Fixing the Health Care Value Chain

BY BEN CONNER Health care is unlike anything else we purchase. When we buy groceries, for example, the price of each item is listed right there on the shelf. When we’re finished paying, we receive a slip of paper with an itemized list of everything we purchased. There’s never any question what it was going to cost, and the receipt gives us a clear historical record of the cost breakdown. With health care, it’s a different story. When someone blows out a knee playing basketball, there’s no choice but to enter the health care system, but there’s never a menu of treatment options available or quality metrics to review. Instead, the treatment costs are never clear until the bill arrives weeks later. This is an unnecessarily stressful experience for patients. By the time someone reaches the facility, they’ve already faced enough trauma, but then there’s the added burden of financing their health care.

Empowering Businesses

The additional stress of staying in the hospital comes from one source: fear of the unknown. Even when a patient receives an itemized list of services and medication provided, the justification for the astronomical prices is often hard to understand. But if an individual had access to better data, he or she could make better-informed decisions for their health. They could consult with better doctors, receive treatment from the best facilities, and access the best medications. Many companies are turning to innovation and creativity to thwart industry standards. Under a normal health care plan, the costs keep rising, and no one seems to understand how to change it.you and your employees pay out a sum every month. Under a self-funded vehicle, you use data and demographics to drive the highest value. Your aim immediately becomes to reduce expenses as much as possible up front to reduce the impact to your bottom line down the road. This is easier said than done, as spending less requires knowing exactly how much everything costs. Without the right information, an employee will seek treatment at whatever facility is close and convenient. An adviser who has access to data can help determine the best course of treatment and course of action for employers.

Empowering Employees

While it’s important for your adviser to understand the market in order to manage risk, it’s equally important for your employees to understand the full extent of the information available to them. If they don’t understand the details, they can’t make valuable decisions. The right data could even guide employees on accessing the most efficient health care at the best price. For example, after an employee blows out a knee playing basketball, your data can show you the facility that provides the highest level of care in the most convenient location. The right facility will improve the outcomes from surgery and reduce recovery time. From there, the employee can travel to a pharmacy where they receive the best pricing. These actions aren’t possible without data. Data allows business owners to stretch their benefits dollars as far as possible—without sacrificing quality. It’s a little like investing in the latest technologies on the market. You can certainly find a cheap model, but that doesn’t mean it’s going to be the best quality. By shopping around, you can find a top-of-the-line product discounted to a similar price point.