Celebrating One Year

Well, folks…it’s New Year’s Eve…and since I’m a married father of two kids (ages 3 and 2), there’s no way in hell I’m going out tonight. Heck, I’ll be lucky to make it until midnight.

I thought I’d take a few moments to reflect…look back…aw, who am I kidding. I was bored and figured a quick post might be just what tonight needs.

December marks the 1 year anniversary of A Musing Healthcare Blog.  It marks a year in which I’ve grown and changed.  And 2012 is likely to hold a whole lot more changes.

So to you and yours, I wish you a Happy Holiday season and the very best for 2012.

Dave (aka DJK)

Doctors and Hospitals – Get Involved With Local Employers

Recently I took part in my employer’s open enrollment, the time when employees not only choose which employer-sponsored insurance they’ll have for the upcoming year, but also take part in things such as health risk assessments (HRAs) and biometric screenings.

The HRA and biometric screening help employers to get a baseline as to the health of their employees.  It’s usually an online HRA then a scheduled sit down with a health professional to get health stats like weight, blood pressure, glucose levels, and cholesterol levels.

Typically the biometric screenings are outsourced to a vendor who travels to your employer and spends a day drawing vials of blood. The other option is that the employee is responsible for getting the tests done themselves at their doctor’s office or a local lab.

In the first instance, the employer is typically footing the bill for the on site vendor to conduct the biometric screening.  In the second instance, it is likely that the biometric screening does not get done. If it’s not convenient for the employee, they’ll probably skip it.

Not to mention that when I called a lab and asked to schedule a biometric screening for my wife, they asked what that meant. (I’m not kidding here.  I had to figure out which tests made up a biometric screening so I could share it with the lab professional).

I began thinking a bit about this situation and have come up with a possible improvement idea that may work in certain markets.

Have the local hospital or physicians practice sponsor the biometric screening for local employers.

Now before you bother me with logistics, let’s just look at the idea to see if it has merit.

Many employers are moving to high deductible, consumer driven health plans today and they need to engage their employees a bit more in their health. These high deductible plans typically come in the form of a PPO – preferred provider organization – meaning the individual receiving care does not need a referral. He/she can visit any doc they want (pays less for in network and more for out of network).

There is good and bad in this type of plan. The good being the freedom of choice (though folks should beware of swinging pendulums). The bad is that this sort of plan does not require the member to choose a primary care physician, whose primary goal is preventive medicine.  As a result, people do not see their PCP for preventive care and only seek care when they are sick.  Couple this with the lack of primary care doctors in the country, and you have a problem.  It is not helping rising costs of healthcare for employers.

Now take a look at doctors and hospitals who are scrambling to find ways to improve outcomes as the industry shifts from fee-for-service to outcomes-based reimbursement.  Accountable Care Organizations (ACOs) are being formed as I write and doctors and hospitals will need to engage and manage their patients better than they ever have before in order to assure maximum reimbursement.

So…you have employers who have shifted to PPO plans, thus eliminating the PCP component, and doctors/hospitals who need to do a better job of engaging and managing patients to improve outcomes.

See any synergies here?

It makes sense for hospitals and physician practices that have access to lab services to engage local employers to sponsor their biometric screenings. Perhaps they do it free of charge or at a reduced rate on the condition that employees agree to choose a primary care doctor that’s part of the hospital or physician’s practice.

It benefits the doctors/hospitals as they are, in a way, gaining new patients for preventive care services.  It also helps to manage the care for the patient and positions the provider to manage the patient’s outcome. It benefits the employers as their employees choose a PCP which helps manage preventive care services before someone get sick, thus reducing claims cost down the line.

I believe the term for this is win-win.

I also believe that this could be the beginning of an employer-provider community healthcare relationship whose impact is just now being explored.