October 2, 2018 - No longer able to rely on traditional cost sharing techniques to manage costs, a growing number of employers are taking an activist role in shaking up how care is delivered and paid for," said Brain Marcotte, CEO of the National Business Group on Health, as reported by CNN.
Healthcare remains the only major economic sector and consumer of roughly 20 percent of the GDP, where the customer generally has no idea on costs, particularly on an insured procedure, medical appointment or prescription drug until AFTER they place the order or receive the service.
Many employers, large and small, who want healthy employees and want to provide benefits have found the current service and funding model to be irreparably broken, and an increasing number of larger companies are employing direct service plans, ranging from onsite medical clinics to incentivizing wellness and Health Saving Account options (HSA), which are particularly popular among younger/healthier employees.
In an odd twist of irony, well over 24,000 GM salaried employees across southeast Michigan will next year be able to select such a less expensive service delivery model (with significantly lower premiums) with care provided exclusively by the Henry Ford Healthcare System. Ford Healthcare will provide all medical services, surgeries, and E.R. visits, as well as prescription and pharmaceutical products via its network of six hospitals, 3000 doctors and health care providers through GM's new "Connected Care" plan. GM's thousands of hourly workers and Union employees will continue to receive health care via a contracted benefits plan and more traditional service model. Connected Care will also provide wellness exams, chronic care monitoring and preventative screenings, in addition to prompt appointments with providers and virtual visit options delivered via telemedicine.
Comcast, the nation's largest cable provider and owner of NBC networks as well as Universal Parks & Resorts, is turning its $169-billion behemoth ship as well as holding the annual increase in its health care costs to roughly 1 percent a year. Comcast spends roughly $1.3 billion a year on health care for its 225,000 employees and their families. But instead of charging their employees higher premiums, Comcast has instead selected a flat up front deductible expense (subtracted from payroll) of on average $250.00 per employee. That is an ANNUAL figure.
Instead of handing this massive headcount to any leading insurer, Comcast is directly contracting with a handful of highly specialized service providers. Comcast uses several technology start-ups, one of them called Accolade (in which Comcast is also an investor) providing employees with health care Navigators to help them understand, as well as guide them through the host of service and treatment options. The focus is on keeping the employee healthy, without requiring them to become expert at managing co-pays, deductibles, generic drug costs or nearly requiring a medical certification or training if a member of their family is chronically ill.
Another Comcast system provider, Grand Rounds, is available for more complicated health care challenges, serving as both a check on costs and charges, and a referral network of skilled practitioners for more complex surgical and related treatment needs. Insurers hardly love this delivery model, which treats them like an expensive middle-man, providing little or no real value or return on investment.
Some insurers are receiving that message and also responding in the marketplace. Following a raft of research which demonstrates that health care costs decline when a consumer’s basic social and well-being needs are met, WellCare Health Plans of Tampa, Florida opened a call center for customers needing assistance with housing, transportation and other social concerns...now being connected to community and social service organizations, in addition to health care providers.
Kaiser Permanente in Oakland, California, is investing $200-million in projects to protect and preserve affordable housing in the Bay area, to revitalize challenged neighborhoods as well as improve overall community health. United Health Care has partnered with another start-up called Healthify to use software in pre-screening new insured clients to better assist them with identifying social service and community support groups in addition to better coordinated care among their network of service providers to help insure better patient outcomes.
Our traditional health insurance/government hybrid service delivery model has long been in need of a check-up and some surgical upgrades. Unfortunately our state and federal government leadership typically lacks the courage or stomach for touching this proverbial 'third rail' of American politics...leaving the private sector once again to try and shine a light and lead the way. More power, and more innovation to them.