washington to michelle obama. sundays at 8:00 p.m. eastern on american history tv on c-span3. >> next, a discussion of various health insurance plans and how they are affected by the health care law. then experts talk about the religious basis for islamic extremist and whether islam plays a role in in citing terrorism. >> after that, agriculture secretary tom vilsack at a house hearing on the epa's new clean water rule and what it means for the agriculture industry. >> now the alliance for health reform hosted a discussion on the various health insurance plans available to consumers and the changes in those plans due

to the health care law. this is just over an hour and a half. >> good afternoon. my name is ed howard. i'm with the alliance for health reform. and i want to welcome you on behalf of senator blount, carden, our board of directors to this program today on how best to empower consumers as they make more and harder health care coverage and care decisions. i suspect that you've heard the point even in these briefings made repeatedly that consumers are being asked to do a lot more, to take a lot more active role in selecting their insurance plans and their providers and evaluating their care options.

well, today we're going to look at how well consumers are prepared to make those decisions, how literate are they for example, when it comes to things like deductibles and co-pays. what information do they have available. how hard is it to get that information? and can these empowered consumers, if we can empower them drive the system toward lower costs and higher quality. those are the other two of the triple name. we're pleased to have two partners in today's program. anthem, which among other parts of its business operates blue cross plans providing coverage to more than 38 million americans. and the national consumers league which is america's oldest consumer organization.

their mission is to protect and promote social and economic justice for consumers and workers. i should mention that with these same partners, anthem and the league, we'll be exploring in september a related topic that is the kinds of tools available to us when we become actual consumers of care, otherwise known as patients, and we think it will be a valuable book end to the kind of discussion we hope to have today. a couple of logistical check-offs before we get going with the substance. you'll see that the wifi credentials are on the screen. they are on the table in front of you in case you want to get on to the internet. and one of the things you might do if you need that is to tweet comments and questions about the conversation. the hashtag #consumerhealth is

the key to doing that. now in your packets you'll find a lot of information, including speaker biographies, more extensive than i'm going to have time to give our folks. there's a one page materials list that you'll find useful, i believe, along with the power point presentations that the speakers are going to use. you can find all of that also at our website, allhealth.org. there's going to be a video recording of this briefing available as early as monday followed by a transcript a couple of days later. also on allhealth.org. at the appropriate time, i have two colors for you to remember. green question cards where you can use your pencil or pen to put a question on them and have them brought forward, and we'll try to get to as many of them as

we can. and the blue evaluation form, which we hope you will take the time to fill out before you leave because we want to get your feedback, particularly those of you on congressional staffs because we want to be responsive to the kinds of information, the kinds of speakers and topics that you think are important in trying to get through your job. let's get to our job which is to present you with this program. we have a terrific lineup of panelists today. and we're going to go through those presentations and then open it up for questions, both among the panelists and from the moderator and you will have a chance to ask your questions as well. i'm going to start with rebecca berkholder, the vice president for health policy at the national consumers league. rebecca we've asked to give us a sense of some of the challenges

posed for consumers today in selecting a health plan in other aspects of the engagement process and what consumers think is important in making those health care decisions. rebecca, thanks for being with us and trying to put this program together. >> thanks, ed, for that introduction. the national consumers league is really pleased to be here today and working in partnership with anthem and the alliance as we bring you this series of briefings focused on the consumer. so today, as i was saying, we are going to be talking about empowering and engaging the consumer, especially as they make choices about their health care coverage. the health care system today can often seem overwhelming and confusing for consumers. and when it comes to selecting coverage, as this slide shows, consumers need to be doing a lot. they need to make sense of drug

formularies, sort through co-pays and calculate out-of-pocket costs, summary of benefits and ensure they have the convenience of their providers being in network. this isn't even get to deciding on their treatments in care. we'll be talking about these issues today, as well as in the next briefing in this series in september which will focus more on tools for consumers as they choose their health care treatments. first let's look at the context in which consumers are making these choices. where are consumers getting their coverage in today's health insurance market? as you can see in this chart in 2014, over half received insurance from their employer. 19% from medicaid. 4% individual or off the marketplace. 3% medicare. 2% military. 2% from the marketplace or exchanges.

