You can save money for your self-insured health benefit plan with a strategy for steering people to higher-value health care.
The best way to get started is to examine your data to find procedures that combine two factors:
- They happen frequently.
- There is a wide variation in cost.
Finding Opportunities to Steer
The first step is to identify high-dollar claims based on your health plan costs. Examine what you spend on Alliance network claims and where you spend it.
The Alliance negotiates significant discounts with all health care providers, but there can still be significant variation for a specific procedure when you compare health care providers.
For example, the cost of surgery to place ear tubes in young children (a procedure known as a “myringotomy”) varies significantly. Fortunately, some providers have significantly lower costs. In some cases, that’s because these providers do a high volume of these surgeries, which is one indicator of quality care.
How much can you save?
Typically, your plan can save by guiding people to providers whose average billed charge is near or below the mid-point when comparing provider costs.
These lower-cost providers can be found within a reasonable driving distance in most communities in The Alliance network.
You can identify opportunities to save by logging into Find a Doctor and comparing costs for providers located near where your employees live and work. Find a Doctor helps you explore costs for more than 50 common procedures.
Incentives and Communication
Once you identify where you can achieve savings, the next step is getting employee buy-in. Financial incentives that reward employees for choosing high-value care are crucial.
Simply stated, incentives share the savings with employees so you both benefit from choosing a high-value provider. A well-designed incentive means everyone saves. On the other hand, resisting incentives usually means no one saves and everyone spends more.
The final step is communicating about incentives to employees and family members. Unless employees know about the offer, they won’t use it. You’ll need to share information on a regular basis so employees remember the offer when they’re making health care decisions.
The Alliance’s QualityPath program is a ready-made way to get started with steerage. QualityPath offers:
|Doctors, hospitals and clinics pay for surgery complications or repeated tests due to quality issues, not the employer.||A single price covers most elements of surgeries and tests.||Doctors, hospitals and clinics meet quality measures and use practices that reduce unnecessary care.||You have less paperwork. For surgeries, the patient experience manager offers personal assistance.|
For employers, QualityPath savings for surgery average more than $11,000 per surgery; savings for tests are projected at 20 percent below current costs. Employees also save with lower out-of-pocket costs, which provides an added incentive to participate.
The Member Services team at The Alliance is happy to help you identify opportunities to steer employees and family members to high-value health care. Talk to your member services representative or contact me at 800.223.4139 x6645 or firstname.lastname@example.org to get started.
Mike has a strong background in health benefits and self-funding. He previously served as a regional sales advisor for Digital Benefits Advisors in Madison, Wis., where he managed the health benefits for more than 160 credit union clients across 14 states. Prior to that position, Mike worked at CUNA Mutual Group in their employee benefits division for almost 10 years as an employee benefits sales specialist.
Mike has a bachelor’s degree with a double major in marketing and business administration and is licensed in both health and life insurance in Wisconsin, Illinois, Iowa, Minnesota, Nebraska and Montana.
Read blog posts by Mike.
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