Health Care Reform – Now What?
What we believe is missing are dynamic support tools for employees and their families to help them in their health care consumption. You can keep raising deductibles and out of pocket costs, but eventually your workforce will get so financially stressed out that it will start to affect their performance. We call that “presenteeism.” They are at work but just not as engaged as you would like them to be.
The tools we advocate take as much work out of it as possible. I recently spoke with a friend who needed a colonoscopy. He wanted to know how much it would cost since he had a $5,000 deductible. I described the type of information we would need to collect in order to determine his share of the cost. At the end of my description, he said, “Man, that sounds like a lot of work!” And even though my friend was asking about a relatively simple procedure, he quickly learned that the charges for it vary widely depending upon where you go and who does it. Yet, just a week earlier he had purchased a $2,000 plasma TV that he says he researched for 3 weeks before he made a decision. He said he saved around $300 by doing his research. So I said to him, “ Let me understand this. You were willing to spend 3 weeks to save $300 but you aren’t willing to spend 15 minutes to save maybe $3,000?” He asked how I came up with the $3,000. Well, in Tampa Bay, depending upon where you go and who does the colonoscopy, the prices range from $1200 to $4200 even inside the preferred network of providers that most employers offer. The trouble is, people don’t have this information so that can’t make good decisions. If an employer has its employees and their dependents running around accessing care without any guidance whatsoever, mistakes are going to be made. People end up going to high cost providers over and over. Will employees and their families take the time to research 50 or 60 possible provider options and the pricing for each? We don’t think so. They need someone to take the drudgery out of the process. If employers make it easy for employees to get this information (and provide incentives for them to do it) then all of a sudden we start moving to an “informed consumer” environment and that’s the direction we want to move in.
Question: I can see why you would want to have your client’s employees going to the lowest cost providers because that would mean the plan would pay less, but what about quality? Shouldn’t that be part of all of this?
Absolutely. In fact, we tell clients all the time that they should never advocate price over quality. The sad fact is that America is ranked around 36th or 37th in the world when it comes to medical outcomes. That should tell us right there that we don’t live in a perfect country where all the surgeons are equally skilled, facilities are equally competent or that outcomes are anywhere near consistent. Some hospitals are 100% committed to getting and keeping their employees highly trained. Unfortunately, we do have some facilities that experience financial problems from time to time and training budgets get downsized along with everything else. If I were to share with you the outcome differences among hospital facilities in the state of Florida for the same procedures, you would question whether the ones performing at the bottom should even have a license to do that procedure. It’s really quite scary. The mortality rates of some facilities for some procedures is abysmal when compared to others. So, it doesn’t do any good for us to send folks to low priced providers if we can’t reasonably expect them to have a good outcome and get back to work. We say employers should help their employees with these decisions. Put the right resources in place so that it becomes a simple task for the employee or family member to quickly obtain this information and make an informed decision. It takes a lot of research to gather all this data. Experts need to interpret it. On an ongoing basis, provider pricing has to be kept up to date. Outcome statistics change over time. People need to see the medical scorecards of potential providers to make these decisions. And, if we can locate a provider or providers with the very best outcome statistics for a given procedure and they happen to be charging the lowest (or one of the lowest) charges, then everybody wins. In fact, we find that in the vast majority of cases, the providers producing the best outcomes indeed charge in the lower cost ranges. The employee pays less out of their pocket, put the odds in their favor for having a better outcome and the employer reduces their claims costs to boot. I can’t think of a better strategy to reduce costs and improve the lives of employees than arming them with this type of information. We all know that knowledge is power and it certainly holds true here.
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