Will Employees Trade Provider Access for Lower Premiums?
While the thought of medical plans with “in-network only” coverage or coordinated by a “gatekeeper” might elicit a knee jerk reaction for some employees, our latest white paper, “Medical Plan Preferences in an Environment of Choice,” suggests that these types of plans are not only tolerated, but even preferred by many health care consumers, when given a robust set of choices with varying plan designs and cost differentials.
What do we mean by “Provider Access”?
Consumers typically choose from an array of providers in their medical plans but the choice of these providers varies by plan type.
“In-network only” refers to policies that only cover visits to doctors and other providers that are in a designated network, often with no need for a referral from a Primary Care Physician (PCP) to see a specialist.
A “gatekeeper” plan is a policy in which individuals are required to use a family doctor such as a PCP, Internist or Pediatrician, to coordinate their care including referrals to see a specialist. The gatekeeper model utilizes a group of doctors and facilities that are considered “in network,” i.e., gatekeepers tend to refer patients to others doctor or facilities within their network.
Employees Willing to Trade-off Provider Access for Lower Premiums
Our research found that almost 90% of employees surveyed would consider a less expensive plan that only allowed access to in-network doctors and facilities or required referrals from a gatekeeper, or both. Given the two options, the analysis found that employees gravitate more towards the in-network provider plans, with 83% of employees open to this option. This mindset appears to translate to actual plan choice, as previous data acquired by Liazon found that the majority of employees using the Bright Choices® Exchange actually chose an HMO plan with multiple restrictions – including in-network only coverage, a narrow limited network, and referral requirements – lending further support to the notion that people aren’t just open to these types of plans, but they are choosing them as well.
A Step Toward “Consumerized” Health Care
Liazon co-founder Alan Cohen sees the proliferation of these types of plans as support of the evolution of the newly “consumerized” health care industry. “When people have the power of choice,” he says, “they evaluate what they are getting for their money and make decisions on trade-offs, just as they do for other purchases.”
As consumers continue to become more involved in their own health care choices, these valuable insights into consumer preferences will help employers understand the need for a variety of plan types for their employee population.