Benefits advisers, let’s look at two common treatment options you might find looking at your client’s healthcare data.
Which scenario is cheaper? The first scenario is more of a traditional form of care. It’s a treatment you might have experienced ten or so years ago if you were recovering from surgery. The second scenario is a more modern approach and, not surprisingly, is more cost effective. It can also be more comfortable for the patient. Not only is the second scenario more economical, but it is also an example of value-based care.
Value-based care has been in the spotlight for a few years. In 2015, Forbes reported that the U.S. government outlined a plan to move Medicare and Medicaid money away from the fee-for-service model of healthcare to a value-based care system. In a fee-for-service model, employers pay for health services separately. Because services are unbundled, physicians offer more (potentially unnecessary) treatments because their payment is dependent on the number of services provided instead of the quality of care. Value-based care focuses more on delivering quality care. In the knee surgery scenario, the imaging, medication, physical therapy and more are all bundled together and billed as a care package. Instead of doctors looking at treatments individually, they monitor to see how they all work together in an episode of care. But the government isn’t the only one steering people towards value-based care. Benefits advisers are creating better benefits packages using their employer’s health claims data by driving employers to value-based care.
In our recent case study, Artemis looked at a client’s dialysis treatment. We were curious to know why their dialysis costs were above the national average. What we found was that our client’s members were going to out-of-network providers and driving up costs. But what if the out-of-network provider achieved better outcomes for their members? Or what if an in-network provider offered better results and prices?
Let’s hypothesize with the example of a large company like Microsoft. In Redmond, Washington, where they’re headquartered, there are just a few hospital systems. Employees have limited choices in where they go for care. Microsoft, through their benefits or consultants team, can look at risk scores, inpatient admits per 1,000, and second opinion services, and more to get clear data showing which providers are offering value-based care.
Benefits advisers are helping direct their employer clients to value-based care because they can achieve both cost containment and better patient outcomes.
Instead of going through insurers to manage their healthcare plans, benefits advisers are also helping employers partner with healthcare providers to get more competitive rates and more cost-effective outcomes. Forming partnerships is essential because employers can negotiate expenses and in-network services.
As we mentioned in a previous blog post, high prescription prices are something both providers and employers are experiencing. By partnering together, employers and providers can share pharmacy data, find inefficiencies, and even negotiate with drug manufacturers. Hospital systems can even track things like opioid prescriptions, signs of abuse, and problem doctors who overprescribe.
By mining their employer’s health claims data, benefits advisers get a big picture of who is providing value-based care. Not only does it help them eliminate providers from their network that are not offering the best outcomes for their employees, but it also helps them partner with providers and share insights with each other to find trends and negotiate rates for healthcare services.
And that is why benefits data is essential. Benefits data is giving benefits advisers the power to change their client’s benefits packages for the better.