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Curbing Healthcare Hikes

Blue Cross Blue Shield's Texas Chief Medical Officer says DFW is the most expensive place in the country to receive care if you have commercial insurance.
By D CEO |
paul hain blue cross blue shield texas chief medical officer
Jill Broussard

Business pays the majority of healthcare bills for the commercially insured in the United States, and Dallas-Fort Worth is the most expensive place in the country to receive care if you have commercial insurance.

At Blue Cross Blue Shield of Texas, we always strive to work with our employer partners to help deliver the lowest cost of medical care while preserving the quality and access that Texans deserve.

However, employers are increasingly feeling the pinch of doing business, which is almost a “healthcare tax” in the form of high facility and physician bills, where most hospitals receive 200 percent to 400 percent of what Medicare pays for a service. What can business leaders do to try to minimize their healthcare tax? Along with getting involved in the legislative process, here are four tips to keep healthcare costs down.

  1. Pay Attention to The Total Cost of Care. Many insurers, hospitals, and other healthcare entities will try to hold the attention of employers by talking about lowering costs in one specific area, be it by direct contracting, narrowing networks, or enhanced patient management programs. Although each has the potential to help, lowering costs in one area while others rise does not aid the overall mission. If you pay attention to all of the dollars leaving your account (via administrative fees, shared savings fees, consulting fees, miscellaneous fees), you will have a better understanding of the best deal for your business.
  2. It’s OK to Engage When Your Insurance Carrier is in Negotiations with a Hospital or Physician Group. Your employees deserve access to quality, cost-effective care, and sometimes it’s your voice that ultimately ensures a fair deal for all parties. Standing firm beside your carrier while asking pertinent questions of both your insurer and the providers during contract negotiations makes a difference. Helping your carrier negotiate lower rates can help you get the best deal.
  3. Free-Standing Emergency Rooms Can Cause Big Financial Problems. Can you imagine paying $72,000 for a few stitches in your hand or $103,000 for treatment of a cat bite? These are two examples out of hundreds we have seen from free-standing emergency rooms (FSERs). There has been an explosion in FSERs in Texas, causing a drastic spike in costs. FSERs are typically out of network and maintain the ability to assess patients for the difference between what the insurance company pays and the billed charges. These bills can be financially devastating and have little relationship to the actual cost. Seventy-five percent of all patients seen in FSERs could be treated in an urgent care clinic. There’s an average cost difference of $2,199 versus $168. That adds up to an impressive escalation of healthcare costs.
  4. Pay Attention to Pharmacy Costs. Years ago, pharmacy costs could be contained by encouraging your employees to use generics whenever possible. In recent years, with new specialty drugs ranging from $40,000 per year to over $1 million, employers must remain diligent about finding every savings available while still guaranteeing employees can get the medicines they need. It’s important to have programs to ensure that prescribed drugs are being given to the right patients in the right doses and that your employees are going to the most cost-effective places to receive infusions.

Dr. Paul Hain is chief medical officer for Blue Cross and Blue Shield of Texas, the state’s largest provider of health benefits.

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