Consumers, as health plan subscribers and patients, should be the ultimate beneficiaries of the value delivered by the system. Too often, however, consumers have been uninformed and passive rather than active participants in their health and their health care. The potential of consumers as catalysts for change in the system has been well recognized, with whole books written about consumer-driven health care. But despite the fact that consumers have become more informed and have more choices, the system has not been transformed.
The notion of consumer-driven health care oversimplifies the problem. Consumers will never be medical experts, nor should they be expected to be. Consumers should not be forced to play roles abdicated by health plans. Consumers should not have to manage and coordinate their own care across a fractured care cycle. Also, no matter how informed and value sensitive consumers try to be, they will be unable to meaningfully affect their care unless results information is available and providers have to compete at the medical condition level.
Redefining Health Care describes the roles that consumers should play in a value-based system, and the expectations they should set for health plans and providers:
Participate actively in managing personal health
Expect relevant information and seek advice
Make treatment and provider choices based on excellent results and personal values, not convenience or amenities
Choose a health plan based on value added
Build a long-term relationship with an excellent health plan