Melina Kambitsi, Ph.D.
SVP, Business Development & Strategic Marketing
Dr. Melina Kambitsi joined The Alliance in 2017 and leads the team responsible for membership growth and retention of the cooperative. Dr. Kambitsi comes to The Alliance from Network Health in Milwaukee and Menasha, Wis. where she was chief sales and strategy officer. In this role, she was responsible for sales and underwriting, strategic planning, product development and risk-based contract analytics. Earlier she was senior vice president of sales at Blue Cross Blue Shield in Honolulu, Hawaii and the vice president of sales, marketing and product development at Blue Cross of Northeastern Pennsylvania.
Dr. Kambitsi received her bachelor’s in international studies and her master’s and doctorate degrees in economic geography at The Ohio State University. She speaks Greek fluently as well as four other languages (Spanish, French, Romanian and Russian).
In a new study released by GNS Healthcare, data shows that employers could save hundreds of millions of dollars by steering consumers toward high-quality, low-cost physicians.
Using 2017 Wisconsin Health Information Organization (WHIO) claims data, they analyzed 3,760 primary care physicians who performed at least 100 evidence-based measurements, totaling $1.4 billion in costs. The result? If the bottom 50% of providers increased their performance, it could save up to $394 million.
Health care costs have increased every year since 1960, and the only strategy fully-insured employers had to stave off cost increases was to shift the financial burden to employees – who have grown dissatisfied with their ever-increasing high-deductible health plans. This trend has caused an overall lower rate of health care utilization, and when combined with a competitive hiring market, it’s causing employers to look for a new health care solution.
There is no correlation that higher cost equals better care, and nearly 1,000 doctors in the study ranked better than average on cost and quality.
The answer then is to educate patients and encourage them to use high-value providers. The only way to lower health care costs substantially is to provide shareable data that employers can use to educate plan beneficiaries. By banding together and volunteering claims data to future studies, employers could push the public policy pendulum towards better cost transparency, forcing that change.
It’s why The Alliance is participating in the new Rand 3.0 study, set to be released in May, which takes an in-depth look at the prices paid by private health care plans in comparison to Medicare. The study will supply the market with much-needed cost transparency, and hopefully drive employers to demand necessary, immediate change
As Dana Richardson, the CEO of WHIO, puts it, “When I think about cost, I say to myself, this journey that we have been on for quality has been 30 years and we don’t have 30 more years to address cost. I contend that we need to think about our work to slow the rise of healthcare cost as an expedition instead of a journey. And we need to do that because it needs to be a serious movement from one point to another.”
What Employers Can Do
Employers can work with an employer-owned cooperative like The Alliance and encourage patients to utilize high-performance providers.
If employers educated their employees and encouraged them to seek low-cost, high-value health care, both groups could save a substantial amount of money. Employers can also participate in future studies by releasing their health care data to increase transparency in the market.
Additionally, they can join other employers in self-funding to increase their collective bargaining power.
For more information on how the Alliance can use data to help you steer employees to the right care, contact Member Services.
“A small group of empowered purchasers can change the system.”
Members who attended The Alliance annual meeting this year heard these words of encouragement from Suzanne Delbanco, Executive Director of the Catalyst for Payment Reform (CPR).
Suzanne provided many examples of employers influencing the value of health care delivery in recent years and explained how their work is becoming even more important, given physician and hospital consolidations. More and more research studies show that consolidation drives up the price of health care for employers. This is something that certainly impacts the markets where we buy health care, with few independent physician groups and hospitals remaining.
Employers have the power to demand better health care spend. They just need to use it. This blog is the fifth in a series that explains how the four core drivers on The Alliance Roadmap to High-Value Health Care fit together. Our last core driver is benefit plan design, which accomplishes two important things:
It makes the right care more convenient, accessible, and transparent to employees, making it more likely that enrollees choose cost-effective and high-quality health care; and
It provides financial incentives for employees and their families to choose high-value health care that delivers better results for lower costs.
Benefit plan design is the driver that brings all the components of high-value health care together: transparency, payment reform, and provider network design.
Examples of Strategic Benefit Design
Financial incentives that reward enrollees for choosing higher-value health care are probably the most common benefit design strategy that employers utilize today. Network tiering is an example of this, where high-value health care providers are more affordable for plan participants. Providers who don’t want to be in lower tiers are driven to change their business model, usually by lowering their prices.
Employers are also using benefit design to help employees get the right care. According to Suzanne, 33% of employers today are increasing out-of-pocket costs for services that are overused or potentially inappropriate without an evidence-based approach. Others are lowering out-of-pocket costs for services that employees need to stay healthy, like diabetic supplies. Yet another strategy is offering advanced primary care through onsite or shared-site clinics at low or no cost. These providers can then help educate employees and refer care to high-value specialists.