in 2014, 12% uninsured. so what are the choices that's consumers have in the health insurance marketplace under the affordable care act? you can see from these slides the number of issuers or those companies or entities providing insurance has grown. there are 25% more issuers participating in 2015 compared to 2014. and in 2015, consumers can choose from an average of over 40 health plans up from 30 in 2014. this really offers new opportunities for consumers to comparison shop and select the plan that best meets their needs. i want to talk about the environment for decision making in health care for consumers. in recent years, there's been some trends that have really impacted this environment for consumers. so first, this huge growth in use and availability of health care information. much of this is by the internet. so our access to 24-hour a day

constantly evolving information and misinformation about our health care options is overwhelming and can sometimes be -- both present opportunities to improve our health care but can also be hazardous as well. according to a recent pew survey, 35% of u.s. adults say they have used the internet to try to figure out what medical condition they or another person may have. what we call online diagnosis. two, there's a desire by consumers to be more in control of their health care. patient engagement has been termed the new blockbuster drug of the century. patients engaged in their health care have better health outcomes and lower costs as well. this consumer involvement in more active health care decision making goes to the case of how important it is to make sure they have the tools and information they need.

third, a shift of costs to consumers, to individuals in their health care costs. and, therefore, more consumer responsibility for informed choice. regarding their health benefits. this is certainly true for high deductible plans or consumer driven health plans that allow consumers to design their own benefits more. really being careful about how they spend those health care dollars. fourth this increase in advertising noise. the average consumer in the united states is exposed to thousands of ads each day. ads about over the counter drugs, prescription medications and consequence of too much advertising is really this clutter, and it becomes harder to attract consumer attention, to hold their attention, and consumers also put up defense mechanisms in that we justice tune people out. tune information out. and fifth, another trend is this

declining level of trust in institutions. including insurance companies and health care organizations which explains the skepticism consumers have when they get messages or information from certain entities. it emphasizes them portent of developing reliable and unbiased sources of information. we know from studies that faced with too many choices, people tend to set their expectations really high and put a lot of responsibility on themselves to make sure they are making the right choice. generally, what are consumers seeking when choosing a health plan? first of all, value. they want the most coverage for premium they can afford. they want to make sure the plan covers the care their family needs, including their medications, talking into consideration their financial circumstances.

they want quality information. they want information on the health plan and consumer enrollee satisfaction, including what consumers report about experiences with the doctors and health care providers in the network and customer service. consumers are also interested in quality information. specifically reporting that the physician level. someone with diabetes, did the doctor perform proper screening. consumers want to know what their own out-of-pocket expenses will actually be. consumers want cost estimates for a complete surgical procedure and don't want to be surprised for added on costs later for an anesthesiologist. let's take a look at the challenges consumers face when picking health coverage, especially literacy and transparency. this slide has information from the 2006 study.

engaging patients in their own health care and health care decision really relies on health literacy. that's patients ability to obtain, process and communicate and understand basic health information and services. so only 12%, about 1 out of 10 u.s. adults have proficient health literacy according to this survey. they are able to use a table that would calculate their cost for insurance during a calendar year. over one-third of u.s. adults 77 million people, as you can see from the pie chart are in the below basic or basic group and would have trouble figuring out some common health care tasks such as prescription drug label or immunization schedule. also, adults over 65 had health literacy. it affects adults of all racial and ethnic groups. compared to privately insured, both publicly and uninsured adults had lower health literacy skills and adults living below

the poverty line had poor health literacy. it can be more problematic for those entering the insurance market for the first time or have not had insurance for a while. that's the case for many enrolling in the affordable care act. 37% of enrollees did not know the amount of their deductible. and their deductible will be really important to their budget. in some cases more important than the premium they'll pay. if people don't understand their deductible and pick a plan based soley on the premium they'll be in for a surprise when they start getting health care services and their deductible hits. many enrollees don't grasp some basic health insurance terms. many, 60%, were not confident in some of the basic terms listed on the slide. this lack of confidence can have

an impact if people don't understand what it means to pick a provider out of network. they can face some higher out-of-pocket fees. and people with lower incomes were less likely to understand key elements of insurance. people who need coverage the most may understand it the least. and then secondly, another challenge is health care transparency which joel will be talking about more, too. we want to make sure consumers have information up front about the health plans they choose. when i pick a major house appliance like a dishwasher, i can access ratings. let's make sure consumers have that for health care coverage as well. we know consumers have the ability to browse anonymously on the marketplace plans. drug formularies. we want to make sure there's clear information on what drugs are covered, especially those with chronic conditions. we also want to make sure

