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.

2 thoughts on “Doctors and Hospitals – Get Involved With Local Employers

  1. Interesting.

    I wonder if you have any evidence that HRAs actually have any benefit. In other words, any studies that document that people who know their numbers – weight (I think most people already know this & it’s pretty easy to identify overweight folks simply by sight), glucose level, cholesterol etc have better health or lower costs?

    Seems to me that people with good numbers will participate & watch their numbers, but people with bad, won’t. Net effect = about 0.

    Related, I don’t see much evidence that cholesterol levels correlate to medical costs or coronary events in any substantial way….so simply knowing these strikes me as very modest value, at most. Ditto for glucose levels – except in the reverse. Studies show that intensively lowering your glucose levels leads to higher mortality rates than leaving the levels alone, or lowering modestly.

    Ditto, by the way, for most cancer screening tests.

    Bottom line: I suspect that HRAs, like annual physicals, are fundamentally a waste of time, effort and resources. I wouldn’t participate….

  2. Gary, what part of “before you bother me with logistics” don’t you understand?? 🙂

    Your perspective is always appreciated. The economist’s view on this shows that there is little to no benefit of some preventive services. And it’s based on data that has been collected and reported.

    But that doesn’t mean that there is no benefit.

    Let’s look at it this way. For those who are on the verge of a serious event, intervention can help.
    I have heard more than a few anecdotes about organizations who do screenings and find folks on the verge of a serious event, get the necessary intervention, and then get that person managed by their doctor. Many times it’s because the individual has not been under regular care by a doctor that the person gets to the point where intervention is needed. I’d argue there is cost savings/cost avoidance here.

    My thoughts in this blog are to look at common needs amongst employers and providers in this new era of healthcare. Providers who are part of an ACO are going to need to better manage each and every person they see. Employers who are likely to continue offering health insurance are going to need to become more active in helping their employees participate in their own health. Preventive services aside, which you point out can be wasteful in some instances, I would argue that those who have known (or unknown) medical conditions are much better off when being managed by a PCP vs. those who are not.

    These ties between providers and employers push the “medical community” or “medical neighborhood” concept which some have recently discussed. David Williams from MedPharma Partners LLC was interviewed by NaviNet recently and made mention of this:

    Now if folks would just log onto and learn which medical services are wasteful and which are not…then we’d all be in a better place! 🙂

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s