What role do employers have in the overall healthcare ecosystem, particularly when it comes to cost control, improving health equity, and holding providers accountable for quality outcomes?
Karen Pinkstaff: Employers have been burdened by the Great Resignation. On top of that, employers have had to navigate challenges from the pandemic, and rising inflation that has affected the cost of goods and services they consume or provide. With all that said, to stay competitive in the market space, employers have had to collaborate with senior leadership to make investments in their employees to provide them opportunities to grow and be well. Employers have to navigate these challenges and embrace emerging concepts like patterning directly with virtual healthcare delivery startups.
David Goldfarb: Employers play a significant role in the healthcare system and, with intention, can reduce healthcare costs, improve health equity, and can help hold healthcare providers accountable for outcomes. This can only occur if an employer is willing to explore transitioning to a partially self-insured health plan. A well-designed health plan allows for long-term sustainability; it provides employers with transparency, flexibility, accountability, improved cash flow.
Awstin Gregg: The role employers have in the healthcare ecosystem is critical. Employers are in the position to advocate for their employees and to push the bar for quality outcomes. Employers are a significant source of healthcare coverage for individuals in our communities. Viewing healthcare with a high standard both internally and externally allows for employees to enjoy the benefits of accessing high-quality providers, while also responsibly stewarding the costs to the organization. Typically, this is a cost shortcut some employers take to save a few margin points on the P&L. It is thought that the cheapest plan creates the maximum bottom line. However, we know this could not be further from the truth. An employer’s obligation is not only to render the business service in a superior competitive manner, but to also care for those in their charge with them. Overlooking this responsibility could perpetuate a flywheel riddled with challenges.
Sharmila Solanki: Employers play a key role in their negotiations with healthcare plans for their employees. Overall, employer-sponsored plans can help improve access to care, as well as encourage employees to participate in preventive and wellness programs that can help improve health outcomes. Ultimately, employer-sponsored plans make for a happier and healthier employee base, resulting in a lower cost burden to the overall health care system. To hold providers accountable, there must be clear communication between the employer and the provider about measurable quality metrics and appropriate service offered to help ensure that employers and their providers are on the same page about the plans.
How do you think COVID-19 will influence healthcare services or how employers think about healthcare for their employees moving forward?
Anurag Jain: COVID-19 has impacted healthcare services and changed the definition of work in many ways. From challenging the healthcare system in its entirety to operate in a different model to pushing the clinical workforce to an extreme edge, causing clinician burnout, COVID-19 did help accelerate some of the trends and transformation. Hospitals are now looking for operational efficiency and adopting global outsourcing faster. Health equity and access have become more central as a discussion topic, and health plans and providers are making changes to make it more accessible and equitable. Employers are now more flexible in adopting work-from-home models to attract qualified employees. At the onset of the pandemic, we had to shift more than 13,000 people in India to a remote working model in 24 hours and had them operational within a week. Thanks to our automated workflow platform and the commitment of our staff, we were at 95% production levels within a week. We have decided to retain about 20% of our workforce on a remote working model and have created layers of security to make that happen; we call this our Home POD model. Business continuity preparedness has taken a whole new meaning as well. We are now looking at new growth opportunities at self-sufficient large campuses (a fully integrated township) on one side and satellite centers in smaller townships. This makes jobs more accessible, allowing us to employ highly qualified workers for our global workforce among smaller towns in India and the Philippines.
Awstin Gregg: Throughout the past few years, the concept of holistic healthcare has become a front- seat passenger in many conversations. Healthcare providers were challenged to introduce innovative ways to reach their patients during challenging circumstances. As we placed more emphasis on this focus and these conversations, collectively we’ve created an innovation cycle, which in my opinion has improved our ability to deliver care. This is equally true in how employers position their organizations to provide for these needs within their employee base. A very refreshing conversation of wellness, health, preventive care, mental health, and physical health have reached a level of visibility where meaningful collaboration can fuse with available innovation. When these variables interact, it will only ever be good news for all parties.
Sharmila Solanki: The COVID-19 pandemic changed the course of healthcare’s future by accelerating the shift to virtual care and telehealth. More than two years into a global pandemic, virtual doctor visits are now the norm and continue to expand and become more mainstream. The pandemic also reinforced the need for access to mental health services, especially as employees continue to adjust from a period of isolation and social distancing. As our society emerges from the pandemic, employers will need to work closely with providers to ensure that high-quality care is being provided to their employees.