consumers have reliable information on the providers in their health plans and that there's a direct link to that directory and that directory is up to date. and lastly, consumers need access to prices on common medical procedures as well. what does it come down to for consumers? in some case we can boil it down do three questions. what does the plan cover? is the plan going to meet my health needs and the health needs of my family? how much does it cost? need to consider the monthly premium and out-of-pocket costs. is my doctor in my plan? is the hospital down the street in my plan? consumers want that for convenience. i'm going to turn it over to my other panelists. hopefully i've set the context for some of these issues consumers are facing. thank you. >> terrific. thanks, rebecca. if you are watching on c-span, for those of you in the room, they are not watching live on c-span, but it will be on the

broadcast schedule later, and on the website. if you are watching on c-span, you can find all of these slide presentations, all of the background materials on the alliance website at allhealth.org. trying to make use of that if you would like to. now we're going to turn to natalie schneider, the vice president for consumer experience at anthem. and we've asked her to describe ways anthem and other insurance companies are trying to respond to the consumer needs rebecca was trying to sketch for us. natalie, thanks so much for coming. >> thanks. as rebecca alluded to, consumers are moving pretty swiftly into the health care ecosystem. and they are the ones driving the changes we're seeing today, and it's not an incremental change.

this is an industry-defining pivot that's taking place. it's quite frankly causing them to issue this collective omg because rumor has it health insurance has not been particularly user friendly in the past. but there is a sense -- certainly across the sector, that things are different. that we're doing business differently. and we're not taking the position that we're large enough to sway the market. we are really, really listening and paying attention to what our consumers want. and in order to understand sort of what's driving this level of urgency and determination that i would say is rather unprecedented, we need to take a look at sort of the narrative and how that is unfolding across the health ecosystem. and the first thing is, increasingly, more consumers are picking and comparing plans that didn't exist before to the tune much 87 million customers by 2018. that will be the size of the

retail market. that's the lion's share of growth. for many national plans. secondly, we're moving more towards narrow networks and high deductible health plans which means in the past where the phonebook was really the provider network, now you are actively needing to engage if your doctor is in network and actively compare prices. and thirdly, affordability continues to remain a persistent challenge. $22,000 for the average family of four. that's the price of in-state college tuition or a new vehicle. so they've got more skin in the game. and then we're seeing this tsunami of health care innovations. it is empowering the consumer to take more control of their health by providing better insights into their own

pathology. and when we engage with uber, amazon, all these companies with 24-7 service, through channel of your source, and really great personalization. all of this is occurring. also know that insurance companies today sort of don't meet a lot of these expectations. if you look at our starting point for those of you that are optimists, unfortunately not third best in terms of scores, third above cable companies. we know what our strong point is. this is unsustainable in a consumer choice market. as i mentioned before, we're really beginning to make changes. if you think about how health plans are responding and how they've dealt with this problem historically.

it's been this find and fix approach. we've come upon this inflection point where we need to go faster and farther and break away from this traditional mode of doing business. the way in which you create distinctive, seamless consumer experiences, the type you see in hospitality or retail is through the application of hundreds of decisions carefully orchestrated through the application of sort of the six disciplines, cost strategy, consumer design, measurement, culture. we went out and listened to consumers and we really, really listened to 10,000 americans through focus groups and interviews to try to find out what makes them smile. what really ticks them off when it comes to health insurance. and that allowed us to coalesce around, what are the things that matter the most?

and we're measuring this through customer satisfaction and through member effort. we're holding ourselves and our executives accountable. and we also discovered that what consumers want the most, and you'll see some symmetry in the remarks between rebecca and i is confidence, clarity and ease. they want confidence that they'll be covered when something bad happens. they want clarity in that they need to know what they bought and what it will cost them. and today, quite frankly, that is not the case. they want ease. and by ease they mean minimal interaction with their health plan. in fact, they don't want a relationship with the health plan that works somewhat like a utility. it should work seamlessly in the

background without much mind share or sort of administrative overhead. except when an issue arises. and then they need high levels of engagement, high levels of personalization and competent responses. and why these can't be reduced to broad generalizations, the interesting thing is they are more similar across statements, across medicare, medicaid, group and individual than there are different. this is a very satisfying answer. you are solving for the same things. when we interrogated the data, not everything matters. in fact, you get to diminishing returns pretty quickly. there were seven critical moments that mattered the most to our customers. when you're selecting a plan, by and large, consumers want the decision about a health plan to be over and done with. equivalent to filing your taxes, getting a middle seat on the airplane, getting a tooth extraction.

