What’s Wrong with this Picture? Health Care System Waste and How Employers Can Take Action–By: Carolyn Pare, Action Group President and CEO
A close friend and colleague recently shared some troubling news. Despite having a respectable income and health insurance, she has been off her blood pressure and cholesterol medications for several months because she can’t afford the hundreds of dollars for the office/lab visit required to renew her prescriptions.
The prescriptions themselves are $18 and $22, but her insurance is $1,200/month — for a $13,000 deductible policy — making “routine care” inaccessible. And she’s far from alone. This June 2019 KFF report is a wake-up call. Costs have become prohibitive to Americans seeking or adhering to health or dental care. Fear about the cost of needed care affects the uninsured and insured alike. HALF of U.S. adults say they or a family member delayed or skipped care because of costs.
And this turmoil is occurring while the U.S. health care system wastes $765 billion annually — about a quarter of all the money that is spent. From low- or no-value (and even harmful) care, to fraud and abuse, to administrative complexity, to lack of transparency, to poor care coordination, to outrageous prices, to unconscionable executive salaries, to a lack of accountability, to pervasive health illiteracy.
What’s wrong with this picture? And how can Action Group members and other employers present a united front to bring about change? Let’s bring some manageable action steps into focus.
- Take advantage of opportunities to network and solve problems with your peers through Minnesota Health Action Group member meetings, Learning Networks, Guiding Coalitions, Community Dialogues, and other events and activities. Use Action Group resources such as the Specialty Drug Employer Playbook and Working Well in Minnesota: Insights and Actions to Help Minnesota Employers Advance Mental Health in the Workplace. Check out our website for the latest news and information.
- Collaborate with and influence health plans to address health care fraud, waste and abuse. Set expectations for regular reporting.
- Put performance guarantees in place that include measures for overuse and underuse of health care services into contracts of your health plan’s provider networks.
- Review and assess your provider network. Do they practice shared decision making with patients? Do they closely follow evidence-based treatment guidelines? What initiatives are in place to reduce waste?
- Use the passage of the 2019 “Minnesota Pharmacy Benefit Manager Licensure and Regulation Act” to shake up conversations with your PBMs, holding them accountable for fulfilling their intended role of keeping down drug prices.
- Set forth a strategy to transition as quickly as possible away from traditional fee-for-service to value-based arrangements such as bundled payments, pay-for-performance, and accountable care organizations (ACOs) that put the health system partially or fully at risk for health care costs.
- Be aware of how organizations and institutions are spending health care dollars on increased profits and margins rather than on direct improvements in access, quality and affordability of care. Does it seem reasonable that hospital revenues are higher than ever and CEOs of 70 of the largest U.S. health care companies cumulatively earned $9.8 billion in the seven years since the Affordable Care Action was passed? While 45% of uninsured adults say the cost of coverage is unaffordable and medical bills are the number one driver of personal bankruptcy? Work with policymakers to call for change that puts people above profits.
- Involve employees in protecting themselves from outrageous medical bills; educate them about the importance of shared decision making and Choosing Wisely®, an initiative of the ABIM Foundation that advances a national dialogue on avoiding unnecessary medical tests, treatments and procedures by providing recommendations to patients on overuse of health care services.
- Improve the accessibility, quality and safety of health care; reduce costs; and improve the health and quality of life for your employees by creating your own action plan to improve health literacy, using the National Action Plan as a guide.
It’s clear that combating waste requires employers, employees, health plans, care systems, patients, providers, consultants, vendors and others to work together. And while there is so much wrong with the U.S. health care picture, employers can help make it right by using their unique sphere of influence to drive crucial change at their organizations, in their communities, across Minnesota, and throughout the country.
- Lower Health Care Costs Act of 2019 (reader-friendly summary from HealthLeaders here)
- Uncovering Waste to Drive Innovation, Health and Value in Benefits Design (National Alliance of Healthcare Purchaser Coalitions)
- UnitedHealth Hikes Profit Forecast After Big 2Q (MPR)
- Private Health Plans Pay Hospitals 241% of What Medicare Would Pay (Rand)
- A Prescription for Reducing Wasted Health Care Spending (ProPublica)
- Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care (The Commonwealth Fund)
- The Sky-high Pay of Health Care CEOs (Axios)
- As Cost of U.S. Health Care Skyrockets, So Does Pay of Health Care CEOs (NPR)
- How Employers are Shaking Up Pharmacy Benefits for 2019
- 17 Ways Employers are Combating Prescription Drug Costs
- The National Quality Forum Issues Vital Guidance to Improve Shared Decision Making Between Patients and Health Care providers
- Even When HIV Prevention Drug is Covered, Other Costs Block Treatment
- Seven Ways Patients Can Protect Themselves from Outrageous Medical Bills (ProPublica)
- National Action Plan to Improve Health Literacy
Carolyn Pare is the President and Chief Executive Officer of The Minnesota Health Action Group