The Employer R(E)volution

In healthcare, there are many different “players”.  The typical players are providers (doctors, hospitals), payers (insurance companies), employers (who typically provide health insurance for their employees), brokers (who help employers buy health insurance amongst other things), and vendors (who sell additional services and products to those in healthcare who need them) and individuals.

[Each of these players exists to serve (directly or indirectly) the needs of the patient, a key player indeed. However I will be focusing on the other players in this post.]

Many of these different players try to be everything for those they serve.  Lets take a look at each one.

Providers are the ones who are there to take care of you when you need it.  They have the knowledge and know how to fix what’s broken. Well, most of the time they do.  However, they are often the most fragmented of all the players in healthcare.  You can be seeing two different doctors in the same practice who have offices right next door to one another. But they may not be collaborating on your case.  The hope is that they’ve entered all that is needed into an electronic record and that the doctors are reading those records.  However, too many times the care is not coordinated. And people sometimes end up getting hurt because of it.

Payors provide insurance coverage so that you can get access to care.  In addition, they have disease management programs to help those with chronic diseases and wellness programs to help keep the rest of us healthy.  But here’s the problem – employers who buy health insurance are often forced to “market” their insurance because of the typical increases received upon renewal – thus they shop for a better rate.

If the employer gets a better rate, they may change insurance.  If that happens, the disease management and wellness programs that were in place for a few years, maybe 2-3 years, is now gone.  The process of engaging those employees with a chronic illness and those interested in wellness begins again. The continuity is often lost during this turnover – this changing of the insurance guard.  Not exactly ideal.

Brokers also provide a certain degree of assistance as well.  Some offer wellness consulting services for its clients.  If an employer isn’t interested in the services offered by the broker, then the broker may be responsible for marketing wellness to find a vendor that best fits the needs of their clients. So the wellness service may come from the payor, the broker, or a separate third-party.  That’s a lot of folks offering wellness.

The employers are the ones calling the shots typically. They choose the brokers who market their programs.  They tell the broker which insurance they would like (typically with counsel from the broker).  They choose insurance plans with networks that may or may not include certain providers.

They are the ones who hold the burden of employee engagement more than any other entity in this equation.  They are the ones with the most at stake.  Healthy employees cost less.  Engaged employees stick around longer and reduce the cost of turnover.

Yet they may not be receiving enough services from any of the other players to promote enough employee engagement to really change the company. Perhaps their broker offers services to help engagement.  But what about the providers?  Likely not.  The payors?  Maybe, but as I mentioned, they’re often turned over every few years due to cost/pricing concerns.

So we’re left with employers struggling to fully engage the very people who are at the heart of the healthcare system – its patients.  The employers are tasked with this. I can’t think of another country who puts this burden onto the businesses who make their economy hum.

And even with state exchanges just a few years out, recent surveys from Mercer and Towers Watson showed that only 1 in 10 mid-sized to large employers are actually considering dropping health insurance and pushing its employees to buy from these exchanges.  Therefore 9 out of 10 employers still value health insurance as a benefit to help attract and retain employees and will continue this uphill battle.

I happen to believe that employers hold a really strong place in this equation.  If they are committed to offering the benefit of health insurance to their employees, then they’re going to take steps to further engage their employees and help control costs.

Some employers are working with vendors like Healthstat to offer on site clinics at the employer site so that the employees working at there are able to see doctors in the confines of their own work area.  Think about that for a moment…keeping your employees on site so they’re contributing to the company’s mission and not spending half a day sitting in a crowded doctor’s office getting coughed on by sick individuals.  Lower absenteeism. Higher presentee-ism.  Win – Win.

And I don’t think this is where employers will stop.  One of the issues with care coordination is the lack of documentation (or records) that “follows” the patient around. Many hospitals have chosen medical record vendors already. But what if you use two different hospitals that use different vendors and they don’t talk to one another?  That’s a problem.

But what if the employer offered the patient record to their employees?  If they’re a self funded employer, they’ll have access to the data.  If the HIPAA/security aspect of it is acceptable to employees, then perhaps the employer can offer incentives to have employees adapt this…perhaps money into an employer sponsored HRA.  The employer could look to make this record portable so that if an employee leaves, they can bring it home and to any future medical doctor’s visit.

Since the payors are also looking at ways to individually engage their members,  I believe they’d have an interest in collaborating with employers to do this.  Of course brokers are looking to evolve as well as I wrote about in a previous blog.  In addition, the third-party vendors now have a new market in which to develop and sell products – the employer market.  A lot of the EHR vendors sell to providers and payors only. Maybe this will change.

I also happen to believe that this is only the beginning of what employers will begin to do. This is only scraping the surface of innovation and collaboration amongst the different players in healthcare.

Once the employer is committed to continuing health insurance coverage for their employees, I think you’ll see some new ideas coming from these empowered employers and their business partners in healthcare. Perhaps some new companies may be created to help serve these employers.

And maybe…just maybe…some of these newly created companies will make it into one of my future “In Good Companies” posts.

(If you enjoyed this post, I welcome you to check out some of the other posts in my “R(E)volution” series)