they want to be separated from the gravity and responsibility of making a choice. today there are complex variables. it takes too long. it's really frustrating and it's a high anxiety event. making plan selection highly intuitive and easy is one of our plans in the next few years. once they've selected a plan, they want to feel value, feel secure and they want to know what they bought. today it's frustrating. you sort of are inundated with all this paperwork that's really complex, really frustrating. and, let's be honest, how many of us have opened up a letter from our health plan and responded, wow, that was incredibly helpful and very, very easy. i'm glad i read that. for the most part it's really, really complex. as rebecca said, even the terminology that's being used. we're taking as an example the 40 most confusing terms.

and we are recoding our digital and print efforts just to make it simple for people to understand. they don't know what a provider is, by the way. so they're streamlining the process. in terms of what's it going to cost me, costs are often unpredictable and unmanageable. the most frustrating part is dealing with cost. 70% of them are demanding hospital prices to be posted online. so as it should be transparency cost and quality, which joe will expand on, is going to become one of the most critical consumer capabilities to empower them as we move to the narrow networks and high deductible health plans. when they are faced with a medical decision they've got a chronic condition and need help staying well. they want to deal with someone that has empathy, but the nuance

is they don't want a health plan to intersect that relationship with their provider. this is an area we're treading carefully. how do we diminish the hassle factor for providers and consumers in a way that we're not trying to own that relationship but trying to facilitate. and when they need urgent care or unplanned needs. it always happened at 3:00 in the morning. this is that moment when anxiety skyrockets because they aren't using their typical pcp, and we're using our innovation lab in atlanta. this is an area a lot of people are focused on. how do we help them quickly understand what's covered and what's not? what is the most appropriate side of care that can't always default to e.r. and they need help navigating to a specific side of care.

and we're also focused to make sure a provider directory is correct so we're not having instances of people going to providers that are out of network. when you pick up your prescription, this isn't necessarily high executive, but when you think of medicare, we're trying to figure out something that happens so frequently, how do we streamline it and make it less hassle. and for any of you in the room that have experienced claim denial, highly abrasive event. we're trying to figure out what interactions can we have with the consumer to prevent that from happening or if it does need to occur, how can we be as empathetic as possible. so we believe as health plans become more systematic and professional about the approach, they'll be able to break away from this competitive convergence that exists today and anthem in particular, we think the only way, given the complexities of modern health

care to treat 37 million medicare and medicaid individual and group customers is to deliver exceptionally well in an anticipatory manner with elegance. >> thanks, natalie. let me grab the clicker here. if i can, let me just take you back to the five reasons slide, if you would. there's six. and there's -- five. the very first one, the 87 million people you described as being likely to be in consumer choice segments. is that basically high deductible plans and consumer directed plans that constitute that population?

>> that is primarily made up of private/public exchanges but also medicaid. what we're talking about here is in the past is employers really made those decisions on behalf of a lot of consumers. it's all instances in which the consumers are actively reviewing and selecting their plan choices. and you think about how the membership calculus changes in that situation. when 60% of the employees are satisfied, 100% will renew because the employee is making the decision. in the case of the retail market, if two-thirds are satisfied, two-thirds will renew and the rest will buy from somebody else, which is why this has got the attention of health plans. >> thank you for the clarification. next we're going to turn to

joanne volt, a senior research fellow for health insurance reforms. we've asked joanne to relate some of the policy issues raised by the challenges that natalie and rebecca have been talking about that face consumers as they choose a health insurance plan. nice to have you back. >> good to be here. i'm going to talk about those policy options that come out of the affordable care act. first a tool available to everyone with private insurance and secondly some tools that are available in the marketplace for plans chosen from that. i'm going to start with a quiz, though. by show of hands, how many have seen a form like this? that's encouraging. this is the federal employee health benefit plan summary of benefits and coverage for one of the options for federal

employees. i'm going to be talking a bit about this form. this is the first page of an eight-page standard form. the summary of benefits and coverage which i'll call sbc, applies to all private insurance plans. so whether you are buying as an individual in the marketplace or on your own or through your employer, you will have a summary of benefits and coverage available to you. the goal of creating this under the affordable care act was so consumers could make apples to apples comparisons of health care options when shopping. certainly, we have a history of health plans providing summaries of their benefits, and some were quite good but they varied depending on the carrier and what they chose to cover and how they conveyed it. if you wanted to do an apples to apples comparison, you would have to decipher a number of different forms until the sbc came along.

