Guiding Employees to High-Value Health Care

The first step of guiding employees to high-value health care is to identify high-dollar claims based on your health plan costs; examine what claims you spend on most frequently and where you spend it.

Finding Cost-Saving Opportunities

The Alliance negotiates lower costs as a percentage of Medicare, but costs for a specific procedure can still vary greatly between providers. The first step of guidance is to identify high-dollar claims based on your health plan costs; examine what claims you spend on most frequently and where you spend it.

For example, the cost of surgery to place ear tubes in young children (myringotomy) is just one procedure that greatly varies in cost depending on where treatment occurs. Fortunately, some providers do a high volume of these surgeries – an indicator of quality care – and those providers are also likely to have better contracted rates because of it.

If you’re interested in finding cost-saving opportunities, see how we can help.

Incentives are a Win-Win

Once you identify where you can achieve significant savings, the next step is getting employee “buy-in.” Financial incentives that reward employees for choosing high-value care are crucial. To put it simply: you must share the savings with employees so you both reap the benefits from choosing a high-value provider – a well-designed incentive means everyone saves.

Communication is Key

Unless employees know about your new incentives, they simply won’t use them, so communicating incentives are a crucial component of guiding. Employers need to share information across the company in many forms and on a consistent basis so employees remember the offer when making health care decisions.

Guidance Works for All Sizes of Employers

Guidance programs aren’t just for small-to-midsize businesses. Companies like Wal-Mart, Lowe’s, The Boeing Company, Pepsi, and Safeway have all implemented changes that steered employees to higher value care that saved money.

• Wisconsin alone could save $394 million per year if employers guided their patients to high-value, low-cost providers. Contact Member Services to find out how much you could save.
• A Potent Recipe for Higher-Value Health Care: Aligning quality, price transparency, clinical appropriateness and consumer incentives
• The creation of benefit designs that explicitly encourage consumers to act on price and quality information, including reference pricing, tiered networks, centers of excellence contracting and V-BID, is a step toward a system that provides and rewards high-value care, while simultaneously driving waste from the health care system.