5 Questions with Andy Neary, Healthcare Strategist, Volkbell

1.  Employers seem to be moving away from demand-side solutions like transparency and more towards supply-side solutions like high performance networks.  Why do you think this shift is occurring so rapidly?

 

My personal opinion is that there is a lack of engagement with transparency tools.  There are some really great tools out there, but they rely on the member to engage the tool and that is just not happening.  As a result, most of the major transparency companies are now targeting larger organizations as the smaller ones just aren’t getting the engagement they need for success.

 

More employers are now focused on controlling supply and putting mechanisms in place to ensure members are making the right decisions.  A high-performance network is one such mechanism.

 

 

2.  How can member experience be leveraged to concurrently improve the value of the plan for enrollees while also controlling costs?

 

This is the foundation of what we do.  For years, employers have been building health plans backwards.  First, they choose an insurance carrier.  Next, they make sure the carrier’s network access is broad enough.  Finally, they design a set of deductibles, co-pays, and out of pocket limits and call it a health plan.  Unfortunately, this model completely ignores the problem which is the member’s experience with the healthcare system.

 

We help employers flip the script.  We start by focusing on the member experience.  THEN move on to the rest of the pieces.  We must start building the member experience first.  That is what makes or breaks a successful program.  One of the keys to making the member experience a positive one is having care coordination embedded into the plan.  We need to help employees make the right decisions when they have to access the healthcare system and we do this by making sure they have an advocate to guide them through their healthcare journey.

 

 

3.  Do you think employees understand the concept of "value" in healthcare?  How can we as advisors better help them understand cost and quality have no correlation?

 

No, they don’t.  Not today.  One of the things we have done is change the name from open enrollment meetings to consumer roundtables.  We need to make sure the voice of the employees is heard from the beginning of the process, through the end.

 

Another major issue is that most people still correlate higher quality with higher cost.  It’s simply not the case more often than not.  We need to educate employees on what the good choices are, and even more so, we need to simply eliminate the poor ones.

 

Lastly, we need to put the onus on someone else besides the member…they need to be able to call someone when they have questions about their healthcare, just like they call someone when they have questions about anything else they purchase.  Employees do not want to know how the healthcare system works so providing them with a care-coordination advocate is imperative.

 

 

4.  You've often described a medical ID card as an unlimited credit card.  Can you explain that a bit?

 

Absolutely.  If you are a self-funded employer, every time you hand over an insurance card, you are handing them an unlimited company credit card.  There isn’t an employer in America who provides an unlimited company credit card.  Even a $50 meal must be approved.  However, every day employers are giving their employees access to an unlimited company credit card via health insurance and have no controls on how, where, and when the credit card can be used.  Healthcare isn’t cheap, and an uneducated employee can, unknowingly, do some serious damage with this unlimited company credit card.  Think about this; an employee has chest pains so he “googles” his condition and fears he is having a heart attack.  So, he makes an appointment with a cardiologist without a referral, tons of tests are done, most unnecessary, and finds out he has nothing more than a bad case of heartburn.  However, he has now racked up $5000-$10000 in costs.

 

There are lots of ways to curb this spending from the start.  One of the ways is to make sure employees are going to the highest quality docs, no matter what.  We have seen many employers adopt the model of not charging anything to the employee when they go to the best doctor for the services they are seeking.

 

 

5.  What's coming next, and who is driving it?

 

If you can picture the image of Atlas holding the globe.  That is how it feels for employees who are burdened by providers and insurance companies telling them what they can and cannot do.  That is the model that has been in place for years.  Our job is to put employees on top of the globe… in control of the healthcare decisions they are making.  We need to take control from the providers and carriers making the decision, and allow the members to make those decisions, and make it easy for them to make those decisions.

 

The good news is the blueprint is already out there.  We work with employers every day that have done this that could be mimicked across the board.

 

When the health plan is created by starting with the member experience, HR Departments love it because employees are happy and CFOs love it because healthcare costs are significantly reduced.

 

 

Rick AbbottComment