Last night, the Wall Street Journal reported on 20 large companies forming an alliance to target healthcare costs. As big companies are wont to do, they are unnecessarily complicating things. They can save themselves a lot of time and money by understanding two simple items that have proven to slay the healthcare cost beast. Massive pricing failure is the biggest factor in out-of-control healthcare costs. In contrast to most markets where price correlates with value, it is often inversely correlated in healthcare. The solution to that problem is outlined below. Primary care has been massively undermined in this country. IBM studied the impact of their annual $2 billion spend on health benefits around the world. The results were conclusive–the countries where there were the most robust primary care models delivered the greatest value. This is why they dedicated Dr. Paul Grundy to lead the renaissance of primary care.
As a self-employed consultant and person of faith, David Schneider chose in 2012 to enroll his family in a health-care sharing ministry to cover their medical costs. Since then, Schneider’s family has received help with tens of thousands of dollars in medical expenses for surgeries on his legs and a son’s broken collarbone. In exchange, the family pays about $700 monthly, and the ministry is not responsible for the first $1,250 of medical expenses annually. The 54-year-old Columbus man’s experience has made him a convert to the increasingly popular alternative to traditional health insurance. In fact, Schneider said he convinced his new employer to offer taxable lump sums that employees can use to buy ministry memberships in lieu of joining the company’s health-insurance plan.
Until she lost her job and health insurance, Karen Bruce never thought twice about visiting hospital or commercial laboratories for the regular blood tests she needs to monitor her level of blood-thinning medication. Once she had to pay for the tests herself, however, she needed an alternative. Bruce, who lives on Indianapolis' Southside, found it at a Greenwood storefront, Any Lab Test Now. A national chain, Any Lab Test Now offers a variety of medical tests, including lipid panels, paternity tests, drug tests and tests for sexually transmitted diseases, at a fraction of what most hospital and other major laboratories charge for the service. In the past four years, Bruce estimates, Any Lab Test Now has saved her hundreds of dollars. At Any Lab Test Now, she pays about $20 a test, much less than what the hospital lab charged.
You're going to pay more for your health care this year, through rising premiums, more co-pays, higher deductibles or balance billing, which is when your doctor bills you for what the insurance company won't pay. The average deductible for 80 percent of people with private insurance was $1,217 in 2015, according to the nonpartisan Kaiser Family Foundation. That's 47 percent higher than the average deductible in 2009, and more Americans are choosing higher deductibles next year in exchange for lower premiums. Bottom line: Health care spending will rise 4 percent in 2016. Disturbingly, there is little correlation between what a procedure costs and how much a provider bills for it, according to researchers at Yale University. Health insurers, hospitals and doctors say they must charge whatever the market will bear to stay in business, which means also turning a profit. If that's the case, patients have no choice than to demand lower prices, expect fairer billing and, whenever possible, shop around for the best deal.
Is health care in America getting safer? This is a question that we all think about as doctors and patients. The answer seems to be not really. A new report found that hospitals have been gaming the system to make their re-admission numbers look good by putting patients who return in a special observation area instead of counting them as readmission. Independently, another report from the Agency for Healthcare Research and Quality shows that nationwide reductions in patient complications have plateaued. Furthermore, part of the reductions was due to creative ways that hospitals code or report complications. Many of us who take care of patients know that health care continues to struggle with endemic variations in quality stemming from poor coordination, misdiagnoses and inappropriate care. While state-of-the-art care is there, delivering it can be messy.