Karen Pinkstaff: COVID-19 has changed the employer landscape forever. The pandemic exposed many organizations’ inefficiencies and there had to be investments made to update current infrastructure and add innovative solutions. The workplace will likely remain in a hybrid (in-person and remote) for the foreseeable future, and organizations will need to learn how to manage costs and the impact to their culture and training opportunities and development.
David Goldfarb: In my opinion, it has brought mental health to the forefront and has required employers to shift the way they communicate to their employees. It has also been a catalyst to more virtual care for healthcare providers.
For entrepreneurs or small business owners, what are your suggestions for scaling their health insurance offerings and keeping costs in line?
Karen Pinkstaff: Business owners need to find that balance of quality employees and technology. If this balance is not in line, the organization will either be spending tons of money on expensive labor that can be done by machines or expensive machines that have no one to operate them. There are many state grant programs that small companies should also leverage for tax incentives, funding, and meeting green incentives that can help lower costs and allow the organization for allocating funds elsewhere.
David Goldfarb: The only way an employer will ever have true control of their health insurance costs and have the ability to have a sustainable benefits program is to evaluate alternatives to traditional, fully insured health plans. An engaged and educated workforce is another critical factor to keeping healthcare costs in line. Lastly, employers should highly consider not only offering, but promoting and incentivizing employees to enroll in HSA-compatible health plans.
How is technology impacting the way healthcare businesses innovate to meet their patients’ needs? Is telehealth here to stay?
Dr. Mark Chassay: While the healthcare industry continues to learn from the COVID-19 pandemic, we know with some certainty that telemedicine is a healthcare delivery option that is here to stay even as people feel more comfortable with again scheduling office visits. This is particularly true for behavioral health visits. In January 2020, our data showed 99% of behavioral health visits were conducted in person. But the shift became 50% to 60% virtual in March 2020 and beyond. So, telemedicine is here to stay as a care delivery option.
Awstin Gregg: The introduction of technology is significantly enhancing the ability to deliver timely care in the service-based business model for many providers, including myself. The recent pandemic accelerated the community’s adoption of the idea of telehealth, and it is my strong opinion this chapter in care delivery survives this pandemic and presents as the new preference for many patients. Additionally, telehealth introduces a delivery platform which largely mitigates typical barriers to treatment. I believe treatment compliance will increase secondary to this chapter in innovation.
Karen Pinkstaff: Technology continues to be a disrupter across all industries. Telemedicine has been embraced by providers who can see their patients regularly and connect with new patients in different parts of the country/world. With the shortage of workforce, originations will look to contract with providers from different locations to virtually provide care to their patients. Patients also realize the convenience of telemedicine and not having to go sit in a waiting room with other sick patients or travel to an office gives them more flexibility that has been received positively.
David Goldfarb: Just as technology is changing our everyday lives, it is impacting the way healthcare businesses innovate. Providers and patients now have opportunities to engage directly, even outside of in-person visits. As long as we stay conscious to continue to serve the sectors of the population who are not regularly using technology, the increase in technology can continue to grow and change the way we “do” healthcare. From a business owner’s perspective, constantly improving technology provides tools for not only accessing data about plan performance but also interpreting it and performing predictive modeling to build a sustainable healthcare strategy.
Anurag Jain: Telehealth is now a $250 billion opportunity. Per a McKinsey study, telehealth utilization rose to 78 times the normal utilization rate in April 2020 and has stabilized at 38 times. With an increasing focus on safe access to care during the pandemic, there was a greater willingness among payers and providers to embrace telehealth as a norm, resulting in reimbursements for such care becoming more conducive. The Center for Medicare and Medicaid Services (CMS) expanded the 2021 physician fee schedule to include telehealth codes for many services. Though it is unclear if these changes will be permanent beyond the current public health emergency, we believe that the shift is definitive. The private equity space is buzzing with investments in digital care delivery technologies, which, in turn, will lead to the emergence of virtual healthcare delivery models. Some of the regulatory changes that facilitated the expanded use of telehealth are being made permanent. For example, the CMS has amended the 2021 physician fee schedule to include reimbursable telehealth codes. After the public health emergency, one is unsure if these services will lose their waiver status or continue, it is up to the Biden administration to make regulatory guidelines for telehealth. Substantial investment interest is flowing into enabling physicians to adopt telehealth on their existing EMR systems. Some behavioral and mental health services can quickly be delivered on the telehealth platform.
Are telemedicine and/or digital apps changing the way healthcare organizations operate? Are they here to stay? What are foreseen limitations and/or benefits?
