30 Oct Consumer Engagement in Benefit Design Principles
Incorporating a holistic consumer perspective into health insurance is a key step toward a more value-driven health care system. The Health Care Transformation Task Force has developed a set of six principles to guide payers, purchasers, and providers in their efforts to better integrate consumer needs and preferences into insurance benefit design.
Guiding Principles on Consumer Engagement in Benefit Design
- Payers, providers, and purchasers should utilize modernized ways of obtaining consumer input. They should also oﬀer eﬀective decision-making support tools that help facilitate greater partnership with consumers in navigating the health care ecosystem, including but not limited to obtaining information, coverage, engaging in care, reporting outcomes, and paying for services.
- Payers, providers, and purchasers should collaborate to create high-performance networks that enable people-centered care. Value-driven networks should directly incorporate input from consumers in their design, including focusing on desirable outcomes and consumer experience.
- Organizations should develop multimodal communication strategies that will simultaneously educate and engage beneﬁciaries around payment and care delivery options.
- Value-based arrangements should include explicit accountability for member experience and outcomes.
- An ideal network and beneﬁt structure centers primarily around the needs of the individual, balanced with the needs of the purchaser, payer, and provider. Elements of beneﬁt design should be conceived through the consumer perspective.
- Organizations should operate systems that promote use of people-centered Health IT. Consumer interfaces should prioritize simplicity, clarity, and transparency. Consumers should have on-demand access to meaningful information that helps them understand their health and care, as well as directly supports informed decision-making.