A goal of this blog is to educate HR, benefit consultants and insurance brokers on healthcare consumerism… from a doctor’s and former hospital finance consultant’s perspective.
My goal is to give you the insider’s perspective on providers, patients, health and disease.
You are a population health manager.
If you work in HR, are a benefits consultant or are an insurance broker, YOU are a population health manager. You are responsible for the health of a group of individuals and the financial implications of that group’s health. Now, you don’t do it alone. You have partners: healthcare providers, insurance carriers, PBMs and other vendors (wellness, Compass, etc.). However, ultimately you are in charge of making all these partners work together to improve health in a financially responsible manner.
So… if I was in YOUR shoes, what would keep me up at night?
#1 Sudden Medical Catastrophe
Sudden heart attacks. Ruptured appendicitis. Rapid onset leukemia. Some of these things you can reduce the risk of… others you cannot. Probably the biggest bucket of sudden medical catastrophe you can reduce the risk of is cardiovascular catastrophe—i.e. heart attack and stroke. How would I do this? Every person needs an annual checkup with a PCP who will perform the appropriate screenings/interventions which are (1) BMI measurement (2) blood pressure (3) blood glucose (4) lipids and (5) smoking cessation/nicotine replacement.
For the rest of sudden medical catastrophe… well, that’s why you have insurance and the on-going care for those catastrophes falls into the buckets below.
#2 Not-So-Wise Choices by my population’s members
Poor lifestyle habits. Being a passive, ‘I’ve-got-a-blank-check’ healthcare consumer.
A poll of employees found that 1/3 of employees are engaged at work, 1/3 are ‘checked-out’ and 1/3 actively despise their employer (Click Here for Forbes article on it). That means 2/3 of a company’s employees are not interested in hearing what their employer has to say about their own personal health choices. So rather than trying to cajole the people in your population, give them choices.
How would I promote wise choices by my population’s members? Give them a consumer-directed health plan and let their own choices impact their wallet or pocketbooks. Next, give them tools. Being an active, competent healthcare consumer is hard. Give them price and quality information about doctors and hospitals. Give them online and real-live-people resources. Now, this is my own personal bias because I think the most respectful way to treat people is as the grown-up, responsible adults that they are and not to feed into a cycle of dependence and victimization. But that is my own bias and your own organization’s culture will need to drive much of how you treat people.
#3 Not-so-Wise Choices by healthcare providers taking care of my population’s members
Burnout/Mental laziness. Practicing defensive medicine. Taking care of one small part of a patient’s health and not treating the whole person.
As this blog has previously reported HALF of all physicians report being Burnt Out. 50%. That burnout often manifests itself as not applying the mental diligence that he or she should. The doctor looks at their schedule—Yikes 30 patients! Just have to churn-and-burn to get through the day.
Ordering too many tests or referring to too many subspecialists just to ‘cover yourself’ legally. Practicing defensive medicine has not been shown to reduce lawsuits for physicians. What actually increases the risk of a lawsuit is the patient feeling like the doctor does not care about them or did not give them enough time. Tests don’t reduce lawsuits. A positive therapeutic relationship between doctor and patient reduces lawsuits.
How would I avoid healthcare providers that make not-so-wise choices? Analyze the data—My own data, the insurance carrier’s data, government agency data, private organization data—to determine who are the wise and not-so-wise providers and then guide my population to the wise providers. What does a wise provider look like? They follow recommended guidelines. They have established processes of care within their own practices or health systems. You don’t need to necessarily look at outcomes. You can look at the data to measure adherence to evidence-based medicine and processes of care. Then use plan design, personal healthcare concierge, online resources to guide your population to those providers.
So if I were in your shoes, that’s what would keep me up at night: 1) medical catastrophe, 2) poor health plan member choices and 3) poor provider choices.
Rome was not built in a day and neither was the ideal health plan, but you can start by systematically addressing each of these three areas.
Click on the link below to watch a 30-min webinar by me on healthcare cost and quality—key components of the above issues.