The deductible reset: How to help patients navigate it

The changing of the calendar year is traditionally associated with health-related resolutions, but it has recently become coupled with a new healthcare phenomenon with potential for influencing  the ability to deliver care: the “deductible reset.” At the same time, the deductible reset period may offer providers a new opportunity to strengthen the doctor-patient relationship.

Other than checking for coverage at intake or reception, many physicians do not inquire about how finances may be affecting a patient’s ability to achieve their healthcare goals. Patients may also consider the financial aspects of their healthcare to be outside the realm of the doctor-patient relationship. However, it is reasonable to incorporate some questions to determine whether there are financial barriers to the patient achieving their goals.

The fact is that insurance companies and managed care play a significant role in our ability to deliver care. Third-party payers have, in various ways, off-loaded administrative responsibilities and costs to physicians and patients. High-deductible health plans (HDHPs) are a way of imposing cost-sharing on patients as a way of making them use care more appropriately. Unfortunately for many Americans, it seems that this strategy has a negative effect on care, with more people postponing or delaying both necessary and preventive care, often to their own detriment. In 2018, 25 percent of adults surveyed skipped necessary medical care because they were unable to afford the cost, according to a study by the Federal Reserve.

Couple this with the increasing recognition of the role of social determinants on a patient’s health status, and it may be time to revisit healthcare insurance coverage and the impact of the deductible reset in the context of medical history, which traditionally includes family history, education level, social history, housing situations, diet and nutrition, and stresses. This is not about assessing a patient’s financial health, but about being sensitive to possible financial considerations that could be a barrier to the achievement of the patient’s health goals.

Patients might delay a necessary treatment until the end of the year when they believe their deductible will have been met. However, having minimized their use of services to save money, the end of the year comes without meeting their deductible, pushing the procedure into the next year. Patients may not be forthcoming about the reasons, claiming unavailability or scheduling challenges. 

With all of this in mind, what can-and should-a provider do? As with any other issue that impacts a patient’s treatment plan, the role of the clinician is to determine whether a barrier exists and collaborate with the patient on finding solutions. During the first appointment in any new calendar year, one of the questions to incorporate into a quick assessment of the patient’s health-related goals for the year should include “are there any financial barriers to your achieving any of these goals?”

Armed with this information, there are a variety of solutions to consider sharing with patients.  Whether a patient’s treatment will be a one-time expense or require multiple visits, talk them through the full treatment plan and the ideal timing for scheduling each piece. Digital wallets, e-statements, and text reminders to pay outstanding balances can make bill-paying more convenient for patients without financial barriers but limited time. A patient portal can support integration of these services.

Payment options may also be considered, including payment plans and accepting medical or traditional credit cards. Payment plans can extend accounts receivable and increase the demands on staff. Medical credit cards can offer deferred interest, which saves patients money over traditional credit cards if they’re able to pay off their balances within the promotional period.

Look for companies whose cardholders express a high degree of satisfaction, as the experience will reflect on your practice. Established medical cards can provide additional benefits to patients and providers. Such companies may be more likely to provide resources, tools and training that support integration for your practice; patients may already be cardholders if the card is widely used.

HDHPs are changing the rhythm of how many patients manage their healthcare. When coverage and co-pays were equal year-round, some patients may have overused healthcare services because the actual costs of care did not touch the patient. Now, increased out-of- pocket costs are causing patients to delay care or make other healthcare decisions based on undiscussed financial factors. It’s time we assessed the impact that health plan design may have on our patient’s goals for quality of health and offer them options to manage their deductibles in ways that can ensure they attain their health goals.

Dr. Merahn is a veteran physician-executive with experience in clinical operations and patient care, hospital administration, and managed care, most recently as chief medical officer for a national behavioral health network. He also provides consulting services to the healthcare industry, including CareCredit. The opinions presented here are solely those of Dr. Merahn.