Articles By Michael Burcham On…

There are 141 million visits to the emergency room each year, and nearly all of them have a charge for something called a facility fee. This is the price of walking through the door and seeking service. It does not include any care provided.

n a competitive labor market, employers are looking for new cost containment strategies beyond shifting more costs to employees. They are pursuing new contract arrangements with providers, offering care coordination to their employees, and considering narrow networks to help them tackle healthcare prices.

I would characterize 2017 as the year of “watch and wait for Congress” within many health plans. I expect 2018 to be the year of “do something big or become irrelevant.”

We are at a moment in time where the fusion of people, process and a technology can re-define the patient experience, improve patient access points, and manage total costs. Such innovation will likely be found as traditional players collaborate with new entrants and form non-traditional partnerships along the healthcare value chain.

Employers that are serious about reducing total health care costs — and improving the health and well-being of their employees — should take a serious look at how innovation through smart use of people, process and technology can streamline all three of these cost areas. And there are many more areas of opportunity for consideration. Most of these innovations will be found in younger companies looking to disrupt the status quo.

Our patients and their families have all grown tired of the status quo. They want a hassle-free experience and coordinated care. They want to build a trusted relationship with our healthcare community.

We must acknowledge that our one-on-one human interactions are at the heart of the consumer’s health care experience. That includes our customer service lines, front desk teams, care management support, scheduling, and practitioner interaction. All of our “improvements” must support and enhance those interactions. 

While legacy health plans wring their hands, a new entrant has emerged - the Health Solutions Company.  Far more agile than legacy insurers, these new organizations are hyper-focused on reducing overall costs for the employer and providing a high-value experience for the employee.

Few insurers will want to remain in a wobbly market with an uncertain future. If not the ACA, then congress must agree on a cure - or an alternative.

The underlying business model of today’s care management processes is dated - built for a different era and  purpose.  It’s time for a change.