Every one of us wants high quality, accessible and affordable healthcare. Before we debate how, let’s start with why. Healthcare is something most of us would rather not think about (outside of routine preventive care). It happens to us and then we respond. Our choices are personal and often times guided by our family, friends and others we might know who are connected to the healthcare system.
Did you know that 37% of the time we are diagnosed it’s wrong and 75% of the time we get a correct diagnosis the recommended treatment plan isn’t helpful, according to Best Doctors? To compound the issue, when we get healthcare, we are not informed about the cost and quality upfront, only to learn afterward, feeling frustrated with the answer — or worse, not well from receiving poor care.
The “rule-makers” (government, large hospital systems, big pharma and insurers) want it that way. They created this system and administer it through an opaque, complex process called “coding/billing,” where the cost of care is determined by the contract negotiated between the government/insurer and the provider — and the variation in cost can be in excess of 1,000%+ for the same service. Can you imagine buying anything that important or expensive without knowing those basic facts first? In an opaque marketplace, the status quo will not change, access to caregivers will suffer and the financial burden will only get worse. It’s not sustainable.
Focus on quality
Deconstructing healthcare starts with making it about US instead of the rule-makers — it’s focused on the quality of outcomes and the employer/consumer experience. And it’s financed in an efficient and cost effective manner. The current system is service-provider controlled, sick care and not transparent, and in most cases it’s impersonal, too. Instead of feeling like a number or taken advantage financially, we can change this paradigm by embracing the principles of transparency, consumerism, health and wellbeing and creating a community like-minded employers and consumers.
Rebuilding our broken healthcare system begins with returning the control and responsibility to us. We deserve a transparent, competitive marketplace where quality continually improves and costs are held in check; where access to doctors is our choice and where we can get the right care, in the right place, at the right time and by the right provider — all at an affordable price.
Middle market employers (50-500) health plan costs have become the 2nd largest expense (after payroll) for those businesses. Roughly 70% of those businesses finance their health plan benefits using a fully-insured arrangement where the employer pays a premium and the insurance company takes all the risk. When they “settle up” premiums versus claims paid at the end of each year the insurer generates a renewal proposal but shares no/limited plan data to justify the increase. Without that data, middle market companies have no way of really understanding what they are paying for. As a result, over the past 15 years the cost of healthcare has skyrocketed, taking those opaque health plan premiums with them.
Large employers (500+) have been able to unbundle those premiums and use their data to build and manage their plans in a way that saves them money and avoids asking employees to pay more premium out of their paychecks or take watered down benefits asking them to shoulder more of the cost. Until recently, middle market companies didn’t have that option. Now they can join together with other organizations using a partially self-insured financing arrangement known as a “captive” and achieve the scale and predictability of large companies, 82% of whom have partially self-insured for years. In this financing arrangement, they get their claims data, make decisions and eliminate waste and inefficiency saving them between 5-20%+.
Designed correctly, this solution can improve quality, lower cost and improve member level healthcare confidence. We can tame rising healthcare costs and improve the quality of outcomes by making the experience about the employer who provides these benefits and their employees and family members who rely on them. For middle market companies hungry for this new world, investigate captive insurance arrangements and take control of your healthcare future.
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