Awstin Gregg: I do believe telemedicine is changing the way healthcare organizations operate, and at the very least, it certainly requires organization leaders to challenge the way they think from an operational perspective. Telehealth removes the typical barriers to treatment by making it profoundly convenient to the user. I think some practices may prefer the in-person model to the telehealth model–and there’s nothing wrong with this stance–but I do believe the consumer market is changing, and this is a hurdle that will need to be jumped by healthcare practices as the delivery of services innovates itself.
Sharmila Solanki: Overall, the COVID-19 pandemic has improved our access to care by facilitating a transition toward digital medicine. Telemedicine and digital applications allow providers a more efficient way of delivering care for patients. With the increased adoption of telemedicine, healthcare organizations will need to add digital tools to support this growing platform to remain competitive. Furthermore, telemedicine will help payers pay for expanded services in which care can be delivered virtually.
Anurag Jain: Wearable technology, such as smartwatches, is shifting consumer focus to wellness, and they enable healthcare providers to monitor many patients remotely. With this ability, hospitals can reduce the length of stay as clinicians can monitor the patient’s vitals from anywhere. Some payers encourage their members to opt for medical devices and wearables that capture data and extend post-acute care to reduce re-hospitalization rates. Payers are also pushing information regarding chronic care conditions and preventive measures to raise overall awareness and the need to stay healthy. As care shifts to the home, wearables will become part of a connected care ecosystem pushing physiological data in real-time, providing valuable insights on patients, and aiding the ability of doctors to provide accurate diagnostics and care. Our viewpoint on these trends is to enable and help accelerate the adoption of telehealth and wearable technology. Healthcare needs increased interoperability and seamless delivery of services at an affordable price point.
Karen Pinkstaff: Telemedicine and digital apps are here to stay. Patients have all these wearable devices and that share outputs of blood pressure, exercise, oxygen intake, etc. These numbers incentivize people as well as keep them aware of their current health. This will allow patients to see providers less and hopefully patients will want to share these data points with their providers to help provide quality care. The current limitations of these devices are that they are still new to the marketplace and some of the numbers provided may not be 100% accurate yet.
Dr. Mark Chassay: BCBSTX uses a variety of intelligent automation tools to assess and accurately review data to help improve care for our members. We invested in the health technology company Collective Health to give new and existing customers access to its digital platform and services. Collective Health’s integrated solution provides a single digital platform that enables self-funded employers to administer benefits, reduce workload, manage costs, and help manage the health of their people in one place. For members, it provides a personalized experience with products and features that makes it easier to understand and manage their health care, from wherever they are.
Companies face continuous challenges with their healthcare choices. How does a business owner balance the benefits of self-insured options with the more standard plans?
Karen Pinkstaff: The benefit of self-insured plans from an employer perspective is that you have more control and influence over your claims expense and experience. The risk is that you could be exposed if you have a large growth in plan experience. There are products to insulate your risk exposure—for instance, stop-loss coverage that you can purchase to minimize the top end of your risk exposure. Additional benefits are that self-insured plans generally have more control over the provider network (i.e. using a narrow network) and plan design (subject to limitations based on legislation and regulations).
David Goldfarb: Business owners should understand their healthcare choices and map out a long-term benefits strategy. Moving to a self-insured plan should be a well-thought-out, long-term decision. If properly designed, self-insured plans can provide savings from the individualized plan management, increased flexibility and control of the plan, improved cash flow, and cost savings from reduced premiums. Self-insured options also afford employers access to much more granular data regarding their plan and utilization, and the data can be used to properly design and manage the plan.
Sharmila Solanki: Self-funded plans are more flexible because they give business owners the opportunity to design a tailored healthcare plan that help meet the needs of their employees and save on premium costs. However, self-funded plans expose business owners to higher loss from extraordinary claims. Because self-insured plans pay medical claims as they occur, business owners will need to have the liquidity to pay for these potential losses. However, these plans can help improve the overall cash flow for businesses. Claim unpredictability can be mitigated with stop-loss insurance, which offers protection for medical claims that exceed a predetermined amount.
Preventive care is another buzz term today. What role do business owners play in improving the health and wellness of their employees? Is it an actual cost-saver? How should business owners think about their ‘wellness program’ investments?
Awstin Gregg: The role is significant! The “cost” associated with this can sometimes be hidden because we are investing in something we are trying to avoid. An example of this could be changing the oil in your car. We change the oil because we want to preserve the engine. We know what happens when an engine is in disrepair. I don’t complain about an oil change because I know what I’m investing in. In the same way, I don’t look at my monthly P&L and complain about the financial allocation to employee wellness, because I know what I am investing in.
