by Sarah Gunter
In Part I of this two-part series, industry experts discussed where we are today in terms of cost containment and outcomes of employer-sponsored healthcare plans. In Part II, we’ll cover the second half of their discussion at the Benefits Design Strategies Summit, focusing on how we move into tomorrow.
The experts left off with host Josh Berlin pointing to an emphasis in the panelists’ responses having to do with the shift from a volume driven world of healthcare to a more value driven one. But how do we define value? What might this world actually look like? Andrea Cockrell used an example from a teammate’s experience with getting coverage for her husband’s colonoscopy. Cockrell worked as a CPA, spending 10 years in public accounting, before working for the city of Plano as Controller, and then as Administrative Services Manager. As her organization’s health plan covered one colonoscopy per member per year, the teammate convinced her husband to apply the coverage and get the procedure. When the teammate came in afterwards, she was very upset, due to the fact that the doctors had nicked her husband during the procedure and needed to redo it, resulting in a bill for two colonoscopies.
“It’s an illustration of the lack of value,” said Cockrell. “When you stay in a hotel, for example, if something goes wrong with your stay and you have to move rooms, you don't pay for two hotel rooms--that makes absolutely no sense. In fact, they if something happened, typically the hotel would comp you, but in healthcare, if they mess up, you're getting billed double and that's what is just outrageous to me.”
If we understand value in terms of the standards we have for other industries and imagine a future where hospitals are subject to these same standards, how do we get there? Deacon points to the fee disclosure rule in the new ERISA laws. Deacon, now with 4C Digital Health, worked as a former bankruptcy attorney and Deputy Attorney General, then special counsel to the governor's office before taking over the state health plan of New Jersey where she represented 820,000 public sector lives. She says, “I think it's on employers to make the most of this rule. But it really puts the onus on the employer and the fiduciary, the personal fiduciary liability risk on the employer and that HR professional to get those disclosures from the broker.”
Leah Binder, President and CEO of Leapfrog Group, urges employers to shift their expectations to align with the outcomes they want to see. However, she acknowledges that taking a tough stance towards hospitals as an employer can be difficult for certain reasons. That’s why she advises starting with the commonsense issues. “Focus on quality and safety, because that argument is acceptable to everyone; even if it is difficult sometimes, it’s still acceptable. Start with safety.”
In her own words, the message to hospitals is essentially this: “Safety is a simple thing—if you screw up, I don’t want to pay the price of that! You should act like an ethical businessperson and absolutely not charge me but pay my extra expenses.”
“These are just fundamentals. No other industry would even survive without doing that. Imagine an airplane crash where you bill the passengers for the rescue,” Binder said, echoing Cockrell’s earlier point.
Turning back to the present, the panelists were asked to conclude by each setting one goal for employers to focus on and accomplish in the coming year. Lee Lewis, Chief Strategy Officer for the Health Transformation Alliance, began, saying, “Get all your data on a server you control.” Deacon agreed, “Own your data, I think that’s key. Remember to use the tools in the toolbox we talked about today,” she said, referring to the change in ERISA laws discussed in part I. Cockrell continued, “And, if somebody doesn’t agree to give you your data, then you need to make a change.” Binder finished, “Make sure that all your employees know about the hospital safety grade and seek care where they are safest.”