Communicating with Patients about High Deductible Insurance: Best Practices

High-deductible insurance plans were designed to encourage consumers to be more selective in their healthcare choices, with a goal of ultimately lowering the cost of care. In 2016, the IRS defined a high deductible health plan as a plan with deductibles that exceed $1,300 for single-person coverage and $2,600 for family coverage.

The Growth of High Deductible Insurance Plans

In 2016, 83 percent of American workers who enrolled in insurance offered through their employers carried a deductible, according to an employer health benefits survey conducted by the Kaiser Family Foundation/Health Research & Trust. The average deductible for employees has risen significantly over the past 10 years, for individual coverage it totaled $1,478 in 2016, up 12 percent since 2015 and up 49 percent since 2011, according to the survey.

But as consumers face higher out-of-pocket costs for care, they become more likely to postpone treatment or service. Two out of five adults with high deductibles have delayed or avoided care based on the amount of out-of-pocket costs, according to a survey by The Commonwealth Fund.

Providers Also Become Counselors

This puts pressure on providers to step into the role of “insurance counselor” for patients who require help understanding what their insurance coverage entails and how much they will be expected to pay out of pocket for the care and service they receive. It also requires physicians and other providers to be prepared to explain terms such as premiums, deductibles, and coinsurance in terms patients and their families can easily understand.

The stakes are high: Nearly one-quarter of people who have high deductibles cite their deductibles as the reason they have not sought preventive care testing, even though by law, these tests are excluded from deductibles, according to research by The Commonwealth Fund. Lower-income adults delay or avoid care based on their copayments at twice the rate of adults with higher incomes. However, even among higher earners, out-of-pocket expense is still a factor in adhering to their physician’s instructions: about one out of five adults (21 percent) with incomes at 200 percent of poverty level or higher reported not filling a prescription or delaying needed care to avoid the expense of a copayment. Such decisions impede physicians’ ability to provide high-quality care.

Health plans should serve as the definitive information source for patients around out-of-pocket responsibility. As such, they should provide easy-to-use tools for consumers to obtain a list of in-network providers, estimate the cost of care or service, and determine out-of-pocket responsibility.

Better Communication Becomes a Necessity

Hospitals’ responsibilities include:

• Clearly communicating the estimated cost for a given procedure prior to the point of service
• Detailing which services are included in the estimate
• Making it clear how complications during a procedure or course of treatment could impact the patient’s out-of-pocket expense

Physicians and clinicians also play an integral role in patient financial communications, starting with helping patients and their families make informed decisions about their treatment plans. When financial concerns are raised by patients, it is the responsibility of the physician to explore these concerns further and work with the patient and family to address them. Physicians also should continually consider less expensive forms of treatment and long-term solutions for reducing costs of care.

Resources for Improved Patient Financial Communications

How can your organization most effectively communicate with patients who have high deductibles? HealthStream partner The Healthcare Financial Management Association (HFMA) has developed best practices for patient financial communications, across all care areas and in specific settings, such as the emergency department. A sample of best practices includes:

• Initiate the conversation early in the patient encounter. Where appropriate, utilize face-to-face discussions to facilitate one-time resolution.
• Provide standard language to guide staff on the most common types of patient financial discussions.
• Reinforce verbal discussions with written information.
• Respect the patient’s privacy by holding such communications in a location and manner that are sensitive to the patient’s needs.
• Focus on steps toward amicable resolution of patients’ financial obligations.
• Ensure that passion, patient advocacy, and education are components of all patient financial communications.

For the full list of HFMA’s best practices for patient financial communications, visit hfma.org/communications. HFMA also provides specialized training for patient access staff that healthcare organizations can use to effectively engage and educate patients and their families, provide constructive pathways for resolving patient medical accounts, and promote patient and employee satisfaction. HFMA’s Patient Financial Communications Training Program features online, self-paced training modules with tools that can be customized to your organization. The program is scalable to the size of the organization’s patient access team. For more information, visit hfma.org/pfcprogram.