The major health carriers have developed a kind of efficiency rating for doctors and hospitals. These rating systems are directly communicating with the consumer. The rating systems show price of a procedure and quality of care. So if an insured wants to look up how many times a doctor has performed a certain procedure they can. They can also view the complication rate from that doctor or facility on that particular procedure.
The American Medical Association is stating that the Rating Measures are wrong up to 25% of the time. This is a very high % if they are correct. The Wall Street Journal confirmed that one of the studies that reported this high % was funded by the AMA.
What we are seeing from the top health insurance carriers is they are developing health plans that want you to use the top rated doctors and facilities. These plans will have less cost to the insured if they use the preferred doctors.
So now it seems that the health care providers are not happy that the insured can now look up the cost of the procedure and the quality of care that doctor provides. All of these types of plans were developed pre health care reform so it will be interesting to see if this type of health care information will continue to be available to the consumer. Recently the HHS launched a site that also gives a quality of care. So at this point there is not just the carriers programs available but now a free service to shop health care.
The ever rising costs of employer sponsored group health insurance have driven more companies to elect high deductible health plans along with goal driven wellness programs. Under these types of wellness programs employee’s can reduce their out of pocket costs by meeting reasonable health goals.
Goal driven wellness programs work best when the program is to alter employee’s unhealthy lifestyle. An example of this would be to help employee’s quit smoking. Where they can have great results is if an employee is suffering from multiple conditions. High Cholesterol, High blood pressure, and Obesity could be a direct result of a un healthy lifestyle depending on the individual. So to educate an employee how they can change their life style to help treat these conditions can have a huge impact on cost to the employee in the form of claims. The wellness programs can even address issues like stress management or how to buy and prepare health foods at a reasonable cost.
The first step is an employee/insured should complete a Health Assessment form. We are seeing these more and more in an online format. After completing the assessment form you will be given information on what you might be high risk for. Some of these programs even address the issue if you drive too fast as it may be linked to stress. With that high risk information you could have access to a disease management program or health coach. In some programs the health coach will help you establish and work towards your health goals.
Once you have entered the disease management side of the program you will be educated on what conditions you are high risk for. The education can include treatments and prevention. There might be 10 drugs out in the market place that can treat that condition and it’s important that you know about the different options. One of those options might cost you a lot less and treat the condition.
The best way to reduce your out of pocket expenses is to actively live a healthy life style and the wellness programs that are being developed today can help you meet those goals.