Anurag Jain: Rising consumerism in healthcare has many implications for the way care is delivered. Price transparency, no surprise billing, digital health, branded care delivery systems, patient engagement, and more are interwoven into this megatrend. Healthcare providers must redesign their revenue cycle around the patient and bring about digital transformation. As patients are paying higher out-of-pocket costs, they are demanding services akin to those in other service sectors and anticipating a seamless experience that they are used to in hospitality, airline, online shopping, and other industries. Healthcare entities must focus on creating great patient experiences while delivering excellent care. There is a serious business case for investments to flow into technologies that enhance the patient experience, improve engagement, communicate the patient’s responsibility for payments, offer flexible payment plans, and connect across multiple channels. Access Healthcare supports its clients in their digital transformation journey by providing technology platforms, process automation, and resources they need to manage their end-to-end revenue cycle and connect with the patients. We are seeing a fundamental shift in healthcare costs and enabling our clients to accelerate their journey towards value-based care.
Sharmila Solanki: The saying, “An ounce of prevention is worth a pound of cure” is appropriate when thinking about wellness programs. It is always better to prevent a disease versus dealing with a chronic illness through lifestyle management and screening. On average, Harvard researchers concluded that for every dollar spent on employee wellness, medical costs fall $3.27 and absenteeism drops $2.73, resulting in a six-to-one return on investment. Employees are our company’s greatest asset and building a healthier workforce will have many tangible and intangible benefits for years to come.
Karen Pinkstaff: A wellness program needs at least two things–it needs to be holistic and employee turnover needs to be low. Holistic means it’s more than an on-site gym or virtual primary care options or diabetes management coaches. These are all parts of what a wellness program can be, but to really see cost savings employers need to develop a strategy and stitch together all the tactical components of a wellness plan that supports that. Furthermore, the options need to be convenient so employees will actually use them. If the free primary care center or coaches are only available in person and some of your employees live far from those locations, they will not utilize those services. Second, in general, the lower turnover is the more beneficial wellness plans can be. Typically, wellness initiatives will not see significant savings right away. Employees need to actively participate in the program over the span of several years to see the largest savings. If employees turn over regularly, savings will likely be lower.
Dr. Mark Chassay: By engaging employees in making smarter choices about their health, employers can help control their company’s long-term medical expenses. Our wellness programs are designed to give members tools and support, while rewarding them for making healthy choices. It includes a suite of online courses about nutrition, fitness, weight management, tobacco cessation, stress management, and more. Empowering and engaging our members to lead healthier lives is vital to the prevention and management of diabetes, heart disease and other debilitating chronic diseases that drive health care costs.
David Goldfarb: Early disease detection and preventive care help bend the curve of healthcare costs for employers. Studies have shown that higher engagement between individuals and their primary care physicians lead to less occurrence of high-cost emergency room visits and episodic care. Reactive healthcare causes unintended consequences and unsustainable costs. Business owners that do not take a proactive approach employee health and wellness are far more likely to face unpredictable situations with that can costly and difficult to manage.
What can be done to ensure quality, transparency in pricing, and a reduction in the cost of healthcare to help consumers?
Dr. Mark Chassay: Primarily, it’s providing a suite of tools to engage and empower healthcare consumers with information to help them understand their options under their health benefit plans, including out-of-pocket cost estimates, information about physicians and facilities participating in networks, and information about provider quality. We offer Provider Finder, an online tool to help our members easily research and select physicians and facilities, as well as estimate healthcare costs. We also have Benefit Value Advisors–specially trained customer service advocates–who use data and other proprietary tools to provide members with choices that allow them to maximize their health care benefits.
Karen Pinkstaff: In my opinion, organizations can continue to provide patients a cost estimate prior to a procedure or inpatient stay that will help understand the patient’s medical costs. People will always need access to medical care but if the industry remains engaged on quality of care and keeping the patient out of a hospital. This will reduce overall costs to the patient and should provide better quality of life to the consumer. There is an issue with this concept because hospitals and healthcare organizations need to see patients to make money so there needs a continued shift to valued-based care.
Looking forward, what do you think the healthcare landscape will look like, say, five years from now?