you can look across the plans and see your deductible and maximum out of pocket and other things that are important to you. it must be provided upon application of coverage once you enroll. when the benefits or cost change enough that it would prompt a change in the content of the sbc and upon request. one shortcoming of this is that third one when the benefits change enough to change the content of the sbc. there are a lot of ways your plans may change over the course of the year when you're locked in that wouldn't necessarily change the content of the sbc and you wouldn't necessarily get a heads-up that something's changed. the first page as you might have remembered seeing that's example is top line information that's probably most useful when

choosing a plan, what the deductible is, what the maximum out of pocket limit is. whether you need a referral to see a specialist which may be important to know they can get to their dermatologist or podiatrist without having to make a stop at their primary care doc. on page two are common medical events. that will tell you what your cost sharing will be for various things you might pursue. a hospitalization, doc visit, lab tests. it will tell you about your provider network, what's your costs will be depending on the tier and cost for drugs depending on the formulary tier. also coverage examples at the back which there are two now. one is for having a baby and the other is for a person with diabetes. these are only intended to be illustrative. they will vary depending on the specific services they use. it's supposed to be a high level way to compare plans and say if you are a person with diabetes

to know what your cost may be under one plan versus another. it must also include a statement on minimum value and minimal essential coverage. these are two important aca created terms. minimum value is the minimum value all plans have to meet and we'll tell you whether your employer plan meets it. the other is minimal essential coverage which is the term applied to coverage you must have to meet the individual mandate. and finally, i wanted to share there are changes currently being discussed for the template that would take effect in 2017. the feds viewed a proposed change to the template and the national association of insurance commissioners is debating what some of those changes may be. to make recommendations to the feds. and i'll talk more about some of the changes they are considering there.

i will say, for example, we've learned in some of our technical assistance work with navigators in some states, helping consumers enroll that the deductible was a really tough idea to get their arms around. what services they might get prior to the deductible, how the deductible was applied. has anyone ever heard of an aggregate versus non-aggregate deductible? you have? okay. so it matters. it tells you how you pool your expenses toward your deductible if you are in a family or individual policy. that may be important if you have one high cost individual. they are also looking at changes to better defined preventive services. this is one area -- this is a hugely popular benefit. this is the idea for recommended

preventive services you should be able to get them free of charge. we learned in our discussions, i'm a consumer rep there and have been participating in the discussions. helping consumers know what services they may get cost free is nearly impossible. whether or not you got charged an office visit co-pay in conjunction with that preventive service. whether your plan has to cover that. we found it was very difficult. this highlights some of the difficulties trying to capture accurate and complete information. i'm going to move to the marketplace and some of the tools available there. first, consumer assistance. every exchange must operate a navigator system.

in state-based market places or federal partnership market places, there were additional resources to provide additional consumer assistance in in-person assisters. so we saw more consumer assistance funding in non-ffm states. and they outspent the ffms. some consumers will not bible to get there on their own. we did a report providing technical assistance. for the families that qualify for financial help they can be complex lives and they're trying to fit within complex rules about availability of other coverage, whether it's medicaid or employer coverage. they may have shared households with a grandchild living in the house, fluctuating wages because thaw have three jobs that pay hourly wages and they cut back their hours during certain times of the year.

