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Insurance & Benefits

Doing the Impossible: Better Care at Lower Costs

IntegerHealth is partnering with employers to guide patients to the best physicians while reducing costs.
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Surgery Hospital Doctor
Courtesy: iStock

What if you had a ranking of the physicians in your network? Would you switch doctors?

Local healthcare technology company IntegerHealth is working to give employers and employees more information about the physicians they are visiting in the hopes of guiding patients to the best providers. The aim is to drive down costs while improving outcomes, a challenge for any industry. “We have not been impressed at all over the years with how the healthcare system ties finance to quality,” says IntegerHealth Chairman and CEO Dr. Jack McCallum. “There has never been a valid quality measure for how healthcare is delivered.”

So how do they do it? IntegerHealth partners with employers, and analyzes healthcare claims data and employee absence records, getting a clear picture of which physicians get employees back to work sooner. If two employees with similar health backgrounds get the same shoulder surgery from two different physicians, and one is back to work a week sooner than the other, the employee is losing wages, and the employer is losing hours on the job. By steering employees to providers that consistently get patients back to their everyday lives, they improve quality and eliminate healthcare costs and productivity losses.

Integer Health partnered with the City of Fort Worth, one of the most progressive employers when it comes to creative benefits, to reduce absenteeism and healthcare costs. Integer looked at 20 years of Fort Worth’s claim data and built a network of physicians who ranked high on the quality efficiency measures. The data even allowed Fort Worth to see results for specific surgeries performed by surgeons. One orthopedic surgeon might be great at knees but not so much at shoulders. Another might have great results with stints, but not so with valves. The data can help patients know where to go where they will have a successful and quick recovery.

The data also allowed the employer to compare similar patients to make sure the rankings were fair. If a surgeon only works on complicated cases, he or she may have worse results but may be very skilled. That level of analysis was crucial in establishing quality measures. “Healing times will be different for different patients,” says Mark Barta, the assistant human resources director for the City of Fort Worth. “We want to be fair to our doctors, look at the length of the claim and how long they missed work which helped create a process to evaluate them.”

The goal is not just to point the finger at providers and tell them they are doing a lousy job. Many physicians don’t even have access to this type of data, so learning about their patients’ outcomes and recovery can guide their practice. Using past data, Fort Worth and Integer worked on predictive modeling to see if practitioners would meet expectations. Barta found Integer’s practice genuinely unique. “Very few people were taking a claim, predicting it, and then looking back and see how it could have been done better.”

Currently, the report cards are just for internal use to ensure most of the physicians are doing well enough. The city hasn’t incentivized patients away from their existing doctor right now, as those relationships and the location can be crucial to employees who may live all over the region.

To make these changes, organization leadership needs to have agency and desire to change the way business is done. But as costs continue to rise, more and more C-suiters are paying attention to their healthcare spend.  The key to all of the data accumulation is moving beyond just looking at costs. If a provider charges less for surgery, but patients aren’t back to work quickly and may need further care, the payers (patients and employers) aren’t getting the deal they think they are. “We can drive people to better care doing it this way rather than just lowest fee schedule,” McCallum says. “Costs are more than claims. We will tell you who gets the best outcomes, not just the best price.”

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