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Forbes Reports States Fail on Transparency – How Are You Doing?

 

By DrScott – Posted on March 27, 2014 on www.compassphs.com

Transparency transforms employee’s relationship with health care. Actionable data delivered in a way that allows informed decision making has the potential to save tens of millions for both organizations and individuals at risk for health benefit expenditures.

The Accountable Care Act requires making transparency information more available and actionable for the public. This article points out that our states have not navigated this challenge successfully – yet. As Suzanne Delbanco executive director for Catalyst for Payment Reform states, “As much discussion and activity as there is around transparency, the truth is that today it’s a very rare instance when a consumer can easily find meaningful information about health care prices. We’ve got a long way to go.”

The challenge is even bigger than this article acknowledges. In order to go from an F to an A in the state transparency ratings, all that had to occur was for the data to be put on a web site. As the article states “In order to get a good grade, the groups say a state needs to provide public access to a “fully functioning website” as well as ensure regulations on price information are accessible for a long period of time.”

Engagement data suggests that having access to a web portal is only a beginning. Translating the web information into action often requires human support and interpretation. The moment questions like “is the MRI with or without contrast” are asked, many users are stumped and abandon their transparency exercise.

Charting a New Path. Why Creating New Habits Saves Money at Work.

By DrScott – Posted on February 11, 2014 on www.compassphs.com

Sixth in the How to Switch On Your Employees Series

For one Compass client, “Contact your Health Pro” became the mantra.

  • “Which plan should I choose: the PPO, HMO, or high deductible plan?” Contact your Health Pro.
  • “Who is a great female family doctor near my home?” Contact your Health Pro.
  • “Where do I get my colonoscopy done by the best doctor?” Contact your Health Pro.
  • “How do I find the best, lowest cost place to get an MRI of my back?” Contact your Health Pro.
  • “My doctor says I need glasses, how do I use the vision plan?” Contact your Health Pro.
  • “I have a 3 month prescription and I don’t know how to do mail order.” Contact your Health Pro.
  • “Where is the best cancer center and which doctor should I see?” Contact your Health Pro.
  • “Do I qualify for a weight loss program?” Contact your Health Pro.
  • “Have I met all the requirements for the best health plan next year?” You guessed it: Contact your Health Pro.

The human resources staff had only a few employees. The new outcomes based program had too many variables, something had to change. In the past employees called HR, they were given the phone number for the insurance plan, the wellness program, the PBM, the vision program, and so forth. But the number of phone calls and the complexity was too much. Often in frustration employees just gave up, the HR staff members were exhausted, participation in programs was low, and costs were not coming down.

A new concierge program was brought in. The Health Pro concept, telephone number and website link, were introduced through a number of communication venues that included:

  • Through open enrollment communication materials and meetings.
  • At company meetings.
  • On the back of the health, vision, and dental cards.
  • On the corporate intranet site.

Involvement in the program and services dramatically increased. Every contact was tracked, behaviors were followed, and results documented.

The results were significant:

  • Calls to the HR department went down 25%.
  • Over 40% of employees contacted their Health Pro.
  • Participation in mail order prescriptions, the employee assistance plan, smoking cessation and weight loss programs all increased by double digits.
  • Health care costs for CT scans, MRI scans, and colonoscopies were reduced by 50% for dozens of employees.
  • Use of the “Designated Physicians” who met quality and cost metrics increased by over 25%.

The financial return on investment for the new Health Pro program was reported quarterly and varied from 5:1 to 8:1. In addition, the Net Promoter Score for the Health Pro was 72 – the highest for any vendor the company used.

As Chip and Dan Heath share in Switch, managing the path forward required shaping a new path. The employees had to change their habit from relying on the HR department for all the answers to contacting their Health Pro first. They were beginning to use all of their benefits, and to provided cost and quality transparency information. The “herd” had made the turn and actually encouraging each other on this new path.

The third key ingredient in making the “switch” was successfully navigated and momentum was building. By managing the three aspects of change, the question was not “if” but “how much” success would occur each year. In the next blog we will complete this series and review how to successfully navigate to a high performance, outcome based system.