Suppliers and employers need to work together more to avoid a bigger crisis

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It can be difficult to think about the big picture in the midst of a crisis, but providers and employers should take this opportunity to work together on new and alternative models of care delivery and financing that directly affect people. costs, results and experience.

Many hospitals and doctors are waking up to the silent crisis of 2022. After funding and overcoming COVID-19-related slowdowns and staffing shortages over the past 2 years, they are now facing ongoing losses due to these issues, as well as inflation, patients showing up sicker, and the inability to travel to other facilities.

However, this time there is no government money to help solve the problem. So what is the government doing? Price increase to try to get out of their difficult financial situation. Employers, however, are no better placed to accept these steep increases, and many insurers have already filed rates for next year. This all seems like the perfect opening act for a collapse of the healthcare system, with hospital bankruptcies or consolidations, cost shifting from employers and loss of employee coverage to come.

There must be a better way.

Part of the problem that is fueling the plight of providers is how doctors and hospitals are paid. In healthcare, we don’t buy cures, we buy visits and procedures.

In the realm of health care, if you go to the doctor with a weird rash, you will most likely receive a diagnosis and a prescription, but since it’s all based on evidence and probability, the treatment may not work and you may need to come back. at the doctor’s office. You pay for each trip and there are no guarantees or frequent buyer discounts.

We’ve been talking for years about alternatives like pay-for-value and pay-for-performance, but most of the country is still operating under some form of pay-per-view arrangement. This is probably the reason for the sudden resurgence of interest in health maintenance organization type plansin which employers pay a lump sum for employees regardless of the amount of health care they use.

Traditional belayers, however, cannot be the ball carrier on this play; most of their profits are still based on avoiding procedures and overspending redlining groups. There needs to be more direct collaboration between employers, doctors and hospitals, otherwise the costs will continue to rise.

When they work together, they win.

A collaborative and direct relationship between employers, doctors and hospitals was shown to successfully reduce costs of care and achieve better health outcomes over time. First, these relationships can simplify access and make it easier for the patient to know where to go and what to do. Second, they can create targeted programs and awareness activities to address the specific health issues of a company’s employees. Third, they can create more direct accountability in terms of what gets paid and what actually happens. Finally, they each have equal seats at the table where they share data, results and goals and can quickly rotate if adjustments are needed.

It can be difficult to think about the big picture in the midst of a crisis, but providers and employers should take this opportunity to work together on new and alternative models of care delivery and financing that directly affect people. costs, results and experience.

Here are some quick approaches that could help break the impasse and avert a protracted health care crisis:

  • Work with local employers to develop direct programs and contracts, thereby consolidating care, improving the healthcare experience and preventing loss of services
  • Find a collaborative health plan administrator, preferably with experience working with providers, to help grow and administer the business
  • Shift more from fee-for-service contracts to value-based contracts and put desired increases in bonuses so that if you save money, you make money and increase alignment

If this newly designed system has any chance of success, it requires more energy and a willingness to engage directly with local businesses. However, the benefits are enormous for patients, employees and the healthcare system as a whole.

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