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This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies and provides updates and insights on policy, regulatory and legislative changes. 

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A consumer-driven culture of health

The Affordable Care Act has disrupted the US health care market's current fee-for-service economic model. Out of this disruption may emerge an open, consumer-driven health care ecosystem focused on transparency, actionable insights, collaboration, and engagement.

Analysis

Public health insurance exchange enrollees

Insights from the 2016 Survey of US Health Care Consumers

Findings from Deloitte’s Survey of US Health Care Consumers shed light on how public health insurance exchange enrollees shop for coverage, their confidence in handling future health care costs, use of online services, and knowledge of costs. As health care consumers’ expectations continue to evolve, what does it mean for the future of the US health insurance industry?

A look at health insurance exchange enrollees

The public health insurance exchanges have been in operation for nearly three years now and may be opening the door for a new generation of engaged health care consumers. Deloitte’s 2016 Survey of US Health Care Consumers sought to understand their satisfaction with coverage, confidence in handling future health care costs, use of online services, knowledge of costs, and how they shop for coverage.

Findings reveal:
  • Exchange consumers say they are satisfied with their coverage at the same rate as people with employer coverage
  • More exchange consumers feel prepared to handle future costs and are more able to access affordable care than last year
  • More than twice as many exchange consumers report using online information sources to shop for a policy than the average consumer, including those with employer coverage
  • More exchange consumers say they understand their costs than consumers with employer coverage, and when they used their coverage, few had surprise out-of-pocket costs
  • Exchange consumers shop around for coverage and evaluate the total costs before making decisions, and they continue to be willing to accept network tradeoffs for lower payments

2016 Survey of US Health Care Consumers

Deloitte press release

More health exchange consumers say they feel prepared to handle future costs and able to access affordable care

Exchanges enrollees appear to be satisfied with their coverage and many are going online to shop for coverage

NEW YORK, May 11, 2016—People who obtain health insurance through the public health insurance exchanges continue to act like savvy shoppers. They are showing signs of increased confidence in coverage affordability and are just as satisfied with their coverage as people with employer coverage, according to Deloitte’s “2016 Survey of US Health Care Consumers,” now in its eighth year.

In 2016, the study explores the behavior, decisions, and actions of people who obtained insurance through an exchange. It found that while exchange enrollees are satisfied with their coverage at the same rate as people with employer coverage, they are still less satisfied than those with Medicare and Medicaid. However, compared to last year, more exchange enrollees have confidence in their ability to access affordable care.

“We’re witnessing the continuing evolution of a more consumer-centric model of health care, and the ways in which consumers are navigating the exchanges provide evidence of that,” said Greg Scott, principal, Deloitte Consulting LLP, and vice chairman and national sector leader for the health plans practice.

Health care consumers’ expectations for information and transparency are increasing, as is their interest in intuitive tools to access relevant information. Meeting these expectations should lead to increasingly more confident and satisfied customers in the future.

One reason for increased confidence could be that 70 percent of surveyed exchange consumers say they were able to manage their out-of-pocket expenses in the last year and only one in four say they had higher out-of-pocket costs than they expected after using their coverage. However, some groups report more difficulty than others. For instance, lower-income individuals report more difficulty paying for out-of-pocket costs.

“Out-of-pocket costs have been increasingly top-of-mind for health care consumers as the nature of insurance has changed over the past several years,” said Paul Lambdin, director, Deloitte Consulting LLP, and exchange practice leader for the plans sector. “This cost issue appears to be making exchange consumers pay close attention to the details of their coverage, and changes in benefits and premiums year over year.”

Knowing what costs to expect could also be increasing exchange customers’ confidence. More exchange consumers say they understand the costs of their coverage than people with employer insurance. Moreover, more than half (61 percent) of exchange consumers say they look at the total costs—not just premiums—when they evaluate coverage options. Nearly 40 percent say they look at brand and total costs when evaluating different coverage options.

Additionally, the report found that more exchange customers are willing to accept network tradeoffs for lower payments than in 2015. These tradeoffs include a smaller network of hospitals (27 percent in 2016 as compared to 18 percent in 2015), a network that does not include their current primary care provider (26 percent in 2016 as compared to 16 percent in 2015), and a smaller network of doctors (26 percent as compared to 18 percent in 2015).

The report found that 66 percent of exchange consumers used online tools to compare out-of-pocket costs. Only 58 percent of people with employer coverage who shopped for a policy online and had access to similar tools used them.

“The exchange markets remain very much in flux. Insurers and consumers alike are learning and adjusting, and trying to determine how to get the most value out of the exchanges,” said Scott. “Our findings suggest that exchange consumers continue to shop around for coverage and evaluate costs before making decisions, and appear to be responding to messages about going online to look for health insurance information.”

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Explore findings from previous surveys

Insights from the 2015 Survey of US Health Care Consumers

Public health insurance exchanges (HIX) are beginning to deliver on the promise of transforming the individual insurance market. HIX customers are actively engaging in the buying process, using both “high-tech” and “high-touch” purchasing channels, and putting health plans on notice that they will switch if they are dissatisfied. The exchanges already rank among consumers’ most trusted sources for information, suggesting that they are quickly becoming an accepted way to purchase health insurance.

Through this new buying experience, the exchanges are opening the door for a new generation of actively engaged consumers. Findings from the Deloitte Center for Health Solutions 2015 Survey of US Health Care Consumers suggest that HIX customers differ from those with other sources of insurance coverage. They are more cost-conscious, price-sensitive, and focused on finding a plan that offers good value and fit. By the time they enroll, HIX customers have a better understanding of plan benefits and costs than individuals with coverage through employers, Medicaid, or Medicare. They are inclined to compare plans, providers, and services on price but show interest in quality measures, too. These early signs suggest that HIX enrollees are becoming savvy, informed consumers who are geared to shop around not just for health insurance, but also for health care services and products.

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About the Deloitte Center for Health Solutions

About the Deloitte Center for Health Solutions: The source for health care insights.

Sarah Thomas

Director of Research | Center for Health Solutions

Harry Greenspun, MD

Managing Director | Center for Health Solutions

Bill Copeland

US Life Sciences & Health Care Industry Leader

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