The American medical system has its own financial hydraulics, self-insurance employers to create and maintain an entire provider against the “fund shortages” perceived by public payers such as Medicaid and Medicare. There is a sophisticated and opaque “game” that depends on. Both doctors and hospitals are completely dependent on the financial benefits of commercial insurance. On average, private buyers pay about 2.5 times the Medicare fee for hospital care (even higher than Medicare for outpatient hospital services), according to a RAND study.
The COVID-19 pandemic only enhances this dynamic. Despite the huge spending of the federal government, employers are afraid that the overwhelming health care system may turn to them to relieve the financial pressures caused by the pandemic.
Large companies want and need existing healthcare systems to work. But so far, too many solutions to fix the broken ones are in the “Pimp My Ride” version of MTV. It badly shapes the chassis and engine and bolts advanced technology to a tired, old and ineffective frame. Large employers no longer want to play this game or extend blank checks to hospitals, doctors, health insurance and consultants, regardless of quality or proof of results.
Drafting a new team: where employers are heading
Many of the top US companies, such as Disney, Wal-Mart, and Boeing, aim to partner with private and non-profit organizations to leverage their vast purchasing power to change the rules of their games to attack inefficiencies. We are launching a new company. Instead of the “Pimp My Ride” approach, they are increasingly thinking about how to create new high-performance vehicles by making fundamental changes in the conception, pricing and delivery of clinical services in five broad areas. I am.
Set a standard and buy it
Increasingly, large self-insurance employers are focusing on working with open entities to meet quality and service standards and make meaningful measurements of performance. More companies are expected to move away from all-purpose arrangements with large-scale medical systems and medical plans to continue business as usual. And they work with providers who are willing to move away from a service fee system (which acknowledges that the employer has contributed) that does not allow the types of care that are known to maintain the health of employees. Some large companies are committed to changing their payments within three years so that integrated care focused on health outcomes and well-being can flourish.
Resist the integration of providers and payers
Large employers continue to scrutinize the further integration of their healthcare systems, despite the unfounded debate that they are somehow better for consumers. They then use the Sutter Health proceedings as a template to drive restrictions on anti-competitive business practices that have increased costs unnecessarily and intentionally.
Disciplined purchase of digital disruptors
Large employers want to know which solution is actually doing what they claim, as huge amounts of money continue to be poured into so-called “digital disruptors.” They rely on external organizations to deal with and evaluate the onslaught of marketing. A new company with clinical rigor and results data. These ratings help large companies make purchase decisions.
Retaining an intermediary in your account
Large employers, whether consultants, health insurance, or pharmacy benefit managers, also provide cost and quality performance to industry intermediaries and their employees they hire to fight for them. We are more proactive in taking responsibility. Employers’ historically unfulfilled expectations that vendors are transparent about how they spend money are driven by the trustee requirements of the 2021 Consolidated Expenditure Act, demonstrating the value of services purchased by self-insurance employers. Face new obligations to do.
Targeted Public Policy Initiative
Finally, with the support of skilled coalitions, large self-insurance employers are more cautious about looking for policy solutions in the event of a market failure. This is the way to successfully advocate the provisions of the Balanced Budget Act to extend surprising billing terminations, demands for hospital price transparency, and negotiated pharmacy discounts to commercial payers. was.
After all, while they didn’t take bold action to fix healthcare and change the funding of “game” employers, the interests of others are greater for their business and employees than to continue their current path. It is a threat. But even the largest employers know that the system cannot be modified alone. The way to do that is to work with other private and public buyers to increase their firepower by putting pressure on the healthcare system and improving its performance. The “game” has to change, and many of the country’s largest employers are taking bold steps to do just that.
Elizabeth Mitchell is the CEO of the Health Buyers Business Group, a coalition of some of the largest employers in the United States, an internationally renowned writer, consultant, and futurist, with a particular focus on long-term forecasting. And specializes in planning. Healthcare and a changing business environment.
Disclosure
For decades, Morrison has been a paid speaker and advisor to many parts of the healthcare ecosystem, including hospitals and healthcare systems, healthcare planning, employers, pharmaceuticals and healthcare technology companies. He is currently a member of the board of directors of the independent non-profit Martin Luther King Community Health System in Los Angeles, a senior advisor to Leavitt Partners, a member of the Founders’ Council of the United States of Care, and a senior advisor to Concord Health Partners. , Private Equity Farm.
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