Consumer Driven Health Care
Morgan Dosher
Managed Care Trends
L. Ludwig
5/9/2014

Consumer-driven care is a type of health care plan that includes the use of health savings accounts, flexible spending plans or some other sort of savings plan for minor health expenses. Larger expenses for more serious care issues are covered through a catastrophic health insurance plan, which has a large deductible and cannot be used for things such as routine doctor visits. (Goodman, December 2006) The use of a health savings account, flexible spending account or another form of personal savings allows individuals to not worry about whether they are receiving care from an in-network doctor or not. They may seek care from whomever they choose. Further, they alone choose how much to put away in savings for medical issues, and will likely get a choice of different catastrophic plans as well. The main job of any health insurance plan is to prevent the patient from having catastrophic financial losses. While most traditional health plans will also cover more routine matters, this often pushes the cost of those plans higher than they would otherwise be. That is why catastrophic plans were created and the thrust of consumer-driven care. The idea behind patient-centered approaches like consumer-driven care is that if individuals use a health savings plan or flexible spending account, then they will take a more careful assessment of their health care spending, according to a policy brief paper written by John Goodman in December 2006. (Goodman, December 2006) Thus, overall efficiencies will be seen in the system because individuals have to take more responsibility for payment. If putting money away in some type of medical savings plan, individuals must understand there will be times when it is needed to pay for more than just routine care. The money can also be used to pay the deductible in a catastrophic or high-deductible health plan. Therefore, it is important to make sure some of that money is set aside, in case something like hospitalization is needed. Gail Shearer, director of Health Policy Analysis for the Consumers Union, testified before the Joint Economic Committee in Washington, in 2004, that consumer-driven care was not the answer. Among her criticisms were that those families who had members with chronic illnesses could not build a nest egg and thus were forced to spend more than the average family for health care. Further, managed care does nothing to address the problem that many have regarding not being able to find coverage for pre-existing conditions, Shearer said. (Consumer Driven Care, 2014) When a person decides to enroll in Family Care, they become a member of a managed care organization. MCOs operate the Family Care program and provide or coordinate services in the Family Care benefit. The Family Care benefit combines funding and services from a variety of existing programs into one flexible long-term care benefit, tailored to each individual’s needs, circumstances and preferences. In order to assure access to services, MCOs develop and manage a comprehensive network of long-term care services and support, either through purchase of service contracts with providers, or by direct service provision by MCO employees. MCOs are responsible for assuring and continually improving the quality of care and services consumers receive. MCOs receive a per person per month payment to manage care for their members, who may be living in their own homes, group living situations, or nursing facilities. Some highlights of the Family Care benefit are: * People Receive Services Where They Live. * People Receive Interdisciplinary Case Management. * People Participate in Determining the Services They Receive.
Managed care is structured around a variety of incentives to encourage the practice of cost-effective medicine, and to minimize variation in clinical practice patterns. "Efficiency" here means providing a product, in this case health care, while minimizing resources used, most often dollars. Most often, efficiency is maximized by increasing productivity while fixing cost. Hence, managed care may create pressure to do more with less: less time per patient, less costly medicines, and fewer costly diagnostic tests and treatments.
Monetary incentives are often used to affect physician behavior, and may include rewarding physicians who practice medicine frugally by offering financial rewards, such as bonuses, for those who provide the most cost-efficient care. Those who perform too many procedures or are cost-inefficient in other ways may be penalized, often by withholding bonuses or portions of income. Nonmonetary inducements to limit care take the form of bringing peer pressure, or pressure from superiors, to bear on those who fail to take into account the financial wellbeing of their employer. These monetary and nonmonetary incentives raise the ethical concern that physicians may compromise patient advocacy in order to achieve cost savings.
A related ethical concern pertains to the effect of managed care on physician-patient relationships. Many worry that managed care will undermine physician-patient relationships by eroding patients' trust in their physicians, reducing the amount of time physicians spend with patients, and restricting patients' access to physicians.

References
Consumer Driven Care. (2014). MCOL, http://www.consumerdrivencare.com/.
Gallagher, T. H. (2014). Patients’ Attitudes Toward Cost Control Bonuses For Managed Care Physicians. Health Affairs, http://content.healthaffairs.org/content/20/2/186.full.
Goodman, J. C. (December 2006). Consumer Directed Health Care. Social Science Electronic Publishing, Inc, http://papers.ssrn.com/sol3/papers.cfm?abstract_id=985572#PaperDownload.