brot-Goldberg Z.C., Chandra A., Handel B.R., Kolstad J.T. What Does a Deductible Do? The Impact of Cost-Sharing on Health Care Prices, Quantities, and Spending Dynamics. 2015 Nov 2 (Forthcoming, Quarterly Journal of Economics)