we found for some consumers they need this in-person assistance to understand what they are eligible for. certainly the literacy challenges came up from the exchange shoppers. but so the navigators had to work with that. also post-enrollment questions. they'd come back and say now how do i use these benefits? there are funding constraints. a little more money for the ffms but they're going to try to leverage other resources, including brokers and online tools to help more consumers get there without the in-person assistance. >> just to clarify. ffm -- >> sorry. >> it applies to? >> the federally facilitated market places. >> as opposed to -- >> state-based and the shared, the partnership states run some of the functions themselves. quickly on some of the policy tools available in the

marketplace, a number of things coming online that will make it easier for consumers. a new rule all those sbcs that get cost-sharing reductions must reflect what their cost sharing will be. if you are in a marketplace plan and have income under 250% of poverty you'd qualify for an enhanced plan that fills in some of your cost sharing. better than plat enemy for some. almost platinum for others and better than silver for some. it's not a requirement your sbc had to show you what that cost would be which made it complicated. they are going to roll out for this next open enrollment an out-of-pocket cost calculator for consumers. similar if you look at the materials about the discussion of the fehbp tools and help you estimate your cost going forward. not just the premium but deductible and what it might look like with your office visits as well.

there are going to be improvements to the provider directory and formulary. we saw experiences where consumers saw if their provider of choice was covered by a plan online to find out the directory was out of date or inaccurate. they're going to have to also include information imp portent for consumers like whether the doctor is taking new patients, their medical group they might be part of as well as contact information. the drug formulary must also be easily accessible from the website. be updated with each change. if there's a change in the formulary that one drug is no longer covered and shouldn't take effect until consumers can see it in the updated formulary online. it must be valuable in machine readable format to help outside vendors form it into other tools to help search for a particular provider, for example.

i want to touch on one function of the marketplaces. in certifying marketplace plans to be qualified health plans for carriers to participate in the market place, there's one function, the certification includes the exchange act in the interests of consumers. it is this catch-all meaning they can do things beyond the minimums beyond the requirement of the law to make it easier for consumers. georgetown did a report. it looked at some of the tools that state-based -- requirements placed on plans to further standardize benefits. you could look at a set of plans and know they met certain rules for cost sharing. you heard about that from the california exchange. it's this notion of a consumer might know they get three doctor visits before meeting the deductible and further refining the plans so it's easier to compare. and that's it.

>> okay. thanks very much, joanne. by the way, we heard a lot about literacy and the challenges to it. i want to call your attention to one of the pieces in your materials. it's department of labor produced glossary which is about as simply put and clearly written as anything i've seen on this. >> that's a companion piece to summary of benefits and coverage, required to be made available. within the sbc a bunch of terms underlined or bold which means you can find it in the glossary to know what they mean. >> terrific, thank you. finally we're going to hear from joe white who is the president of the council for affordable health coverage and its clear choices campaign. some of you remember joel, i'm sure, from his two decades of service on the health, including

six years on the staff of the house ways and means committee. joel today is going to talk about cost and quality transparency, including ways to help consumers and employers make more informed health care choices. thanks for joining us. >> thanks, ed. thanks for making me feel a little old today. didn't think it had been that long. but thank you to the alliance for putting on this briefing. it's critical at this point in health care that we have this dialogue around health care transparency and the information presented to consumers as they make choices about their health plans and providers and prescription drugs. so i'm going to talk about what's going on in the marketplace right now and get into a few policy options to talk about presenting that better information. so just real quick, clear

choices is a multistakeholder advocacy and that's why i'm talking about some of the policy options. these are some of our members. but why do we need transparency and better information in health care right now? i think unless you've been living under a rock, health care costs are increasing. sorry for the news flash. we're estimated to spend $40 trillion over the next decade alone. and the total cost a family is spending is increasing and at an alarming rate, we think. 18% of total family income was spent on health care in 2002. today that's about 35%. by 2030 it's going to be 60% of the typical family's income. what we're seeing on the ground right now in terms of the marketplaces is next year we're looking at an average premium across 45 states of about 12%. that's on top of a 5.4% increase in 2015.

so the costs are starting to stack on the premium side. why is that important? we know that people in 2014 and 2015 made a lot of plan choice decisions based on the price. the price was the premium. they weren't generally looking at the cost sharing. the important thing that we're seeing on the affordable care act exchanges is the cost sharing is much more than we see in the employer market. what we're seeing is higher plan cost sharing deductibles. this year the typical silver plan, which is where most consumers are signing up for an individual deductible of about 2900 bucks for a family about 5800 bucks. that compares to about $1400 on a typical employer plan. there is significant variation in both cost and quality of

