- Strategic cost management of health care programs working with a broad spectrum of clients, ranging from the restaurant and hotel business to health care to high technology.
- Specialties: Creating, implementing and running health & welfare programs for companies ranging from 100 employees to over 5,000 focused on consumer-driven health plan education and adoption.
- Recipient of 2010 HR Symposium's Excellence in Partnership with HR award.
- All 7 Best Practices
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Consumerism and Transparency in the Health Care Marketplace
For decades, our crazy and complicated health care system has had very little consumerism, and very little transparency.
As costs have continued to spiral, however – most estimates are 8 percent to 12 percent annual increases over the last decade – both consumerism and transparency are emerging trends. They've given rise to health savings accounts (HSAs) and transparency tools that are allowing employers and employees do a better job of shopping for health care.
"Claims experience," the amount of care a company's employees gets in a year, is the biggest driver of premium costs. Larger companies get more detailed information from an insurer on what types of (and how much) claims they paid; smaller companies get less information, such as the amount of premium the insurer paid out in claims. And in some cases, employers get no information at all. In all circumstances, however, the claim experience has an effect on the price to renew for the following year.
When an employer and its employees learn how they can be better consumers of health care, they can reduce the total dollar amount of claims and, as a result, reduce premiums.
Many people don’t realize there's a gigantic variation in the prices for health care services. Many employees, and even their employers, think they might save $50 on an MRI exam by going to a different provider. What they don't realize is that the MRI might cost $400 at one provider and $4,000 at another just a few miles away. Surgeries can have tens of thousands of dollars difference in pricing. There are thousands of dollars to be saved by better shopping for health care services.
Consumers of health care also have little idea of the differences in quality. They often go to a place recommended by a doctor or a friend, or choose a nearby provider. They don't know if that provider is actually the place they should be going for quality care.
There is increasing transparency in both cost and quality, however. As more consumers go on high-deductible plans that give them a greater share of health-care expenses, providers are becoming more accustomed to consumers asking how much procedures cost. Meanwhile, governments and private-sector sources are gathering and dispensing data on the outcomes of medical services at a wide range of providers.
If people become more educated and use these tools and resources, they can go to lower-cost providers that often provide better care. That helps save employees money and keeps them healthier. It saves the employer money by reducing their claims dollars, resulting in a much lower renewal price for the following year.
Here is how a high-deductible plan with an HSA might work:
- It could be the exact same network of providers as in a company's PPO or HMO plan.
- But when the employee goes for a doctor visit, or to the pharmacy to get a prescription drug, or to get an MRI, that employee now pays the full discounted cost of that service up to the employee's deductible amount.
- An employee could go to the pharmacy and instead of paying a $20 co-pay, have a choice of $86.53 for a brand-name prescription drug or a choice of generics for as little as $16.
- The money comes from the employees' HSA account, which often includes money contributed, tax-free, by the employer.
- It's their own money that employees are spending, and if they spend less, they keep the difference in their pockets. This gives them the correct financial incentive to become good consumers.