Sharmila Solanki: Five years from now, up to 50% of healthcare could be delivered remotely. Technology and data sharing will likely influence the trajectory of health care in the future, especially with the advancement and adoption of wearable devices. These devices can help healthcare professionals provide better care for their patients because they are now able to track their progress through data collection. As a result, there will be continued consolidation and change in the healthcare industry, where improved IT systems will be critical to sustain the adoption of data-driven, value-based care.
Karen Pinkstaff: In five years, the healthcare landscape will remain in this hybrid model where patients are seen virtually and in person. Healthcare technology with wearables and monitoring devices will continue to grow so providers can track patients regularly outside of an office setting. Paired with these wearables will be a continued push for data analytics and using this data to better predict what kind of care a patient will need and how to be more proactive with patient care as opposed to reactive. This hopefully reduce the number of frequent inpatient and office visits.
Dr. Mark Chassay: The healthcare industry is overdue for a paradigm shift–one that incentivizes value, quality, and outcomes. But it will take meaningful collaboration between payers and providers. By sharing administrative, clinical, and financial data, we also have a chance to hasten the movement toward value-based care. Another path forward is supporting doctors. That means contracting directly with independent physicians so their patients and our members can access care at affordable rates. We must empower physicians so they can make healthcare decisions that match the needs of their patients and our members.
Awstin Gregg: I believe the healthcare landscape in five years will be fueled with innovation and technology. In the past 12 months, we have seen a strong emergence of the utilization of technology to increase convenience for the consumer. A particular emergence was telehealth and the supporting technology to deliver clinical care. This has shown to increase attendance to appointments, increase convenience, and in several instances maintain or exceed average outcome measures. I believe we are on the cutting edge of a truly exciting chapter in healthcare, and one that we’ll be perfecting over the next five years.
David Goldfarb: The healthcare landscape and ecosystem as it stands today is unsustainable. We will continue to see growth in value-based care, specifically with direct contracting–it can benefit both employers and the healthcare system. For employers, it can provide a predictable window into spend, many times negotiating rate corridors that represent a discount over historical prices paid, all while eliminating administrative overhead that comes from working with third-party payers. For the healthcare system, this arrangement represents market share and an expanded community footprint, without the complexities of an intermediary standing between the patient and provider regarding care decisions and payment.
Mental health is becoming a routine part of the conversation these days. In what way does an employee’s mental health contribute to a healthcare organization’s success?
Awstin Gregg: The relevancy of the mental health of employees relates to an organization reaching its internal and external goals hand-in-hand. Ensuring our organization has resources to address mental health is equally as crucial as ensuring physical health. In my opinion, one of the most significant ways an organization can promote an employee’s mental health is by choosing leaders who have the skill of leadership. The ability to communicate criticism constructively, the ability to resolve conflict civilly, and the ability to understand EQ without condescension, belittling, or hostility are just a few of the ways employers can promote mental health of their employees. Our employees decide if we’re leaders, our title only decides if we’re their boss. There is stark contrast to what is possible in an organization with leaders versus bosses.
How are the healthcare worker shortage and the battle for talent impacting your practice for healthcare providers?
Anurag Jain: As a company focused on the revenue cycle management space, we think the healthcare worker shortage is debilitating and is here for the long term. We see that the deficit is across both clinical and administrative areas. Most of the solutions we provide are in the administrative space, where we help providers manage their revenue cycle. Our ability to solve administrative staffing through global workforce scalability is unique. We have added over 10,000 people in the last 15 months, helping some of the leading healthcare systems stay on top of their revenue cycle and accelerate cash flow realizations. Our processes for hiring, training, and deploying a high-quality workforce enable us to help solve many financial challenges hospitals are currently facing, including virtual scribing, clinical documentation, and coding.
Sharmila Solanki: For our clients, regardless of the sector within healthcare services, finding and retaining talent is one area that is keeping management up at night. We have seen labor costs increase across the board regardless of clinic level. Staffing agencies are helpful, but there is a disparate cost structure between the employees and agency staffing. For many providers, this is not sustainable and eroding their margins. Also, it creates issues between the pay levels between people performing the same function. Employers are becoming creative by adding enhanced benefits and sign-on bonuses to attract and maintain their existing workforce.
Karen Pinkstaff: The labor shortage has affected quality of care and has forced employers to spend more money on salaries and benefits to attract and retain employees. Staff members are responsible for completing more tasks to cover the unfilled roles and the nurse/provider to-patient ratios have increased which can also affect quality of care.
How does the Dallas-Fort Worth healthcare business community differ from other major regions? What are our competitive advantages and differentiating factors?
