Sunday, October 3, 2010

HealthCare.gov Compares Insurers With Little Evidence That It Works

As further testimony to the current Administration's commitment to force those dastardly commercial health insurers out from under their rocks into the cleansing light of righteous Obamacare, the "health care dot gov" web site has posted all the nation's commercial insurers' pricing and application rejection rates. Input your state of residence, marital status (single, married, children), whether you've been rejected for coverage, age, overall health status, employment situation, and zip code and [poof!] the site will generate (when the Disease Management Care Blog took it for a test drive) several pages of options with varying deductibles, co-pays and premiums.

All well and good, says the DMCB, until it thinks about the evidence that this will work as intended. For consumers who are lucky enough to fall on the more affluent side of the digital divide and have a choice of media, only a minority actually use the internet to shop for health insurance. The DMCB could find no published research on the topic of it changing purchasing behavior, which is ironic, given our federal infatuation with comparative effectiveness research.

Research on internet-based ratings of hospitals has shown internet-based comparisons are not the slam dunk that many assume they are. The ratings are subject to variable methodologies (an issue for healthcare.gov that was already raised by AHIP) that can "confuse, rather than inform consumers," or may not tell the whole story, or simply get it wrong. The surfing public may not reward "better" entrants with increased market share and one reason may be because users don't find the information helpful. Even CMS's own web site that compares hospital quality isn't really all that.

While the insurer compare site may have given the Obama Administration some positive news media attention, (aided by AHIP's needless push back) the DMCB doubts it will ultimately have much of a material impact - based on the current evidence - on the purchasing behavior of consumers of health insurance. To go about this right, HHS should measure "hit" rates and conduct user-surveys to see how it's going. If the data are disappointing, hopefully they'll have the courage to take down the site and announce its demise with the same fanfare that accompanied its start.

Somehow, the DMCB thinks that is unlikely.

3 comments:

Akash Randhar said...

Might not have a published study but does it not make sense? I know two friends who have been helped immensely by online health insurance information / comparison. I shop for all kinds of things online and dont see why I wouldn't like credible source about health insurance (or doctors or hospitals for that matter). Where else can I get any of that information? Not scientific but there wasn't one either when Amazon.com started selling books online. I do fall on the right side of the digital divide. But if that is the biggest knock against publishing that information, I'd say - publish it for those who can use it today, and for those who cant, do something (education, internet availability, supplement online with phone) so that they can too.

Jaan Sidorov said...

I agree there is a role for common sense, entrepreneurship and anecdote in setting up things like this. On the other hand, if that's all we relied on, we'd be making a lot of mistakes. In this instance, use of internet-based information to change the purchasing behavior of health consumers HAS been researched, and the piture isn't pretty. I have a feeling that the combination of the information wanted (for example, is my doc included in the network and how much hassle is involved) and the GUI (listing insurers that probably have the best combination of features based on my preferences)isn't there yet. That's one obvious difference between HHS and Amazon. There are others and I don't know if Washington DC-based web portal designers will be able to sort it out.......

Lisa said...

Giving consumers access to more information is always better than not giving it to them. I suspected that Blue Cross Blue Shield's heavily advertised individual Keystone plans in Pennsylvania were rejecting many applicants--they rejected me despite no serious health problems and offered my husband a surcharged price for flimsy reasons. Sure enough, their rates of denial and surcharges are among the highest. Shopping for individual health plans is a nightmare. Anything that might help is welcome, even if it is imperfect.