Consumer-focused policies to improve health care delivery and payment

Nov. 22, 2021 / By L. Gordon Moore, MD

A neighbor of mine is undergoing her third round of chemotherapy this week. As we head into the end of the year, she was relieved that she had already passed her out-of-pocket threshold and didn’t have to contribute to the $15,000 bill for the medication this month. But she will be required to meet her 2022 deductible and will of course blow right past the out-of-pocket max in short order.

Why do we do this as a nation? What sense does it make to force a person with cancer to foot these bills? Are they supposed to shop for cheaper meds or choose a less expensive doctor?

The way we pay for health care in the U.S. is packed with bizarre rules that (hopefully unintentionally) punish people who need care. It is hard for me to understand the benefit of this approach—it’s certainly not resulting in less expensive health care or improved quality.

If every system is perfectly designed to get the results we see, we need to look hard at the factors driving this system and we need to discuss why so many have to suffer so much to maintain this unfortunate set of incentives.

Let’s shine a light on the negative impact of consolidation in health care—where some health plans and/or hospital systems become functional monopolies, dictating price in ways that are not very transparent. Let’s bring more transparency on price and quality so consumers have at least a chance at making informed choices. Let’s look at payment incentives—especially the impact of fee-for-service payment creating powerful incentives to do more even when more may not be the better option.

Listen to the Inside Angle podcast with Sophia Tripoli, director of health care innovation at Families USA, where she leads Families USA’s work on value initiatives that focus on re-orienting the health care system to deliver health, and on forwarding consumer-focused policy agendas to improve health care delivery and payment systems.

Dr. Gordon Moore is senior medical director, Clinical Strategy and Value-based Care for 3M Health Information Systems.