Employers are the largest purchasers of health insurance but how successful are they in using their influence to bring about improvements in the health plans they purchase or encouraging their employees to take active interest in their own healthcare? Many surveys show that healthcare costs are on the rise, and substandard care and chronic conditions are driving the costs even higher. Employers can bring about a welcome transformation in the present healthcare system – they can promote healthy behaviours among the employees, ensure that employees get better care and more effectively manage their chronic conditions, and work to bring about solid changes in the healthcare system by paying for superior quality, high-value care. The need of the day is the creation of a national market for healthcare that is quality based, and for this data is necessary. Comprehensive data mining such as that offered by a data entry company will be required to analyze the market and come up with effective strategies. Along with employers, health plans with their access to data and expertise in data analytics have a significant role to play in creating a quality-based healthcare market.
Employers are the providers of health insurance coverage and they must educate employees regarding how they can join hands more effectively with their healthcare providers and obtain better care. They can also recommend providers who have a reputation for providing the right care at the right time. Wellness programs can be organized and employees can be encouraged to participate in these programs.
The Harvard Business Review (HBR) recently carried an article on how large employers can help to reform healthcare. The article highlights President Obama’s review of the Affordable Care Act where he discusses “lessons for future policy makers.” The President quotes “hyper partisanship” and “special interests” that hinder the establishment of change in the healthcare system and appeals for “pragmatism.” HBR, however, lists some practical ways in which employers can help to resolve the challenges that lie in the way of healthcare transformation.
- Co- operation and co- ordination in establishing quality standards: Healthcare providers and quality organizations follow different “best practices” for providing healthcare but consistency in the definition of best practices would help minimize unnecessary treatment, and increase the safety of patients. Buyers and sellers of healthcare will then use the same vocabulary and have the same information about quality and value. When there are multiple variants of best practices, it can be confusing for employers as well as the employees seeking care. The best way to ensure standardization is by engaging multiple providers and employers in a collaborative effort supported by medical evidence.
- The problem posed by special interests: To address this issue, competition must be fostered among care providers on the basis of their performance and reputation in adhering to the quality standards. Once the quality standards are set, employers can purchase product lines i.e. care services they clearly understand and compare for merit. They can have providers submit proposals describing the methodology they follow to ensure quality care. The employer can review the various proposals and choose one or more of the provider groups. Selected providers then provide the employer with the data on their patient outcomes. This data is important because providers know that it will have a bearing on how they fare in the next contracting cycle, and will ensure a higher level of performance. In this way the quality of care naturally increases across the market.
- The challenge of getting pragmatism to prevail when creating and implementing the legislation for change: Employers can use their purchasing power and quality standards to address this challenge. They can ask a group of providers in a given market to endorse a single purchasing standard based on quality. If the providers do not resolve the conflicts among themselves and come to a decision, the employer can more on to other suppliers. Instead of being ideology-based, the solutions would become efficient and practical.
If the full efficiency of the Affordable Care Act is to be realized, employers can utilize the mechanisms for cost reduction contained in this Act, combining it with their purchasing power to create a complementary quality-based market. In this way they can not only ensure the best care for their employees, but also help avoid escalating healthcare costs.
