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Influencing Health Costs Through Insights, Innovation, and Trust

Healthcare Challenges

We have come a long way. There are now many options for self-funded employers to influence healthcare costs and outcomes: advanced analytics, direct primary care, direct procedure contracting, rx stewardship, etc. However, I was recently reminded of how long a way we have to go when a client missed an opportunity to save hundreds of thousands of dollars on sourcing a particular medication because their PBM threatened breach of contract.

Alas, we can all imagine that conversation even as we rail against the bizarre notion of being told we are contractually obligated to pay more for a prescription medication – not because we negotiated a specific price but because the hidden games of spread pricing, rebate skimming, and other opaque misalignment are buried in an impossibly complicated contract. Buyer beware.

Attending a health benefits conference this week, we will encounter similar stories and associated cries for help. Many continue to cry to the government for relief: forced price transparency, forced price controls, more intervention, more government. However, even the best intentions have unintended consequences and, let’s face it, there is too much money on the table to rely on best intentions. No, we need to own this and continue to work on solving it with less regulation.

For those of us serving self-funded employers, the call for help has never been louder. In the worksite health center space, onsite and nearsite wellness centers have served as a step forward for employers seeking the means to influence their healthcare spend while aiming for the best possible health outcomes for their employees.

Though the full promise of these employer-funded health clinics remains unfulfilled, we are getting glimpses of these sites as a potential nexus of care for their employer-sponsors. New services. Better mechanisms for measurement. Increased visibility on data and costs. Improved care coordination. Efforts to broaden points of influence on cost and care. The call for help has never been louder and, though worksite health centers are a long game from a value perspective, we’re beginning to see that the value is worth the wait. More influence and higher value are appearing on the horizon.

However, we’re not there yet. Barriers remain to a world in which employers and their employees make rational decisions based on good information, clear choices, and strong options. The infrastructure created to help employers navigate the complexities and costs of healthcare has its own challenges. For those of us living in that world, we can do better. We need to do better. Looking broadly at the issues and opportunities, employers are telling us they need four things:

  1. More trust, less obfuscation.
  2. More innovation, less me-too.
  3. More insights, less uncertainty.
  4. More influence, fewer excuses.

More Trust, Less Obfuscation

Companies are growing increasingly frustrated with the opaque world of incentives that permeates the health insurance and employee benefits market. The question of “who is getting paid for what” has never been more relevant. Transparency has become the operative word as companies seek to unravel the twisted maze of incentives dotting the health insurance and benefits landscape. The goal isn’t to eliminate profit for those who bring value, the goal is to ensure that value is being provided for the amounts of the incentives.

Ask yourself, if you felt really strongly about getting paid for a service you brought to a client or making margin on a product you delivered, why would you hide the fact that you made money on the transaction? We all want to work with people we trust and we don’t trust people who hide things. Integrity goes hand-in-hand with transparency; none of us want to work with those who obfuscate the truth.

More Innovation, Less Me-Too

Employers are bombarded with products, services, value propositions and various other “shiny objects” promising big results for a fee.  What do we need? Meaningful innovation. Business leaders need new ideas that make a difference. The era of playing copycat to the buzzword, new idea-of-the-day, has grown tedious and unsustainable. We can’t afford all of the shiny object solutions and high-value partners are the ones who bring creative solutions that solve real problems.

Meanwhile, me-too competitors are too busy trying to win, outmaneuver, hide behind the legal system, lock us in with contracts, and copy first movers rather than bringing their own innovation. What is meaningful innovation? 1) It solves a real problem, 2) It centers on your business, 3) Its cost is more than justified by its value, and 4) It tackles old problems in new ways. While we’re at it, why don’t we push for more? I don’t want a solution that justifies its cost, I want something to bend the curve. Give me something that is 10x better than what I’ve got today. Me-too? Don’t waste my time.

More Insights, Less Uncertainty

Companies want actionable insights. Don’t bury us with data, give us something that actually helps us make a decision. Big data has been a wonderful buzzword but how much of that big data is making its way to a medical provider serving a patient? The reality is that we’re trying to assimilate so much information that clarity remains obscured behind lines of data populating endless spreadsheets or presented in glossy dashboards that don’t get to the real issues. Insights come from conclusions drawn from all of that data. Employers need partners who are helping them analyze it, summarize it, and draw useful conclusions. Ultimately, we want to make the best decision while avoiding the pitfalls.

In the worksite health center world, understanding the intersection between patient care and the financial impact to the employer is a great start; determining the five highest value activities stemming from the analysis of patient health outcomes and corporate healthcare financial data is priceless. Why isn’t this happening? Competence. Focus. Priorities. We need partners with the capability to collect the right data, the willingness to focus on the information to draw insights, and who prioritize our success.

More Influence, Fewer Excuses

Employer healthcare costs this year are expected to increase to pre-pandemic levels. Companies want answers to the big questions and solutions to their problems. Companies don’t want excuses: the government, COVID, elections, unhealthy employees, bad luck, the stock market, etc. Quit telling us about the things we can’t control. A major promise of the worksite health center model is to mitigate uncertainty by directly influencing the overall health of an employee population.

Why are employers firing advisors, brokers, vendors, and clinic vendors on a record pace? They want more. We all know the problems, who can we rely on to bring us solutions? When you hire a company to help you manage your benefits spend, identify new ideas, or help employees live healthier lives, you want to see positive movement. As soon as the excuses begin, we know you’ve run out of ideas.  Employers are seizing control of their health spend as a matter of necessity. All who exist in this space need to listen closely and focus on making an impact…regardless of the all of the reasons you believe it is impossible.

The Way Forward

The challenges remain but the opportunities are significant. Punting healthcare into the bottomless pit of government bureaucracy may seem like an easy answer but the price will be steep. Companies have not yet given up on impacting the delivery of care, finding ways to improve health outcomes, or more effectively managing their healthcare spend. The stakes are high but so are the benefits. Somewhere in the middle of the fray is a place where our dollars intersect with the opportunity for all of our team members to thrive. Somewhere in the pursuit of happiness lies the chance for us to manage the morass that has become healthcare and deliver on the promise of our system.

For self-funded employers with an onsite/nearsite health center, expect more. Demand more. Your investment should be toward making that wellness center a nexus of care for your employees, a catalyst for improving outcomes, and a lever for lower overall costs. Demand more trust, more innovation, more insights, and more influence. Demand results. Anything less is unacceptable.

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