Healthcare payment reform is an issue that businesses have been grappling with for decades. The traditional system of healthcare financing has become unsustainable, and employers are seeking new ways to afford health benefits for their employees. While challenging, payment reform is achievable and can lead to significant benefits for both employers and employees. Here are four steps that can pave the way for meaningful healthcare payment reform.
1. Data Analysis and Network Strategy
The first step involves employers taking a deep dive into their data to identify cost-saving opportunities. By understanding the healthcare needs of their populations and working with data analysis partners, employers can pinpoint where they can save on ‘shoppable’ care. This could mean finding healthcare providers that offer high-quality care for less. Utilizing all-payer claims databases (APCDs) is crucial in this stage to understand the total costs and make informed decisions.
2. Plan Design and Employee Education
Employers are also rethinking their health plan designs. Transitioning from low to high-deductible plans encourages the use of high-value care resources. Combining higher deductibles with little to no cost for high-value care, such as certain procedures covered at 100%, can be beneficial. Educating employees on how selecting high-value care can lead to personal savings is key. This education, coupled with contributions to health savings accounts, can create a win-win situation for all parties involved.
3. Advanced Primary Care and Care Navigation
Onsite clinics have become an integral part of value-based plan design. They offer a range of primary care services at lower costs and can aid in care navigation, particularly if they are staffed by clinicians who have access to data on high-value care. These clinics, along with care navigation services, can guide employees to make informed decisions about their healthcare needs.
4. Leveraging Health Policy and Competition
The final step involves the regulatory and competitive environment. Employers need the freedom to apply free market principles to healthcare purchasing. This may require engaging with lawmakers to ensure that the regulatory landscape is conducive to value-based payment strategies. For example, opposing legislation that aims to preserve high profit margins on certain high-cost medications is part of this step.
By following these steps and investing the necessary time and effort, employers can make a meaningful impact on healthcare payment reform. The end goal is a healthcare market that rewards high-quality, cost-effective care, benefiting everyone in the system.
In summary, payment reform is not just a possibility but a necessity. It requires a comprehensive approach that includes data analysis, plan design, advanced care options, and proactive health policy engagement. When done correctly, the results are not just reduced costs but also improved healthcare outcomes.