What can Employers Do?
Employers can use the tools The Alliance has developed to create benefit plans that make high-value health care accessible and less expensive for their employees. Because when enough employers get involved and
provide these kinds of incentives, physicians will be motivated to improve the value of their care and make real change in the market. Please reach out to the Member Services Team to start strategizing today.
You might expect employees who benefit from an employee stock ownership plan (ESOP) to quickly become good health care consumers. When employees save money by making smart health care choices, both the company and the employees (as owners) will benefit financially. But even employees who own the company need help understanding how their decisions impact health plan costs, according to the leaders of Trachte Building Systems, Sun Prairie, Wis.
This blog is part one of a four-part blog series that aims to go deeper into each of these four core drivers on the Roadmap to High-Value Health Care, as explained at The Alliance 2019 Annual meeting. The goal is to provide transparency, helping employers get more value from their health benefit investment and driving real change in the market.
Transparency is the first core driver and has been a buzzword in health care for some time. But what does it really mean? At The Alliance, we’ve always defined it as putting accurate, comparable, and understandable information about health care cost and quality at employers’ fingertips, enabling them to share that information with employees and dependents to make informed decisions about their care.
It’s also being open and collaborative with health care providers about how we measure their performance so that we can reward them for value instead of volume. What is critically important to understand is how interdependent these pieces of the puzzle are. We can’t reward providers for value unless employers and consumers become active health care shoppers. And we know that won’t happen unless we help employers provide actionable information and help them align incentives for employees and their families to choose high-value providers. After years of advocacy on behalf of our members in this arena, we firmly believe this chain of events is key to driving change for the better at hospitals and clinics.
Transparency in Action
Many Alliance employers are using QualityPath® as the catalyst to make this vision a reality. Through QualityPath®, we provide reliable information to both employers and providers on specific areas of care, such as inpatient surgeries like knee/hip replacements and outpatient testing like CT scans and MRIs. Employers are then able to use that information in their plan design to encourage enrollees to choose providers that deliver great results at a lower price. We’ll talk more about benefit plan design in a future blog post, but this is a critical element.
We also offer bundled payments as an option for outpatient surgeries. We know that transparent cost information is only half the battle, but believe it is preferable to choosing health care in a void. Many of the surgeries for both QualityPath® and bundled payments also come with warranties for additional peace-of-mind. There exist major swings in costs per episode of care from one network health provider to the next, and that provides an opportunity for cost savings if employers learn to harness this information.
Quality measurement in health care has come a long way, but gaps remain between the information we need and what is available today. We are evaluating quality information from both publicly available and commercial sources and will soon invest in new, meaningful quality indicators to add to our comparative price information used by employers. Our health policy advocacy at both the state and federal levels aims to advance and accelerate these efforts.
What Can Employers Do?
Employees and their families want answers to questions about health care options, how much they cost, and where to go for safer, quality care. We want to help them find the answers. Our solutions are customizable to each of our member-employers’ circumstances and appetite for change and the ensuing cost savings. It’s going to take the power of many employers to be successful, but we will meet you where you are and bring you along on this journey. Members and their advisors are encouraged to contact their Account Executive as the first step.
The Alliance Annual Meeting served as the launchpad for our Roadmap to High-Value Health Care, featuring real-life examples from employers that use the flexibility and data The Alliance provides to move the needle on quality and cost.
Brakebush Brothers Inc., headquartered in Westfield, Wis., uses self-funding to look for opportunities to lower the cost and increase the value of their employee health benefits. Many of these opportunities arise because Brakebush is willing to challenge the status quo in employee health benefits, according to Dan Ludwig, director of benefits and safety.
The status quo for employers typically means that insurance plans own the employer’s health benefits data; providers set their own prices and increase them regularly; and patients have limited ability to judge where to go for care based on cost and quality.
Instead, Brakebush utilized their claims data (a perk of self-funding their health benefits) to find opportunities where they could modify their health benefits plan to lower costs and promote better health outcomes. Employees and vendor partners were included in this process.
The result of Brakebush’s collaborative efforts provided employee health care options that were more easily accessible, less costly and provided high-value specialty referrals.
Support from The Top
Ludwig praises open-minded executives at Brakebush for their support for changing the company’s approach to health benefit costs.
“Employers have to get rid of the status quo,” Ludwig said. “That means employers can’t do it the way they’ve always done it. At Brakebush, we’re given the freedom to explore opportunities. We have to justify every one of these changes, but we’re given the ability to go and explore.”