coverage for providers that are included on those plans. and so the confusion that a lot of consumers make is as they shop for a lower priced plan they aren't necessarily looking at, is in provider included in the directory. is the network a high quality, high value network. and the other mistake we see in the research is they equate more expensive coverage with higher quality on the provider side. so absent good quality information on providers, people can be choosing higher cost, lower quality providers. and because this -- these costs are increasingly being shifted on to consumers, they are running this risk of choosing this lower value health coverage. so just very quickly, some of the things we're seeing in the marketplace, consumers have more

information on televisions than they do on their doctors. if you have ever been to a retail setting where you are looking at the price of the tv and whipped out your smartphone and gone on to amazon to compare the price. that's a real experience with televisions. next time you're in your doctor's office, ask him for his e-mail. you're more likely to get information on your television than you are to get your doctor's e-mail is the point. prices within local markets vary significantly. we see this from new york all the way to san diego and sacramento to washington, d.c. it is about a 700% difference in some local markets. what we see on the healthcare.gov website is that a lot of times the consumer experience is that it's not user

friendly. it's very difficult to compare and select a health plan off healthcare.gov. as was mentioned, there are some basic rudimentary tools available on the state-based exchanges and federal exchanges based on whether a particular drug is on a formulary, at one tier and even to compare the common name versus the scientific name. finally, i think what we see in the marketplace is a lot of the data just isn't available to people. this is leading to a lack of tools increasing health care costs. donald berwick has said this increases costs between $84 billion to $174 billion every year. and while $90 billion is a pretty big range, that's still a lot of money even here in washington, d.c. so in terms of the goals, what

we have been able to divide through our stakeholder groups is there are three core issues that i think we need to satisfy to make an effective system for consumer choices. the first is we need better data. basically, to measure the right ings, and we need to understand what consumers value in order to empower them in making choices. they can only make choices through better tools. so these are improved health plan websites and improved out-of-pocket cost calculators. better tools lead to better data and better tools lead to better markets. if we see a better operating markets, we think people will have additional choices that will help address some of the cost issues we're seeing. so if i can drill down into some of those issues there, the first on the better and more data is that what we're seeing through hhs is really a lot of data dumping. it's being dumped out there

without a lot of context. and so people get confused just by the data cms is releasing. for example, earlier this year was a release of physician claims data. the thought being i would get online and search my provider online and search my provider and see how many claims he was responsible for, the cost of that provider. the media picked up on this, and a lot of it was gotcha journalism. so my provider is the most costly provider because they prescribed the most costly drugs, for example. that's not necessarily helpful to a consumer. i could turn that around and say, my provider does the most hip replacements, and therefore, is an expert at doing hip replacements. so we need to put this data into context. the second thing that we know consumers really value is this cost quality equation. in other words the value equation.

right now, we don't have very good measures of quality. so the information that could be presented on some of these health plan comparison websites just simply haven't available. we're just measuring the wrong things and things that consumers don't find necessarily helpful. most of the measures used are measures of underused, did i perform the mammography on the preventive screen, did i do some of those preventive measures. did i prescribe an antibiotic for example for a viral infection. some of those types of quality measures are absolutely critical to consumers, because they get at the core competency of the provider. and then finally we know big data is kind of a catchism. but more data we have in the system, the better, more granular insights we can make. right now, congress passed an sgr law earlier this year. hhs is going to find it very difficult to double the amount

of claims data in the system because medicaid and shift data is not standardized at the state level. we need to standardize that data and put it to use at the federal level so consumers can use it to make better choices. switching over to better tools, one of the things that we think is absolutely critical, and we took a look across the cms plan comparison websites, and we also looked at health care.gov and the state-based exchanges. and we're going to be releasing a paper on best practices for planned comparisons this fall. which will include a number of consumer focus groups. and what consumers actually value in making planned selections. i think what we found was a little disturbing. a lot of the websites don't present accurate information. and they don't present it in plain english. it's very hard to select a plan on a website where you're trying

to make an honest comparison if the information itself simply isn't accurate. and if there are loaded terms, jargon-based terms that are being used, we've heard some people today that some people don't even understand deductibles. we have to get better at explaining these terms in plain english. the research we've done, there are three primary things i think consumers value. the first is the searchable integrated provider directory and formulary. it's absolutely critical to know whether or not your provider's in that network or not in that network. it's absolutely critical to know if your drug is covered by the formulary, on what tier and know that information based on the plain english name, not the scientific name. why is that important? well, if your provider is not in the plan and you have to go out of network, that adds to your

