Health Care and Employers- Innovative Solutions for a Changing Marketplace

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In the U.S. health care expenditures are 50% higher than any other country in the world, totaling about 16% of GDP. As costs continue to increase at a rate of 8% per year, which is twice that of the Consumer Price Index, total U.S. healthcare costs will consume about 20% of the economy within the next 6-7 years. Furthermore, employer’s medical costs have increased 80% since 2001, causing many organizations to lower plan benefits, eliminate coverage, or propose more affordable solutions.  Likewise, employees have shared the cost burden by seeing their out of pocket expenses quadruple over the last 5 years.

Interpretation: Since 75% of all procedures are elective, patients have enough time from the point of diagnosis to surgery to weigh their options and make informed decisions. With a proper model in place, there is plenty of time to research and choose a provider or treatment based on cost, quality, experience, and results. Unfortunately, many companies and their employees don’t have the means or infrastructure to research addition surgical options. As a result, many employers continue to miss out on one of the best opportunities to improve quality outcomes while reducing their healthcare costs.

SURGICAL BENEFITS MANAGEMENT

Surgery benefits management is quickly becoming one of the best ways in which employers can reduce their healthcare costs without compromising healthcare quality. Implementing a program like this can be simple and very effective if two major components are utilized:

Medical travel: A Medical Travel program is a voluntary employee benefit program offered as a supplement to an employer’s self-funded health plan. Currently, thousands of U.S. patients utilize supplemental surgery networks every day, saving millions of dollars for their employers. The providers in these networks can perform surgeries consisting of anything from a major complex cardiac procedure to a simple minimally invasive out-patient treatment. The purpose of using a defined program is to simply bridge the gap that exists between the employee who needs the surgery and a network of specialized health care providers that can perform the surgery.

Interpretation: Implementing a Medical Travel program presents a tremendous opportunity to receive higher quality treatments while reducing costs for both employees, who benefit by paying little to no out-of-pocket expenses, and employers that typically save between 20-60% per procedure. This is not a new concept – medical travel has been around for many years, which simply consists of somebody leaving their local community to get treated somewhere else. In the past, it was predominately used by wealthy or those with chronic conditions or diseases such as cancer or organ transplants. But today, medical travel programs are being implemented by employers to expand their employee’s options and to improve their outcomes, while lowering the overall health care costs. Using a quality medical travel partner is paramount to a successful program as they pre-negotiate discounted global case rates which usually include pre and post-surgery consultation, physical therapy if necessary, and all hospital and surgery expenses.

Expert Diagnosis Services: A team of 3 -5 experts review the records of each patient in detail. Afterwards, they summarize the issues presented and recommend a specialist who will review the case in detail. Often times this process involves even reworking tests and examinations through their comprehensive provider networks. Comparing this method to a traditional second opinion, expert diagnosis services are proven to be effective at helping to ensure patients get the best treatment possible.

Interpretation: Published data states that approximately 20% of surgeries are deemed unnecessary, resulting in nearly

$220 billion in wasted costs each year. Expert Diagnosis Services helps to prevent unnecessary procedures, and shorten the recovery time by making certain the right diagnosis and the right treatment approach has been chosen. Adding this step into your treatment algorithm will improve the health of employees and reduce unnecessary health care costs.

On the surface the outlook for employees may seem grim with out-of pocket expenses continuing to increase in the form of high deductible, co-pays, and co-insurance. However, employers can make an immediate difference by taking an active approach to neutralize these trends. An understanding of where and how health care dollars are being spent is the key to uncovering potential solutions. Top organizations are turning to surgery benefits management as an alternative to increasing costs and reducing medical coverage. In conclusion, we believe managing surgical costs is an innovative technique that will improve outcomes, reduce costs and deliver consistent results.

About the Author

David Goldstein, President of Health Options Worldwide (HOW), has extensive experience in the healthcare industry. Through his exposure to the inner workings of hospitals and physicians, he learned of the inefficiencies that exist in the healthcare industry and was inspired to make a difference. His professional experience in dealing with business owners, benefits managers, physicians, and hospitals has been a large reason he’s lectured and presented to companies ranging from startups to Fortune 500 organizations.

Founded in 2008, Health Options Worldwide (HOW) has worked hard to develop solutions to counter the ever rising costs of healthcare. As a healthcare IT company, HOW delivers a tailored network of global medical facilities within our technology platform to engage employees into bettering their health as well as reducing overall healthcare costs. Since launching in 2010, HOW has quickly become a top destination for physicians, hospitals, employers, and patients. As a trusted, unbiased resource, HOW’s free online marketplace provides patients with direct access to top medical institutions and physicians, often providing fixed rates for treatments. HOW works with many self-insured employers, carriers, and other partners to help reduce their overall healthcare costs while demonstrating outcomes. For more information on HOW visit Http://www.HealthOptionsWorldwide.com or contact David Goldstein at David.Goldstein@healthoptionsworldwide.com.