Playwright Oscar Wilde once wrote, “A cynic is someone who knows the price of everything and the value of nothing.” The government certainly feels The Importance of Being Earnest in its attitude toward patient empowerment, but it may give doctors greater dread. Recent legislation to provide price transparency for medical services and hospital charges will help us avoid surprise billing (if not sticker shock), allow us to negotiate lower costs, and improve quality when providers know they are under greater scrutiny. This was the same theoretical theme expounded by Nobel Prize winning economist Milton Friedman when he promoted health savings accounts. The problem, then as now, is not so much the absence of data, but navigation of knowledge. We need answers to questions such as: How do we explain complex pricing? Where else can we go for similar services? When is negotiation possible when “preferred provider” contracts are in play? And who can we trust for objectivity about efficacy and effects of recommendations?
Ask anyone who has suffered a serious injury or illness, or is living with a chronic condition necessitating continual and considerable expense, how they feel about the state of health care in the U.S. The inner workings of our health-care delivery system remain a mystery. Transparency is helpful, but like all such legislation, it spawns additional questions. For example, what does the terminology mean? Does this include any contract or cash discounts? Are there alternative therapies or procedures available, and what do they cost?
Health care not only costs a lot, but the pricing is a mystery. Shielded behind third-party payors (insurance companies or employers), indecipherable discounts, confusing claim statements, and the ordering of tests and procedures (not pre-approved and not always necessary), it is a system shrouded in mystery and often opaque even to the most acute observers. Politicians recognize this and some believe Medicare for All will solve the problem. It only exacerbates it since it is control from the top down, using the same tools as all third-party payment systems—rate caps, rate negotiation and rate reduction. Compelling transparency, clear benefit explanations (Affordable Care Act), and a potential for foreign drug importation (new proposed FDA regulations) are helpful. Reform, or even revolution, however, must come from the bottom up, which means arming patients not just with information, but the ability to use that information to their benefits.
There are several resources available, not surprisingly, but they don’t often appear directly to the public. It is difficult to pierce the outer (and inner) walls of the system. Health-care providers are often constrained by contract from providing alternatives, or the ability to explore expenses. Insurance carriers won’t always tell you if a procedure is covered, how it is paid, and what you may owe until you submit the claim. Health professionals, already battle-weary from debating patients armed with Internet diagnoses, won’t welcome pricing wars, especially when they rarely know the cost bases. How will price transparency help this patient? What can help? What will help? The answer is simple advocacy, a combination of system knowledge and the wisdom of how to ask for what is needed and then get it. The broker who has access to resources, companies, consultants, and concomitant communications is in your corner and should be employed.
There are a number of resources employers should expect from industry experts such as a benefits broker, advisor, or consultant. Helping employees to become better health-care consumers is key. Health benefits professionals can provide your company and employees with pricing information; educational information; guidance to navigate the system; strategies employees can use to become their own health-care advocates; and assistance from providers when English is a second language. Additionally, second-opinion programs offer another way to use the system more effectively, and also reduce costs on a global or employer-specific basis.
The tendency now is to limit the broker-consultant relationship to discussions of price, design, markets and options. As a result, the disconnect between the system and the patient is permitted to continue. Employers and their employees can better manage health-care costs, access, and utilization while participating in their own financial and medical outcomes, fostered by concerned, knowledgeable, and attentive advisors.
As health care increasingly evolves to consumers having to make a financial decision (my medication or my mortgage?), advocacy and enlightened discussion of decision consequences move to the forefront. It’s not enough to see the cost; without data and education, you’re lost. Employees need information and support to help them understand, appreciate and act on how best to derive value from abstruse facts and figures, as well as get the highest quality and most appropriate care, medically and economically, for their individual situations. Employers can help make this more consumer-centric model a reality, calling on benefits consultants to communicate, explicate, and most of all advocate on behalf of employees. Better to rely on who you know and what they know, so you can improve health-care consumerism among your company’s employees.
Arrow Benefits Group Senior partner Jordan Shields has been a leading industry consultant for over 40 years, and is dedicated to client and community service Arrow is one of the Bay Area’s largest private benefit consultants, focused on "humanizing" the intricate benefits process and creating new solutions in the complex field of employee management. Learn more by visiting arrowbenefitsgroup.com, or calling (707) 992-3780.