Pricing confusion, high drug costs, enrollment stress and information gaps—they’re issues frequently mentioned in surveys and studies as sources of consumer dissatisfaction when it comes to health insurance. At Tufts Health Plan, we get it—and we’re taking meaningful action. Below are five of the most common consumer complaints, and how we’re addressing them.
The Problem: Lack of transparency
One of the major frustrations of health care for members and employers alike is how difficult it is to find out in advance how much various medical services and prescriptions cost. Providers and pharmacies rarely make pricing information available up front, in part because the amount they charge varies based on what they negotiate with different health plans.
Costs for the same service can vary significantly between different providers and facilities, even within the same geographic area. The same goes for prescription drug prices, which can vary by pharmacy, manufacturer, and dosage. As a result, consumers have little choice but to choose their medical care based on factors like convenience, past experience with a provider or recommendations from friends and family.
What’s telling, however, is that when consumers do try to research prices, they’re generally looking for the best value, not necessarily the lowest price.1 If it were easier to do that, it would not only benefit them directly, but could also benefit employers by driving premium prices lower.
Our Solution: Treatment Cost Estimator tool
We don’t think anyone should be in the dark when it comes to planning for health care costs. That’s why we developed our Treatment Cost Estimator tool. This simple-to-use tool lets members compare costs of services, facilities and doctors and get out-of-pocket cost estimates for procedures. Members can see costs and services for the entire timeline of care for a given treatment, from diagnosis through follow-up, including medications, for a big picture view of the costs they may encounter. Members who use the cost estimator tool also have the opportunity to earn rewards in the form of gift cards when they choose high value providers.
The Problem: The high cost of prescription drugs
The U.S. spends nearly $334 billion a year on prescription drugs2 with the average American spending $1,200 per year on prescription drug co-pays alone.3 Out-of-pocket costs for many drugs continue to increase, to the point where some consumers have to cut back in other areas of their household spending or use credit cards more often so they can afford prescriptions.4 According to the Centers for Medicare and Medicaid Services, overall prescription drug spending in America will continue to grow at an average of 5.6 percent annually until 2027.5
As with medical care costs, prescription drug prices can be hard for members to track down in advance. The drivers behind the high cost of drugs are many and complex. The most commonly used drugs tend to be (but aren’t always) cheaper, since the demand is highest. But medications for complex, difficult or rare health conditions often cost much more. Further muddying the waters is the fact that different pharmacy benefit managers (PBMs) and/or health insurance companies negotiate different discounts and rebates on the prices of prescription drugs with pharmaceutical companies. A member of one health plan might pay more or less out-of-pocket for a given drug than a member of a different plan.
Our Solution: MyPrescription Shopper
While we can’t solve the challenge of high prescription drug prices, we do try to make it easier for our members to make informed choices and save money when possible. One way we do this is with our MyPrescription Shopper tool. This tool analyzes each member’s prescriptions to identify potential savings opportunities of $5 or more. If there’s something a member can do to save money, like ask their provider about an alternative medication or modified dosage, use mail order and/or refill their prescriptions through a less expensive retailer, we send them a notification.
Members can access MyPrescription Shopper through their Tufts Health Plan member account or mobile app. Once they’re registered, they can view all of their savings opportunities in one place and define their preferences for communications and alerts.
We don’t think anyone should be in the dark when it comes to planning for health care costs.
The Problem: Trying to pick a provider
With dozens if not hundreds of options to choose from, finding a new primary care provider, specialist or hospital can feel like taking a shot in the dark. Further complicating the decision is the fact that the costs of care with any given provider or facility are difficult if not impossible to research in advance. Some people turn to one or more of the many provider review sites on the internet in hopes of finding information to help them choose, but the information is often scant, outdated or unreliable. In the end, many people stick with the providers they already have, or the ones family or friends use, simply because it’s less hassle—even if it means traveling farther, paying more, or working with a provider who’s not quite the right fit.
Our Solution: A better provider search tool
After hearing about our members’ frustrations with choosing providers, we set out to develop a more helpful provider search tool—one that makes it easier for members (as well as non-members interested in joining Tufts Health Plan) to pinpoint the right provider for their needs.
Our robust search tool allows members to narrow their search using multiple variables, including gender, sub-specialty, location, facility type, languages spoken, board certifications, whether new patients are accepted and more. The tool even lets members compare providers side by side, making it easy to see several providers’ information in one place and make an informed decision.
Finally, we let members know which providers and facilities they can earn rewards for choosing. When members choose high value providers, which we designate based on cost and quality of care, they can earn rewards in the form of gift cards.
The Problem: Employee confusion and stress during open enrollment
Choosing between health plans during open enrollment and switching to a new plan can be stressful for employers and employees alike. Understanding what the deductibles and copays are for various plans, determining which price points and coverages are the right fit, and trying to get answers to questions can be daunting. Employees may have concerns about whether they and their family members can stay with their current doctors, or whether the care they’re receiving will be interrupted. In one survey, 49 percent of employees say making health insurance decisions is always "very stressful" for them and 41 percent feel the open enrollment process at their company is "extremely confusing”.6
Human resources staff and benefits managers often find themselves scrambling to help employees understand their options and make decisions. This, of course, is on top of all the administrative requirements of open enrollment. But it doesn’t have to be this way.
Our Solution: Hands-on support every step of the way
At Tufts Health Plan, we’re committed to making open enrollment and changing plans as simple and worry-free as possible. During open enrollment, we do live presentations and Q&A sessions—on site or via video call, as appropriate—to guide employees through the process and answer their questions. We’re also available to talk with individual employees one-on-one if they have questions regarding their medical needs or financial situation that they’d prefer to discuss privately. We can even get our care managers involved to talk with employees in more detail about specific health care needs, such as care for chronic or serious conditions.
When it comes to continuity of care, our dedicated member experience team helps new members who have previously scheduled procedures or appointments, or who are in the midst of treating an illness or condition, get the authorizations and referrals they need to keep their care on track. We’ll remind them to fill out our Member Care Form, and then we’ll follow up as needed with questions and recommended action steps. Our goal: To support members so that on day one of their new plan, they are set up for the care and medications they need.
While we can’t solve the challenge of high prescription drug prices, we do try to make it easier for our members to make informed choices and save money when possible.
The Problem: Lousy communication
Infrequent or non-existent. Jargon-y. Impossible to understand. Poor communication from their health plan is a persistent consumer complaint—even now, in the midst of the COVID-19 pandemic, when communication is more important than ever. According to the most recent J.D. Power Commercial Member Health Plan Study, as many as 60% of private plan members say their insurers never contacted them regarding the virus.7 The irony is that, according to the same study, customer satisfaction is directly linked to customer engagement.
Our Solution: Information made simple, accessible, and proactive
At Tufts Health Plan, engaging and communicating with our employees is a top priority. We put significant time, energy and resources into making sure that our members not only have easy and convenient access to the information they need, with tools like our MyWire text messaging service, which sends targeted notifications about a range of health care-related topics to members who opt in, and our mobile app, which allows members to view and manage all of their health care benefits and information securely on the go. We also communicate proactively, with alerts, reminders and other information relevant to each member, including opportunities to save money, reminders from care managers, and, yes, updates about urgent concerns like COVID-19.
But it’s not just about communicating; it’s about communicating clearly. We go out of our way to avoid using confusing jargon in our benefit information or marketing materials. Have employees who don’t speak English fluently? We provide complete translation services in dozens of languages, at no extra cost.