Health Systems Should Model Care Access Around How Consumers Actually Buy Care

Mark E. Lutes and Richard H. Hughes, IV, Members of the Firm in the Health Care & Life Sciences practice, and Jeff Brown, Strategic Advisor at EBG Advisors, co-authored an article in Healthcare Business Today, titled "Health Systems Should Model Care Access Around How Consumers Actually Buy Care."

Following is an excerpt:

Health systems are often described as being “on the brink” of consumerism, as though the challenge were still one of future readiness. Even OpenAI is banking on the consumerization of health, announcing ChatGPT Health earlier this month, which allows users to review medical test results and connect to electronic medical records and wearable devices. 

Change in consumer behavior is being driven less by retail disruption than by the financial architecture of coverage itself. More consumers now encounter health care as a self-directed purchasing decision rather than a plan-mediated benefit, and that change has profound implications for how access should be designed.

High-deductible health plans paired with health savings accounts (HSAs) have become a defining feature of the commercial insurance market. Among higher-income and professionally employed populations, these plans are not viewed as a burden but as a tradeoff: lower premiums in exchange for greater control over how health care dollars are spent. Today, over 50% of private sector workers have access to HSA eligible plans already, and affordability challenges are making them more necessary. 

Government regulation is making these plans more attractive and accessible, with multiple Senate proposals—though not yet law—that would use HSAs as the primary mechanism for federal support tied to the ACA marketplaces. Key provisions within the One Big Beautiful Bill Act expanded HSA eligibility to all bronze and catastrophic plans while making catastrophic plans more broadly accessible to the market.  With affordability challenges reaching a threshold, buy-downs into these low cost, high out-of-pocket plans will accelerate, making them the new standard for Commercial / Employer Sponsored Insurance.