cost sharing. and not only that, it doesn't count against your annual limit. the second thing there has to be a smart comparative display. i need to be able to match up my anthem plan with my aetna plan with my blue shield of california plan, to make an apples to apples comparison across the deductibles, premiums and covered benefits as well as the providers and formularies. we're not seeing on some of the exchange websites certainly and on health care.gov is the good smart comparative tools that empower the consumers. and finally, something that came under a lot of criticism, but that consumers really value, and makes a heck of a lot of sense is we need to allow people to window shop. we need to allow them to compare those plans before they have to actually log in, get a user name, or sign up for a plan and

commit financially. doing those three things we think, would vastly improve the consumer experience in the marketplace. would also vastly improve and continue to bring down the number of uninsured. and be a better match for plans and a better match for consumers that we think will ultimately lower health care costs. and thank you, ed for having me. >> thanks very much, joel. we'll now get a chance to get into an interchange. we have microphones that you can use to go to and ask questions in your very own voice. or you can pull out that green card, write something on it and hold it up. and somebody will bring it forward. and i want to get us started here actually with what joel was talking about, in the way of the steps that could be taken if the

regulators and the people who run the marketplaces were to be able to do them or were required to do them. and i wonder whether the private sector is doing in its segment where it is controlling in dealing with employers or if private exchanges, are they moving in this direction any faster than the government seems to be doing joel? >> the simple answer is yes. we're seeing a lot of innovation at the plan level. what we saw in '14 and '15 was a lot of competition on the price. i think a lot of plans, and now you can probably speak to this better than i can, a lot of what they're seeing now is they need to have the customer service component where they are tracking people and sailing, we've got to get a better fit here. it's not just the consumer who's harmed -- not harmed, but not just the consumer who if they

sign up for the wrong plan, the provider is not in the network or their drug's not on the formulary, that doesn't just impact the consumer but it affects the plan as well. the plan has to deal with the appeals process and not having a good fit for that individual. and so having this information i think better matches up consumers to the right plan. and what we're seeing is some acceleration of the innovation around the plan tools available in the marketplace, but not yet on the exchanges. >> do you want to comment on that? or natalie? or both? >> no, i would agree. and to everyone's benefit that the consumer is able to pick the plan that best fits their need. i think the challenge and natalie you can talk about this some more is how do you do that. so that's all consumers can really have that information, and match it up accordingly.

and without really being able to predict the future, too we've been talking here about how consumers choose their health coverage, but we need to remember, that's just one small step in their health care experience. as you said, they want to pick their health insurance and be done with it. but how do we make that experience the most productive that it can be. >> we've found that by and large, consumers have an idea of what they've purchased. we have verbatims from the focus groups and interviews. there have been some instances, people use the eveny meany miny mo, because there's a $2 difference in sort of the -- the different products. affordability is a big thing. a lot of people are buying on price. without fully comprehending what the indications are, with respect to co-pays deductibles and all those types of things. that remains the most significant challenge to

overcome. >> your question about whether employers are doing of the one of your members of the specific business groups on health, they have a tool that allows consumers to estimate their out-of-pocket costs. for the federal employees, and like the one contemplated by the feds, still requires consumers to sort of equate themselves as a low medium or high health care utilizer. it's a very rough estimate. it's difficult to predict the future. like if you want to get pregnant later in the year if it turns out to be a complicated pregnancy, it will cost more than you anticipated. even if you're a person with a chronic condition like diabetes, what doctors you'll need or what drugs you need to take on a regular basis you don't know what else is coming down the pike. the tools are useful as a way to ballpark things and help consumers shop and compare, but it's still a rough estimate because health care by its nature is sort of an unknown in

the years ahead. >> joel spoke about this. just the huge variation in price with no discernible difference in quality. while there is a lot of unpredictability in the cost there are certain instances where we can all easily come very far along in terms of helping people make costs, and sort of partake in the economics of smart decision-making. >> one more thing. that's just about the whole issue when we talk about the tools for consumers of choice architecture design. so it's really how we present this information to consumers. and there's been some studies that consumers will go with the default. we really have to think about how we're presenting the cost information, if it's just based on premiums. careful thought needs to be put into that. >> thank you. we have a lot of folks lined up.