Anurag Jain: Dallas Fort-Worth has an exciting business community that is engaging and connecting to solve some of the most pressing business problems. The region’s growth during the last five years indicates how companies have flourished and grown in the area. We believe that time zone, climate, and access to affordable living are the reasons for the city’s growth. Dallas had a small gap in the biotech and life sciences startup scene. I believe that gap resulted from the amount of money readily available to companies. There are a lot of promising entrepreneurs who are coming out of companies with important research or new product discoveries but hit a wall in terms of the early-stage ecosystem. With many family offices (private financial management firms for high-net-worth individuals or families) and money, the later-stage ecosystem is reasonably well-covered. But if you, the startup, never get through the beginning, you’ll never get to the end. That’s why I think Austin and Silicon Valley have surpassed Dallas, but Dallas can now hold its own with new and emerging companies. Through Perot Jain, we want to enable that and help companies reach the next level. Our entrepreneurs are also focused on serving the community. Many of us joined to deliver meals through the Get Shift Done initiative during the height of COVID-19. North Texas Food Bank is another example of how we have united in this spirit of giving back to the community to find solutions to those in need.
COVID-19 exposed the wide disparity in healthcare access and outcomes for communities of color. Why is it important for business and political leaders to address these inequities?
Dr. Mark Chassay: Addressing social determinants of health factors–such as education, employment, neighborhood, social support systems, and access to healthy food–is a key step to helping achieve health equity in our communities, where everyone can receive their highest level of care. Data and technology can help bridge the gap between clinical care and community health, allowing us to work with our network providers and community partners to measure and meet needs such as housing instability, food insecurity and lack of reliable transportation.
Anurag Jain: Healthcare access is an essential subject across the world. The social determinants of health (SDOH) are important indicators of health and well-being. Inequities in healthcare access include issues faced by specific population groups including quality and cost of services at the point of care, lack of cultural competencies, inadequacies in healthcare population data for specific disease conditions, and economic disparities versus other population groups. The issue is not just racial but social and economic; it is partly the role of clinicians to break the cycle of perceived oppression and differential treatment and the role of everyone supporting access to specific health plans, focused studies, and better insurance coverage.
Karen Pinkstaff: Social Determinants of Health (SDOH) have been around for a long time, and the pandemic exposed these issues to the larger public. When patients were not able to see providers in person and did not have the technology access, or there were no providers within a 25- to 30-mile radius of these communities, this exposed a large population that didn’t have access to care as other communities. For a community to flourish, it needs access to care. All communities (regardless of color or ethnicity) are part of the larger ecosystem, and when one community is affected, this has a ripple effect into the other communities. Some communities didn’t have access to the COVID-19 vaccine being as available as other communities, and this is just one example of the need to reduce any SDOH disparities.
What does the M&A outlook hold for healthcare?
Sharmila Solanki: Healthcare is very fragmented. Currently, a significant portion of healthcare service companies are owned by mom-and-pop providers. As value-based care and reporting of outcomes continues to be on the forefront, there will be substantial investment in consolidating and professionalizing these platforms. For example, homecare and hospice are two sectors that are consolidating, along with other sectors, including physician practice management. These consolidations can lead to more scalable models, improving negotiation with payers, systems, and reporting capabilities. Furthermore, the professionalization of management teams will help take these businesses to the next level by focusing on efficiencies while providing quality care.
Is the site of care or medical service utilization important to reducing healthcare costs?
Dr. Mark Chassay: We recently implemented an initiative that increased the maximum allowable standard fee schedule reimbursement for nearly 1,500 outpatient surgery services when performed at in-network Ambulatory Surgery Centers (ASC) for commercial members. We know that surgeries performed in a hospital can cost nearly three times more than an ASC and can unnecessarily increase total cost of one’s care. A portion of this additional cost could be passed on to patients through coinsurance or deductibles. This initiative creates an opportunity to increase reimbursement to physicians by 15% to 50% on each qualifying procedure while allowing patients to receive the same quality of care they would get in a hospital but at a significantly lower cost.
What can healthcare and employers do to better navigate inflation in the short- and long-run?
Karen Pinkstaff: Chronic diseases continue to drive the cost of healthcare. Some of these diseases are preventable by lifestyle choices. Healthcare and employers have already tried to push the general public to make better decisions when it comes to health and wellness, but this push needs to be harder. Employers should continue to think about how to incentivize their employers to make better decisions regarding their health. Healthcare also needs to continue their push, primarily through primary care, to focus on the wellness of all their patients.
