Have you given any real thought to how we select certain health care providers such as physicians or hospitals? We do so out of complete ignorance of any quality measures. Today, it would be common to ask a friend or neighbor who’s had a particular procedure “where did you go and who is your doctor? How did that turn out? Maybe I’ll see them.” Or we might just trust the doctor who referred us to a specialist – who could be their friend or a familiar colleague.
We spend more time shopping for a vehicle and/or other goods than we do for healthcare providers. We can look at the detail on a vehicle sticker or the customer rating on Amazon, but we don’t know how to measure quality or providers or even have the access to quality metrics.
The reality is that the vast majority of us have no access to any quality measures or outcomes for physicians and hospitals. From time to time we may see a variety of hospital awards which may be self promoted or using criteria that doesn’t really reflect quality. Physician quality is even harder to come by – we certainly may know the reputation of a clinic or physician group but once again, the reality is that physicians come and go.
Believe it or not, higher-quality translates to lower costs for the member and the health plan. Quality can be measured in certain ways, and some of the more common criteria to look for when selecting providers (hospitals and doctors) would be:
- Lower Readmission Rates (National average is 15.6% according to CMS)
- Fewer Misdiagnoses (Cancer has a reoccurring 10 to 20% misdiagnoses rate according to the American Cancer Society)
- Lower Infection Rates (1 in 25, or 1.7 million hospitalized patients will contract a hospital acquired infection rate each year. 100,000 of them will die from it according to the CDC)
- Reduction In Patient Harm (nearly 100,000 patients die each year due to medical errors according to the Center For Patient Safety)
- Fewer Complications (surgical complication rates are 20% nationally according to the National Surgical Quality Improvement Program)
- Appropriateness Of Care (this affects nearly 12 million people per year according to the National Academy Of Medicine)
What would you think if you had an objective, healthcare professional seek out the highest quality of physicians and facilities for you? That would be a good thing, right? We all want the best quality healthcare for ourselves or our loved ones, but the way we seek quality is so informal and void of quality information.
We are now creating health plans for employers that give employees the opportunity to utilize independent healthcare professionals to research the highest quality providers when seeking healthcare. These professionals give an employee several alternatives of physicians and/or facilities to utilize for their upcoming procedure. These physicians and facilities will be the ones that have the highest quality measurements and outcomes. If an employee chooses to use the recommended providers, then 100% of their out-of-pocket costs are waived. Should the employee choose to use a different provider of their choice who may or may not be in the PPO network, then they would be responsible for the health plan deductible and out-of-pocket costs. If a recommended provider(s) is not within their immediate geographic region and the employee chooses to travel to that provider, then travel costs are also waived.
I know it sounds counterintuitive to everything else we purchase but in healthcare, high quality translates to lower costs. The net-net results actually reduce claim costs by 18-20% by using the highest quality providers.
If you’d like to learn more, please contact me at [email protected] and I can fill you in.
