RM: Are employers trying to make it simpler for the employees to make better decisions?

JP: Definitely. Health insurers are focusing on better communications with employees to try to break down what employees are getting for each plan being offered. This is not just the summary of benefits and coverage that employers have to provide but really speaking to the employees in terms that make sense: “This is what you had last year. This is what is different this year.”

Built into the private exchanges you mentioned is a feature where members can have direct contact with benefit advisors who can tell them what they’re getting. Of course, a lot of this is done online, and there are strong efforts focused on figuring out what formats are easiest for people to understand, what kind of information they are looking for, and real-life examples of “if he gets this procedure, it’s going to cost this much.”

RM: That last part especially is important to emergency medicine because we frequently have patients with high-deductible plans. Our ability to take care of them and then get paid can be a challenge, especially if it’s a complicated patient. The other side of the coin is that that high deductible has really generated a large amount of competition for those first dollars in terms of the urgent care clinics and retail clinics. What do you see in that growth of consumerism and the first dollar affecting the growth of new types of businesses in the market?

JP: We’re at an interesting place in the implementation of the Affordable Care Act. There’s this whole new group of low-income people and “young invincibles” who now have access to coverage but still have trouble accessing care. If you’re low income, you can’t always leave work as easily or miss those working hours to go to the physician’s office. As a country, we’re still working through issues of where people are ending up in the access process. It is a learning experience both for the employees and consumers of health care, as well as the providers.

RM: Virtual care and telehealth have been slow in the uptake but are now accelerating. Do you have any insight into that from the business side?

JP: We’ve seen a huge emergence of health information technology, and everybody always assumes that more technology is better in whatever form.

Of course, we hear a lot from the physician side that electronic health records are really slowing them down. It’s causing dissatisfaction in the workplace for physicians. But we’re seeing more innovation in this space to make technology more useful and even tailored to physicians based on specialty.