Healthcare Disruptors Claim War Is Won

Great progress has been made in solving the problem of cost and quality -- but there sure are a lot of battles still to fight.

The above picture and caption reflects the view of a somewhat select but growing group of consultants and brokers within the healthcare cost management community known collectively as disruptors. It illustrates our feeling about the traditional healthcare funding system and how it has failed those it was to benefit. To all those known as disruptors, I say, “We have more battles to fight but the war is won.” To you, my fellow disruptors and Health Rosetta friends, as well as non-industry readers: Every day, I am amazed about the success stories I share, and the stories shared with me by my fellow disruptors in the healthcare consulting world. It is now commonplace to hear how long-term cost of care is being controlled, primary care provided at no cost to employees, employees no longer struggling to decide if they can afford to take their child to the doctor. What it means to have real access to your (yes your) primary care doctor. Real access is defined as access to your (yes, your) doctor within 15 minutes, 24/7 at their office, your home, your office or by video. Does anyone remember Marcus Welby M.D.? The ability to shop for surgical procedures provided by the best doctors at the best facilities and employees who now see their healthcare funding plan as a real benefit. A benefit worth staying with their employer for and a benefit worth changing for! All of this is accomplished everyday by consultants who have chosen to think outside the traditional “buy insurance” box. Heck, some of you never even saw the box in the first place. It is the success we are having that brings me to the core issue for this article: “If We’ve Won the War on Healthcare Cost, Why Are We Still Fighting So Many Battles?” See also: Whiff of Market-Based Healthcare Change?   You see, it seems counterintuitive to me that answers can be so clear and abundant, yet we continue to struggle in communicating our message of change. The first struggle I see is the client who always wants to know who else has done this or tried that. I believe this comes from years of no innovation, real thought or transparency from me and my fellow consultants. Even those of us around before PPOs (that’s you, Bill Rusteberg) became numb to the annual increases and the status quo that followed their introduction to the marketplace. We bought into the whole medical trend and discount mindset, allowing our clients to bear increases year after year, all because we believed it was the new normal. Because of this past lack of leadership by the consulting community, why should we be surprised when employers are skeptical and want to know who has done this before? What makes today unique, however, is that the question very rarely comes up in other employer expense categories. I believe this is because the free market system has continued to flourish in the other categories and been well-applied by the business community in all areas other than healthcare. Is it any wonder that when you tell an employer it can return 30% of their No. 2 business expense to the bottom line, stabilize future cost and make employees raving fans of the healthcare funding plan, the employer would like to see proof? I think not. The second struggle I see for us is the 30-plus years we allowed the big insurance companies and hospitals (now healthcare systems), to tell us and employers that you must have access to a PPO to avoid the huge bills the healthcare systems generate. Heaven forbid you have a $500,000 heart surgery and don’t have a PPO to discount it to $250,000. And then, in an Abracadabra “Wizard of Oz” moment, we are told not to look behind the curtain where we would see a cash price of $75,000 to $100,000. So, let’s get this straight: We need a PPO to discount a $500,000 bill to $250,000 when we could have paid $100,000 cash? Not to forget these same PPOs have exacerbated the fee-for-service model, which has led to long wait times and an average time spent with the doctor of seven minutes a year. These actions perhaps more than anything else have decimated the primary care doctor. I would encourage the reader to move that process to any other area of their economic lives. The best example I can think of is a furniture sale. We consistently see furniture advertised for 50% to 60% off. Yet if you take the time to really shop you will find that just maybe the prices have been increased to allow for the advertised discounts. The model we have used for so long simply makes no sense when truly reviewed. However, and this is important to understand, it is the system employers and employees know. As a bit of defense to my profession, the access we now have to data did not exist even 10 years ago. For many of us, it was that early ability to finally “see behind the curtain” that started the transition to how we do business today. Additionally, the internet, with all its problems, is a remarkable tool for collaboration. It, more than anything else, has allowed for innovation and collaboration within our community. As an additional illustration, please view the video from David Contorno, a friend and healthcare cost disruptor from North Carolina. Faced with the need for a hernia surgery, David’s effort to find a quality and cost-effective solution brought him out West to Oklahoma City. Thanks, David, for allowing me to use this video. Thirdly, we need to be passionate in sharing what we know. Employers are struggling with increasing cost of health insurance. Few of them have realized that the cost of health insurance and the cost of healthcare are two very different things. They are concerned about their employees who watch the increases in health insurance premiums eat up the raises they receive. Many employers have gone to plans with high deductibles and higher out-of-pocket cost in an effort to control premiums. However, this attempt while initially somewhat effective is no longer having the desired results. High-deductible plans are now increasing at the same or greater rate than traditional PPO plans. Studies show that the No. 1 concern of employees is where they stand financially, and the No. 1 financial concern is the cost of insurance and healthcare. I want the employees and employers I/we work with to know that those with whom I/we associate are passionate. Passionate about the employees who can’t afford the family premium to cover their spouse and kids, passionate about the single mom who wakes up at 2 a.m. with a child who has a 105-degree temperature and has to decide if she can afford a trip to the hospital because she doesn’t have a primary care doctor, passionate about the 50-year-old diabetic who ends up with a preventable surgery because he couldn’t afford his diabetic supplies, passionate for the employers that I/we have allowed to overpay into a bloated system, passionate because for so long I/we were a part of the problem but now understand that we can truly make a difference. We damn well need to be passionate. See also: How Advisers Can Save Healthcare   No. 4: While most of us in the disruptor community have already changed our compensation models, our profession, as a whole, must do the same. Being paid a flat percentage of the total cost of the plan simply adds to the problem. How can my goals be aligned with an employer if I receive an automatic pay increase when rates go up? Additionally, if I/we work hard for a client and improve/reduce healthcare costs, why should I be paid less? Better to have an open and honest discussion with the client about compensation. This allows for total transparency and allows for all goals to be aligned. By changing to a fee-based model, you can set expectations, provide better service and, with time, good works and trust, become a trusted member of the employer’s healthcare cost management team. Finally, to those of you who are not industry professionals, those employers and employees who have made it through this self-reflection of mine. I want you to know that there are real solutions that can help, and there are many nontraditional brokers and consultants who will be glad to show you the way. I would encourage you to simply reach out to any of those named here: Mark Watson with Union County Employer; Marilyn Bartlett, State of Montana Employer; Jeff Bernhard, Continental Benefits; William Rusteberg, consultant; David Contorno, consultant; Dave Chase, author; Mike Dendy, Asserta Health; Chas Dummit, Higginbotham; any member of Health Rosetta. Some, like me, are consultants, some are employers who have made a change, some are authors and speakers, and some are unique vendors who are making a difference. We are geographically diverse but united in purpose. I know that any of us will be glad to visit. We are all passionate!

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