AMA promotes benefit design to mitigate cost of high-deductible plans

The American Medical Association wants to see more flexibility in benefit design to help the increasing number of consumers enrolled in high-deductible health plans.

Patients face out-of-pocket costs in the form of co-payments, coinsurance and pre-deductible expenses, the AMA said.

A new policy adopted today by the nation's physicians at a Special Meeting of the American Medical Association House of Delegates builds on the AMA's support for tailored flexibility in health plan design. It recognizes the same medical service could be high-value to one patient and low-value to another.

The new policy encourages active collaboration among organized medicine and payers during plan development, according to AMA Board Member Dr. Mario E. Motta. 

It encourages benefit designers to look beyond health plans with blunt instruments for shifting healthcare costs, the AMA said. Action from payers, employers, organized medicine, and researchers can alter the mounting financial and clinical barriers patients face as a result of high-deductible health plans, the organization said.

WHY THIS MATTERS

The financial burden of increased out-of-pocket costs causes many people to forgo necessary care, especially patients in marginalized communities or patients with multiple chronic conditions or lower socioeconomic status, the AMA said.

Employers, as designers of healthcare benefits, can provide education to help employees make good use of their benefits to obtain the care they need; take steps to understand their employees' health insurance preferences and needs; tailor their benefit designs to the preferences and needs of their employees and their dependents; and pursue strategies to help enrollees spread the costs associated with high out-of-pocket costs across the plan year.

THE LARGER TREND

A significant number of people have lost their health insurance coverage due to job cuts caused by the COVID-19 pandemic.

The AMA said it continues to work on increasing awareness of options for subsidized coverage from individual states and the federal government to ensure that fewer people fall through the cracks.

Individuals who have lost coverage may forego care until an illness becomes more serious and costly. When this happens, physician practices and hospitals face more uncompensated care costs.

ON THE RECORD

"The pandemic has prominently displayed the critical barriers posed by underinsurance, with many health plans not providing affordable coverage for services to treat chronic conditions and COVID-19- related illness," said AMA Board Member Dr. Mario Motta. "The new policy encourages research and advocacy to promote innovative health plan designs that respect patients' unique healthcare needs."
 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com