Value-based health care is an important trend in delivering quality care to consumers in general and, in group health insurance, to employees and their families. It is a delivery model in which self-insured employers and health insurance carriers compensate providers based upon their outcomes, instead of a negotiated fee for services rendered. Data has shown that this compensation method can be impactful not only for patient recovery and reducing time away from work, but also in the amount of waste that occurs in the medical field.
The following tips reflect the highlights captured from the upcoming podcast hosted by Carol Harnett, president of The Council for Disability Awareness and Dr. Stephen Schutzer, president of the Connecticut Joint Replacement Surgeons, physician executive for the Orthopedic Service Line at St. Francis Hospital and Medical Center, and the physician director of the ConnecticutJoint Replacement Institute at St. Francis Hospital and Medical Center.
1. What is a Center of Excellence?
Many consumers with complicated diagnoses often wind up receiving complex treatments—such as spinal surgeries, joint replacements, or organ transplants—without access to a network of specialists who produce the best outcomes in their fields of expertise. Instead, people will choose to see a local physician for treatment regardless of that provider’s performance history. Employers, however, possess the ability to align their health insurance plan design with centers of excellence where the best patient outcomes are achieved.
2. Giving Employees Access to Quality Healthcare
Providing a competitive benefits package helps employers in their effort to attract and retain talent. Health insurance that gives employees and their families access to the best available care garners employee loyalty and appreciation. With value-based healthcare, workplace productivity increases, as employees get back to work more quickly and waste associated with unnecessary procedures is reduced.
3. Employers Face Challenges in Moving to Value
It remains in the best interest of both Employer and Employee to have good health coverage – especially in cases where good care can be the deciding factor in an employee’s prompt return to work time and mitigating time and suffering associated with more complex procedures. According to Dr. Schutzer, the overall healthcare ecosystem is complex, and the various entities are not always aligned. Research indicates that the health care industry often gets stuck in its old ways. As a $3.2 trillion dollar business, different players may resist change, especially when saving money for some means taking it away from others.
4. How to Move Beyond Obstacles – Change Happens When Employers Engage
Dr. Schutzer named health insurance benefit design as one of the biggest obstacles to moving toward value-based health care. Employees need incentives to opt for a center of excellence for their care, and the onus largely falls on employers to encourage its workers to choose health care quality over convenience or habit. To do this Dr. Schultzer recommends employers:
- Do your homework when choosing contracts for health care providers for your insurance plan; make sure to review the data carefully at the benefit level. Dig deep.
- Make sure the data is clean, and then recruit experts to provide insight.
For more resources from The Council for Disability Awareness check out DisabilityCanHappen.Org.