Ludwig believes that only companies who realize health care can be controlled will be able to achieve flat or lower benefit costs. Employers who are unwilling to challenge the status quo, learn about health care pricing or embrace innovative approaches are unlikely to gain the full benefits of self-funding.
“The lack of understanding in the world of how health care is paid and what impact it has on business has really led us to this problem,” Ludwig said. “Employers have to look at health care and say, ‘We’re done with this.’
“As employers, we control everything else that is on our budget and we hold vendors accountable for giving us high-value products and services. Why are we not holding health care to the same standards?”
Are you an employer searching for self-funded health benefit solutions? If so, Ludwig offers the following tips for you to consider.
Brakebush Brothers’ Top Tips for Self-Funding Results
Get ready to self-fund. Looking back, Ludwig thinks Brakebush should have had new solutions ready to introduce when self-funding started in 2014, so employees immediately noticed the difference.
Be willing to change. Employers get the best results by combining self-funding with data-driven changes in their health plan.
Develop a team of collaborators, internally and externally. Internally, create a team of employees who take responsibility for changing the health plan to focus on high-value health care. Externally, network with peers at other companies and then find vendor partners who are interested in working with you on innovative solutions. Your relationships will make a difference in what you achieve.
Make sure partners have aligned incentives. They should “win” financially when your company wins and lose when it loses.
Tell employees how self-funding makes a difference to their out-of-pocket costs. Explaining the relationship between the company’s costs and their health benefit premiums is a great place to start.
Remind employees of ways to save, again and again. Sharing information at open enrollment is critical, but employees also need reminders throughout the year. If you have an onsite clinic, make sure clinic providers know all the current options for employees to use programs such as Centers of Excellence.
Use employers’ combined power. Employers’ ability to change how they purchase health care grows when they work together.
Read the case study on Brakebush Brothers for details about their award-winning approach to changing employer-sponsored health benefits.
There are two things people often mention when they talk about health care frustrations. They want:
A bill they can actually understand.
A price they can compare in advance.
Of course, that’s not the way that most health care is purchased. In our current “fee-for-service” health care system, each separate item or service carries a separate fee, which usually makes it impossible to know what a surgery or test will cost in advance.
Health care bundles are the exception. Health care bundles are now available for many surgeries and tests.
What’s a Bundle?
When you buy health care in a bundle, it means you:
Pay a single price for many different services that are part of a surgery or test.
Know the price in advance.
Typically save a significant amount when compared to buying the services one-by-one and fee-plus-fee.
Unfortunately, not every surgery or test can be easily turned into a bundle of care. Surgeries and tests typically work well as a bundle when they:
Are not emergencies. That means that patients have time to “shop” for care and compare prices.
Can be delivered in an outpatient setting. Bundled prices can sometimes be used for “inpatient” care, where the patient stays in the facility overnight. For example, The Alliance QualityPath program offers bundled prices for some inpatient joint replacements, as well as outpatient colonoscopies and MRI and CT scans. But most surgeries and tests with bundled prices are available only for outpatient care. These outpatient options usually have the greatest savings for employers.
Are available from many different providers. That means patients have an opportunity to compare their options for where to have care. At The Alliance, for example, patients can choose between multiple bundled providers as well as traditional fee-for-service care for many surgeries and tests. Well-known providers who offer “bundles” for care and are part of The Alliance network include NOVO Health, Twin Cities Orthopedics, Marshfield Clinic Health System and Smart Choice MRI.
An Employer Opportunity
Knowing the price in advance gives employers the opportunity to decide whether to offer incentives for using bundled care. If you can know you can save hundreds or even thousands of dollars on a surgery or test by using a specific bundled provider, for example, you may decide to share a portion of the savings with employees as a way to increase participation.
Encouraging employees to choose a bundled provider also helps employers begin to move away from buying health care on a fee-for-service basis. We all know that fee-for-service health care prices vary wildly from provider to provider and from service to service, even when a provider network provides discounts on the cost of care. Bundled pricing provides a framework that lets you fairly compare these prices and make clear decisions.
The health care marketplace has a long way to go before we can all make sense of bills and pricing. In the meantime, buying care in a bundle is one way to gain savings while helping the market find better approaches to paying for care.
Many employers are intrigued by the opportunities and savings that come with self-funding your health benefit plan. Learn how you can move from being fully-insured to taking control through self-funding.
Self-funded employers take employee well-being seriously. That’s because they know that every dollar saved by improving employee well-being — whether it’s from spending less on health care for chronic conditions or gaining more from higher productivity — has a direct impact on the bottom line.