Higher quality can lead to lower costs
We know we are at a Health Insurance crossroads, but what we don’t understand is whether to veer to the right or take a quick left exit off of our current trajectory. Or, should we plug on full throttle just a little further because there might be a bigger, better option just over the horizon?
As employers, we keep looking for a viable alternative to the yearly nip-tuck exercise to reduce a 12% cost increase down to a manageable 3% to 5% increase. And as employees, we keep looking for the off-ramp from the continual loop of taking on more responsibility to the detriment of our paycheck.
It’s no wonder when we utter the phrase “Health Insurance”, most of us immediately become overwhelmed with feelings of hopelessness. We’ve lost belief that anything significantly better exists. In fact, most of us claim victory when we find a “less bad” option. But if we focus not on insurance, but rather on our care, there is a beacon of hope down that road.
As more consumers and advisors seek the answer to this cost dilemma, we have begun to chart correlations between quality of care and cost of care only to find an inequitable pathway between high quality and high costs. It is here, at this particular intersection, that we can have that “ah-ha” moment and see hope for not only better care at lower costs, but also care that will ignite a downward cost of insurance and a restoration of hope back into our companies, our employees, and our communities.
So where do I start?
This is really tough, as each person encounters health care differently at different stages of their life journey. Just because you heard me talk to “John” about a Direct Primary Care relationship doesn’t mean it’ll be the most effective option for you. And just because you heard me talk to “Jill” about establishing a Center of Excellence for knee replacements doesn’t mean it will be the most effective choice for you, either.
Quality, however, can affect everyone.
I would suggest you spend 30 minutes to an hour clicking around and learning about your local Hospital Grades and the nuances in your community by using the Leapfrog group’s website.
Let’s just consider that you or that some of your employees will encounter the need for Maternity and Childbirth services in the next few years. And if you are like us, and live in an area with multiple hospitals within 15 miles, wouldn’t it make sense to know what the quality looks like?
I personally live close to the DFW Airport in Texas, and the hospitals I’d typically consider within 10 miles have good-looking scores. But what if one had a better rating for Cesarean delivery? Wouldn’t you want to know?
And then, you start to wonder……..
Like I said, you should start by spending 30 minutes to an hour clicking around and learning about your local Hospital Grades and the nuances in your community. Use the Leapfrog group’s website as your gateway into knowledge.
How does this lower price?
Let’s look at 2 clear examples that we can easily sink our teeth into.
If you look at the hospital data provided by the Leapfrog group, you can easily see their drill down reports into post-surgical infection rates. Anytime you have fewer complications from surgery, you heal quicker. That also means that as you enjoy a quicker recovery, you spend less money overall because you are consuming less health care. Common sense, right?
Let’s also think about one of the key services that you encounter during any surgery: Anesthesia. Anesthesia costs are billed in several different ways, but the biggest indicator is a “per unit” cost of anesthesia. In overly simplistic terms, units are a direct function of time. Thus, any time a procedure is performed by a slower or less skilled surgeon, they can take a significantly longer time to operate which drives the “cost per unit” up.
But what about non-surgical quality?
This one is really quite difficult. Unlike hospitals and surgery centers, which have some clear-cut metrics to report, a physician’s quality metrics aren’t easily searchable. In fact, many of the services you may use have highly subjective feedback. Even researching a doctor on the Texas Medical Board’s website can be misleading.
Without easily accessible quality metrics in place, this is where an emerging trend called “Direct Primary Care” or “DPC” provides hope. In this structure, the payment incentives for quality care come directly from the patient. There is no insurance company playing the middleman, and the doctor is accountable to the patient. This is where questions of care don’t start and end with the phrase “insurance will/won’t approve.” For those already participating in this structure, they are amazed by the doctor limiting their practice to spend a greater amount of time treating and thinking about them individually and directly instead of through indirect physician extenders. I know, this isn’t for everyone, yet………
For those of us still taking smaller steps to adaptation and not quite ready or in a place to choose a DPC relationship, one of the best resources may just be your current insurance company’s member portal. Over the years, each insurer has developed some version of cost & quality tool. Some are easier to use than others, and some are easier to find than others. But nonetheless, the tools that are at your fingertips already are better than the ones you have yet to find.
Now, go forth and seek quality.
It is really that simple. We all have a part to play, and we can either participate in the solutions or we can be complicit in our demise.
Choose quality, choose hope.
About the author: An avid learner and resourceful leader with a passion for problem solving, Bret is a calming force in the chaos and fast paced evolution of health insurance, employee benefits, and the growing burden of regulatory compliance. He helps people develop the confidence to see beyond the problem at hand and start to re-imagine their goals. Whether he’s helping a client or a colleague, Bret believes a successful interaction is one that allows us all to dream a little bigger when we’re done.
About AG Insurance: AG Insurance (www.agiainc.com) helps employers and their employees with solutions focused on positive organizational impact and improved employee experiences.