“Having focused extensively on the trunk of the healthcare tree, we might have forgotten that heavy branches are equally instrumental for node nutrition.”
Apart from federal organizations, large employers cover the majority of the population’s health. Just as high expenses of U.S. healthcare are driving the system towards a new value-based model, the dollars continue to weigh heavily on the shoulders of these accountable organizations. The total cost of healthcare, which includes premiums and out-of-pocket costs for employees and dependents, is estimated to be $14,642 per employee this year and projected to rise to an average of $15,375 in 2020. Employers will cover nearly 70% of these costs while employees will bear about 30% (or nearly $4,500) per employee.
Can We Stop Rising Costs for Employers?
Both employers through their healthcare plans, and the federal government through Medicare and Medicaid programs, are facing increased expectations to manage their patient population proactively with better use of data. The current system we are battling has been perfectly designed to maximize revenue with utilization.
Care costs emerge out of over-utilization and a lack of insights into resource utilization. While we are a nation with the finest specialized care available, neither the outcomes nor the care costs are appealing or sustainable.
So, where exactly is the disconnect?
Primary care providers deliver preventive and primary care to hundreds of patients daily. Despite this, the use of Emergency Department facilities as a primary care point of access is also common in the U.S. This is one of the major reasons for the exceptionally high cost of care. For self-insured companies and large employer-sponsored populations, employers would benefit from a deeper understanding of their utilization data to inform strategies to decrease the costs related to high or inappropriate utilization of resources.
Specialty care is much more costly compared to primary care. Changing the system’s reimbursement incentive strategy would be another way to combat sky-rocketing prices. Rewarding primary care for managing a chronic disease and preventing it from becoming a serious condition thus requiring expensive healthcare, compared to rewarding specialty care that may be unwarranted could be a start. Primary care focuses on moving care upstream to prevent complications and the need for more intensive care.
Challenges for Employers in Providing Primary Care
The challenge of involving primary care is typically access and availability of data. Just as Google maps guide us to our destinations on time, we need tools to leverage crucial data at the point of care. Without timely information, the employer’s workforce may seek out-of-network health services even when there is coverage for the same quality care within the network plan. Incentives and efforts to promote the use of primary care and a preferred network by employees will enable employers to negotiate better deals with payers.
In 1910, the Flexner report defined doctors as data entry machines whose job shifted from delivering care to maintain the records of patients. They were fixed like a master-builder format that was followed for years to come. We were limited in healthcare back then, but not today! Today, we have a healthcare plan and data that everyone on the care team follows. Doctors and clinicians will need to be retrained to collaborate more closely as a team focused on patient-centered care and better outcomes. Employers will want to look beyond paying for an episode of care and focus on paying for the value delivered to their employees.
Successful Primary Care for Productivity
Primary care is foundational to the patient’s entire health journey. This also implies that if used correctly, primary care could set the right direction for preventative actions that prevent health complications and avoid sky-rocketing healthcare prices.
Regardless of the employee’s stage of wellness, primary care often continues to be the first point of contact for the employee’s care journey. This makes it crucial for employers to align most of their initiatives, and investments around the efficient use of primary care. To promote a healthy workforce, employers would do well to promote primary care, preventative care, and wellness programs.
Employees will be better engaged in their health journey and may be more likely to engage in wellness programs that their employer provides and promotes. By promoting primary and preventative care and employer-sponsored wellness programs, employers may see greater utilization of the offered health plans and preferred networks. This may also lead to an increase in workforce productivity and better health outcomes.
Road Ahead
Despite increasing healthcare costs, the employee experience hasn’t changed much in recent years. Employers continue to have a need to design creative initiatives around their employee populations that take into account individual differences in health status and overall health goals.
By better understanding their employee population’s needs through an aggregate view of their health status and medical expenditures, employers will be better able to generate employee engagement through targeted information. Primary care initiatives can be planned around prevalent health issues of selected employees with chronic conditions to help promote preventative care and reduce the healthcare cost to the employer.
Industries across the U.S. can leverage primary care and data integration as a way to tailor the care experience for employees and promote a culture of health across their employee base. The potential of this unified strategy can revolutionize the way employers address healthcare needs and the costs of their employees and cultivate a culture of health.
Photo: AndreyPopov, Getty Images
