Consumer Driven Healthcare Solutions

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The healthcare industry is in the midst of major transformation.

Rapidly rising healthcare costs, which have been well documented in recent years, have a far-reaching impact on both the private and public sectors of our economy – one that could put the U.S. on the brink of a serious financial and quality-of-life crisis if they continue to grow unchecked.

The exponential rise in healthcare costs is driving a shift of responsibility for healthcare from the employer to the employee. To address this shift, a new approach to insurance and healthcare management has been defined – Consumer Driven Healthcare (CDH).

Consumer Driven Healthcare is based on the premise that if the consumer is made aware of healthcare costs, and if they have incentives to manage these costs, then they will change their behavior – and overall healthcare costs will decrease. This movement is creating a fundamental change in the healthcare delivery and management cycle. New products, technology, administrative and operational platforms, and consumer resources are required to support this healthcare transformation:

  • CDH plans require new functionality that legacy claims systems do not support
  • Tax-advantaged consumer benefit accounts (FSAs, HSAs, HRAs, etc.) are now interdependent and must integrate with health plans
  • Consumer benefit accounts, combined with CDH plans, create a convergence of the financial and healthcare worlds
  • Consumers must be given real world tools to help pay for healthcare goods and services, and plan for required future savings needs
  • Comprehensive communication and education programs are required for all healthcare constituents to garner acceptance and adoption of the CDH model
  • Consumers need to be empowered with new resources to manage their new healthcare responsibilities

The bottom line is that health insurance plans, third party administrators, financial institutions, and providers must realign their products and services to accommodate this market transformation.

Metavante can help.