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Economy taking a toll on healthcare spending April 19, 2012

Posted by medvision in Chronic Disease, health data, Healthcare Costs, Healthcare Reform, Insurance Plans, Risk Management, Rx Costs, Uncategorized.
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Health Costs, Rx CostsIn my last 8 years working with employer-sponsored self-funded health plans, and their health claims data, one common element is always a signal as to their clinical and financial health. It’s amazingly simple! The higher the total ratio of primary care cost to total cost, the better the plan performs. (Lowest trend, lowest cost and highest member compliance rates to evidence based medicine/screenings) For example, if a plan only spends 8% of total dollars on primary care, then the plan’s condition is sick/poor. Why? Because the balance, 92% is being spend due to advanced disease–in hospitals, seeing multiple specialists, utilizing high-cost technology and receiving costly drugs.

Again, why? Primary care is low-cost/high value. Primary care is preventative care or health maintenance-care, instead of reactive disease care. This makes sense and is the major reason employer sponsored on/near site primary care clinics, save so much money on disease care! (These centers charge no member co-pays or co-insurance for primary care visits and generic drugs)

Here’s an article saying the public is skipping primary care visits due to the down economy! If you are responsible for an employer sponsored health plan, you need to make member primary care compliance a critical metric. A stay-awake-at-night concerned, metric.



Independent plan data, it’s hard to manage what you cannot see! April 14, 2012

Posted by medvision in Uncategorized.
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I’m always amazed when I meet individuals responsible for managing mammoth self-funded health plans and I bring up the subject of data. I may ask, “what’s your number one procedure group by annual cost”? “Hmm, I’m not sure”. “Which hospital provided the highest value for cardiovascular patients”? What percent of your members age 50 and above have been screened for colon cancer”? “I’m not sure, let me call my broker”.

Being blind to risk and quality issues around member health is why we’re in so much trouble.  Medicare, Medicaid, and the vast majority of employer sponsored plans, are totally or partially guilty. The plans utilizing independent plan data are, interestingly, the plans running at 0 or negative trend. Here’s a few facts helping tilt toward the data route:

  • Your administrator and broker/consultants make more money as your health plan performs poorly. Why is failure profitable to your advisers? Why not make them financially suffer when the plan suffers financially?
  • Benchmarking data is similar to rear-view mirror information, it’s behind, possibly interesting but not generally actionable.
  • If other plan sponsors are failing, don’t copy them.
  • Create an environment which facilitates members receiving the right care, on a timely basis, at the best value. Value equals (safety + best medical outcomes/cost)

It all starts with data + questions!

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