Shopping for Health Insurance: The Role of Decision Support

Given today’s New York Times article “White House Moves to Fix 2 Key Consumer Complaints About Health Care Law” by Robert Pear, it is important to repost this blog from May 2014 about the role of decision support in HealthCare.Gov.

Most employees have online decision support—medical cost calculators and preference-based tools—to evaluate plan options and make informed choices during open enrollment. Federal employees, including those who run HealthCare.Gov, have tools such as Consumers’ Checkbook and PlanSmartChoice.

Why are the tools important? In addition to helping consumers make informed decisions, their user data is saved, aggregated (to ensure confidentiality) and merged with demographic and purchasing data to determine the following about consumers and their buying behavior:

1) Projected Medical Utilization. When consumers estimate their need for medical services (e.g., # PCP visits, RX drugs) for the year in a medical cost calculator, we know the projected utilization across all users and by market segment.

2) Total Health Care Costs. When consumers learn the estimated total cost (out-of-pocket expense plus premium) for each plan offering in the medical cost calculator, we know their projected total costs, again across all users and by market segment.

3) Attribute Importance Profiles. When consumers make tradeoffs (e.g., Which would you prefer? Low premium and narrow network OR high premium and broad network?) and learn how well plan offerings meet their needs, we know which plan features drove plan choice.

The assumption is that HealthCare.Gov shoppers are price sensitive. Yes, but they haven’t had any other way to choose. Decision support will improve consumers’ purchasing decisions for health insurance. It can also generate information about their buying behavior that HealthCare.Gov’s leadership can use to better meet the needs of consumers and their health plans.