For EmployersNovember 16, 2019
Are You Getting the Most ‘Health’ Out of Your Healthcare Dollar?
In today’s competitive business environment, competing for and retaining quality workers is always a challenge. Offering a meaningful health insurance benefit can give an organization the edge over its competitors. And a healthy workforce is a productive workforce.
However, the cost of medical care is quickly becoming unaffordable, and every employer is faced with tough decisions about the health insurance they offer their employees. Do you trim down the benefit package to save money? Do you shift more of the premium cost to your employees and dependents? Do you stop offering it altogether? Moreover, how do you know if you’re even getting the most out of your healthcare dollar? What is your return on that investment?
Engaged Benefit Design was created by Engaged Public, with funding from the Dr. A. J. Kauvar Foundation, Robert Wood Johnson Foundation, and by the US Department of Health and Human Services through a contract with the State of Colorado. Actual decisions were made by top Colorado doctors, including Dr. Dave Downs, Medical Director at Engaged Public and a past president of the Colorado Medical Society. It is used to modify an existing benefit package, building in incentives for better, smarter healthcare decisions. It promises more value for your healthcare dollar at any price point.
Consider the following realities:
The more that costs are shifted to employees in the form of higher copays, deductibles and coinsurance, the more they will postpone or forgo medical care (both necessary and unnecessary).
Not all medical care is created equal. It is clear that healthcare services are highly variable in terms of effectiveness, impact on health outcomes, cost and applicability to specific individuals. Current health insurance values these without much discrimination so that coverage for high cost services with marginal benefit is often the same as coverage for low cost services that have great benefit to both individuals and populations.
A healthy workforce is a productive one, and studies show that individuals with insurance are more likely to be healthy than those without.
Patients are interested in what happens to them. The people with the greatest interest in healthcare outcomes are patients. At stake are their lives and health after all. In spite of this, treatment decisions are usually made by patients and their families without complete understanding about the risks versus benefits or the alternatives. Decisions are frequently delegated to a provider who is compensated to provide the service. In truth, the same treatment may not afford the best outcome for every individual. For example, treatment for prostate cancer, which can result in loss of sexual function and urinary incontinence, might be a fair tradeoff for one person and not for another.
ENGAGED BENEFIT DESIGN – Paying for What Works Best
Engaged Benefit Design (EBD) is a new approach to health insurance. It is a tool created by Engaged Public, with funding from the Dr. A. J. Kauvar Foundation the Robert Wood Johnson Foundation and by the U.S. Department of Health and Human Services through a contract with the State of Colorado. Actual decisions were made by top Colorado doctors, including Dr. Dave Downs, Medical Director at Engaged Public and a past president of the Colorado Medical Society. It is used to modify an existing benefit package, building in incentives for better, smarter healthcare decisions, guaranteeing more health for your healthcare dollar at any price point.
No Co-pay, High-Value For many chronic conditions and preventive services
for which there is a best practice, there is no co-pay when your employees receive that care. These screenings and treatments, such as prenatal care and insulin to treat diabetes, have strong scientific evidence to support their use. For a list of these high value services, click here.
Costs More, Learn More Some treatments may be appropriate for people in certain circumstances, but not others. They are often expensive and require careful consideration by the patient. Such treatments have an additional surcharge, which is intended to serve as a “speed bump” in the decision-making process, sending a message to slow down, learn about all the options, and then make a decision with a caregiver. For a list of these services, click here.
Shared Decision-Making Shared decision-making involves a discussion between a patient and their healthcare provider about their health, their treatment options, the benefits and risks of those options, and their personal preferences and values. It is the act of reaching an agreement together on the best strategy for treatment. EBD’s goal is to create the conditions necessary to enable shared decision-making. It does this through patient education and the use of Patient Decision Aids (PDAs). These PDAs are evidence-based tools, including videos, that include descriptions of health problems and procedures to make the options, benefits, and risks for medical decisions clearer to understand. They help patients consider their personal values and set the foundation for patients to make an informed choice in partnership with their clinician and loved ones. EBD makes these tools available to all employees.