Have you ever thought about how you or your employees have experienced the healthcare system? I have a couple of clients who have surveyed their employees over each of the past several years and found two consistent results.
First, not surprising, our out-of-pocket costs are too high. What employers don’t often realize (or think they can control) is that when employees put off care or treatments because they can’t afford it, that problem likely does not go away, but rather snowballs into something much more problematic. For example, if you have an employee with diabetes that is not taking their medication because they can’t afford it, the chances are high that at some point in time they’re going to end up in the emergency room, costing upwards of $40,000 of your money because they can’t afford their $25 prescription every month.
Second, both employers and employees have a tendency not to trust the healthcare system. They might trust doctors, but are less inclined to trust hospitals, and even less so, insurance companies. So again, we end up in a situation where care is put off or not delivered at all because the patient, 1) doesn’t trust what’s happening, and 2) really can’t afford it. So, where can we go from here?
Here a few examples of situations that can be easily improved:
MRIs are more common than they used to be and physicians are much more likely to prescribe them today. The imaging is considerably more advanced than it was even five years ago, so it makes sense for doctors to regularly order MRIs for their patients. However, there are significant differences in pricing depending on where the MRI is delivered. For example, if an MRI is delivered in the hospital – which is most common – that is where the MRI will be the most expensive. However, if your MRI is not considered urgent, then you can opt to have it delivered in a free-standing facility for probably half the cost. Plus, if you shop around and negotiate the price ahead of time, then the cost of your MRI could drop from $5,000 in the hospital to $1,800 at a free-standing facility…or even less. However, most employees are not aware of these options; and yet, they are truly your first line of defense in understanding and spending your healthcare dollars wisely.
Did you know that 20% of cancer diagnoses are misdiagnosed? Most commonly, these patients are diagnosed with the wrong type of cancer, and in turn receive the wrong treatment. What that means is that if the misdiagnosis is even caught, the patient then has to wait until the wrong chemo clears out of their system before the correct treatment can be administered. How awful is that??
In roughly 30% of cases, back surgeries and muscular skeletal issues are treated unnecessarily. It is unlikely that your employee will know whether or not a back surgery is warranted.
While this all sounds horrifying; there are some simple ways to control these concerns.
First, information in your pockets and at your fingertips is a small price to pay for thousands – or even tens of thousands – of dollars in savings. You can offer your employees access to apps that will give them 24-hour access to advocacy experts and a host of other services.
For example, if you have an employee who is unsure of a provider, or if they have a bill they don’t understand, they can call their 24-hour advocacy from their smart phone and get help. This is just one simple and cost-effective way to give your employees access to 24-hour resources.
Further to this, some of these apps use geofencing to help an employee understand where to best get care. For example, if an employee has that app on their phone and they pull into the emergency room, a pop-up will prompt them to talk to a nurse before entering the emergency room to assess the level of care required, if any, including emergency room, urgent care facility, or a doctors’ visit, thereby saving your plan significant amounts of money. This is very valuable support that determines what care is required for their condition or circumstance
If you offer true care management, or care assistance, as one of my clients calls it – where a medical management company is actually reviewing claims and diagnoses – you can support your employees by 1) ensuring they’re receiving care, 2) accessing better, higher quality care, and 3) ensuring they have someone to talk through their diagnosis with. This is a considerably less expensive way to offer a white glove service. Plus, if a condition is misdiagnosed, it can be caught early and the care management team can encourage your employees to seek care from the highest quality facilities.
The dirty little secret in the health insurance industry is that the highest quality care is generally in the bottom quartile of cost, and there is no way for most of us to know that. High Quality care management companies have plenty of resources that we don’t have access to.
Another thing that often trips people up is how much medications cost. There are tools you can load onto the benefits app that will allow an employee to get the best price for their prescription, or even use an alternate sourcing company that will significantly lower their cost and eliminate their out-of-pocket expense. This lowers the employer costs quite a bit as well.
So, if you’re interested in leveling the playing field and improving the user experience for your employees, click the link below so we can schedule some time to discuss your options.
My name is Allison De Paoli and I started Altiqe Consulting to help employers add control and predictability back into their benefits spending and to get out of the healthcare spend craziness and back to running their businesses, while ensuring their employees have the best care at the most affordable cost.