Finding the answer to the mystery of what hides behind the healthcare curtain that contributes to the escalating cost of healthcare has been an ongoing quest for employers and employees alike for years.
Transparency: Pulling Back the Curtain to Reveal the True Cost of Healthcare
As medical costs continue to soar out of control for employers, and employees continue to have trouble managing their own out-of-pocket costs, both are left frustrated and exasperated with no easy answers in sight.
For the 108 million Americans with employer-sponsored health insurance, pulling back the healthcare curtain to reveal standards in quality and related costs requires increasing transparency. Increased transparency goes beyond obtaining the cost of the anticipated medical procedure. It goes even deeper by also comparing how costs associated for the same procedure can vary greatly (e.g. the type of facility and by geographical area).
In 2013, a review conducted by the Medical Advocate Program® (MAP®) revealed that by increasing transparency and combining it with employee benefits education, price variations are reduced and could significantly save a single large employer between $4.5 million - $6.5 million per year— an amount that could increase upwards of $36 billion a year factoring all large national self-insured employers in the US. (source: Thompson Reuters' white paper by Bobbi Coluni, February 2012)
Using transparency, a single large employer could
save between $4.5 million - $6.5 million per year
Transparency isn't just about cost, however. Quality is equally, if not more important than cost. Yet employees do not know how to incorporate this information into their healthcare decisions as it is not readily available. Even though there are web sites offering online opinions of physicians, they are generally focused on office staff or communication skills, rather than receiving reviews of successful patient outcomes and clinical qualifications as the criteria for provider selection. This is where MAP® is uniquely different and why the services MAP® provides are so important.
Setting up a Transparent Healthcare System
Many companies set up an Internet-based system for employees, which offers customized data based on the company’s health care plan and geography. Additional data might include quality, procedures, and providers, but that data is still limited.
The real key to the success of implementing a transparency program is employee education combined with a phone-based, ‘real person’ system that encourages dialogue resulting in far better outcomes. By example, Anna Fallieras, General Electric’s Program Leader for Healthcare Initiatives and Policy, surveyed her organization’s 300,000 employees asking them whether their preference was a web-based system as their guide for transparency or would they rather speak with a real person. Overwhelmingly, employees said they want to talk with someone who knew the healthcare system. Further, employees expressed that the person they felt most comfortable speaking with was a nurse.
To fill this need, the Medical Advocate Program® (MAP®) was created. And unlike other healthcare advocate services, it is uniquely different. When employees call MAP®, they speak to a registered nurse—a MAP® Nurse Advocate. The nurse engages and interacts with the employee by asking and obtaining all pertinent information in order to guide and recommend the best provider and/or facility based on the highest quality standards which include cost, network and geographical area. While making these recommendations, MAP® Nurse Advocates educate employees to better understand navigating their benefits, authorizations, as well as finding a quality doctor, locating in-network doctors and facilities and saving money in general.
Best Practices for Implementing Transparency
According to a recent article in HR Magazine, employees are bearing more of the brunt of health care costs – 40 percent more than they did just five years ago according to the Towers Watson survey. With this additional responsibility, it is in the employees’ best interest to become more savvy purchasers of their healthcare so that their employer can afford to keep giving them the best possible health plans.
When implementing a transparency program, there are several best practices a company can put into place to ensure a greater adoption rate:
- Consumer education: Select a transparency “champion” among the staff to coordinate education and awareness. Healthcare education is new and therefore redundancy and repetition is required to convert users.
- Anecdotes: Sharing employees’ own stories of successfully using transparency information to realizing a better outcome is a great way to educate other employees about potential cost savings.
- Incentive programs: Some employers offer cash incentives based on the provider or facility the employee chooses for a certain procedure. Shared savings is another incentive where employers share any return on investment over a certain level with employees.
- Personalization: Personalizing information to employees, such as researching their own doctors, makes the data and process more real to them and consequently become more personally invested in the transparency program.
- Testimonials: Share employee testimonials in company newsletters or other broadcast media. The more impressions that are made on hearing the positive outcomes achieved, the more employees are apt to seek help.
- Pre-certification: Most companies require employees to call for pre-certification on certain procedures to verify medically necessity. Employees usually have their physicians call their insurance carrier. Through employer education, employees contact a MAP® Nurse Advocate to discuss non-medical necessity issues: medical alternatives, the need for a second opinion, cost alternatives for available facilities, verification of the doctor’s background and confirmation of provider network participation.
- Repetition: When it comes to changing behavior or implementing a new program, repetition is crucial to success. Communicate key messages over and over and in a number of different ways (company newsletters, presentations, meetings, etc.) and eventually adoption will occur.
If you are interested in obtaining more information on the best practices of transparency that helps employers to reduce costs and improves employees healthcare needs, please call MAP® at 1-888-289-0700.