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Health Plans Prepare for Health Care Reform: Comparative Effectiveness, Consumerism Drive Future Changes, According to Deloitte Study
Date:6/4/2009

ting metrics and transparency programs will be important to optimize collaboration with providers.
  • Statistical variation in actuarial models is likely to decrease as care becomes more standardized based on best practices discovered with comparative effectiveness. As variation decreases, risk margins charged to customers will likely reduce premiums.
  • With the additional granularity that ICD-10 offers for comparative effectiveness research, its deeper refinement in defining diseases and conditions could potentially lead to more customized medical management programs.

    • "As the health plans sector prepares for health care reform, comparative effectiveness has the potential to fundamentally change the industry," said John T. Bigalke, vice chairman and U.S. Health Sciences and Government industry leader, Deloitte LLP. "Generating better evidence about the costs and benefits of different treatment options -- through research on the comparative effectiveness of those options -- has the potential to bend the curve in health care spending and reduce inappropriate variation in the system."

    Consumerism

    Consumers, as the primary recipients of the product of the health care system, have an incredible stake in the effectiveness and efficiencies of health care services. Yet, data from the Deloitte 2009 Survey of U.S. Health Care Consumers indicates that only 27 percent of consumers report that they understand how the health system works, with 16 percent reporting that they have no understanding or very slight understanding. These findings underscore the significance of the potential gap regarding comparative effectiveness research findings and what consumers feel they know about how the health system works and how they view health system performance.

    As comparative effectiveness programs are developed in the United States, health pl
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    SOURCE Deloitte
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