Everyone is concerned about healthcare costs—but some of the most surprising figures in the industry don’t have dollar signs in front of them at all.
- 24% of all physician services are duplicated.
- 44% of patients hit a dead end at some point during care and simply stop.
- 61% of self-referrals end up being ill-suited to the actual needs of the patient.
And here’s one figure that probably won’t surprise you at all: 50% of patients are confused.
As you used to hear on TV commercials, there’s got to be a better way. And there is.
Well, to be technically correct, there are better ways—to both help healthcare consumers and serve them more efficiently, which also will help mitigate costs and produce better outcomes.
They’re called Advanced Healthcare Strategies.
These innovative, data-driven strategies and solutions are focused on major areas of impact. They’re scalable and customized. And the results are powerful.
Areas of impact
There are five key areas where Advanced Healthcare Strategies have proven beneficial—for employers, plan members, and in many instances, both.
- Pharmacy spend: It begins with evaluating pharmacy plan performance and reviewing opportunities to increase efficiency and improve member satisfaction. Strategies then can be implemented to control costs and ideally enhance the experience at the same time, including management of specialty drugs, incentivizing mail-order usage with zero co-pay, etc.
- High-risk/high-cost conditions: Taking a deeper look at common issues and risk factors that drive higher healthcare costs ultimately can lead to mitigation strategies and creative solutions that improve healthcare spend.
- Primary care: Coordinating care and eliminating confusion is crucial for members, particularly those with chronic conditions. Simplifying and streamlining the experience allows them to receive better treatment with lower costs—and less frustration. It also reduces issues such as duplicate care.
- Value-based purchasing: Utilizing narrow network models and contracting directly with providers often increases overall care quality while decreasing costs, a win-win for members and employers.
- Healthcare literacy and engagement: Effective communication and education tools give members a better understanding of their benefits, which in turn alleviates the difficulties they so often face in navigating them.
Custom strategies
The very notion of “advanced” strategies means they are not cookie-cutter, one-size-fits-all solutions. Just as every member is different, so too is every employer—and our role is to create an approach that is tailored to each organization’s specific needs. Here are a few examples of how we help clients:
- In-depth reviews: Typically, our first step on the journey to any new strategy is digging into the claims data. This will identify areas of opportunity to make the biggest impact.
- Concierge service: We often recommend concierge services for our clients—which offers a custom feel for members through support with healthcare decisions and provider selection. This also serves to limit incorrect self-referrals, and streamlining the care process creates more efficiency across the entire plan.
- Targeting the right needs: One client might need only a single solution or enhancement, while another could require a full overhaul of their plan and a multi-year strategy for implementation. The goal of the Advanced Healthcare Strategies approach is to optimize an organization’s plan and the members’ usage of it, whether it’s a multi-year process or a relatively quick change.
Powerful results
All of this sounds good, of course—but our clients have seen the transformative potential of Advanced Healthcare Strategies in the real world.
When one large Alaska Native Corporation experienced plan deficits for a couple of years, reducing reserves significantly, we stepped in with a variety of strategies to reverse the trend. First, we identified current risk and health factors, and also looked ahead to put prospective factors on the radar as well. This was going to be a multi-year strategy, so a forward-thinking approach was vital. We established, measured, and refined population health goals using analytics. Finally, after helping the client solicit proposals for the right plan administrator, we implemented a communications strategy for members.
- Outcome: Over a four-year period, the client’s healthcare trend was down 26% even as program utilization increased thanks to more effective communications. The plan’s reserve is fully funded, and members are getting more out of their benefits.
Another client, a public employer, also was facing plan deficits—and after our deep dive into the numbers, it became clear that diabetes, hypertension, and weight management were among the issues driving up costs. Armed with this knowledge, we embarked on a three-year overhaul that included dedicated programs to address the above health factors, a new worksite clinic focused on primary care and preventive medicine, virtual physical therapy options to reduce surgeries, and more.
- Outcome: Three years after our strategies were adopted, the plan is fiscally healthy—and many members have made great strides with their own health as well. More people are participating, they’re taking fewer prescriptions, and some are even sending notes to the benefits team to express their appreciation. Plan increases are well below trend, too.
Ready to get started?
Improving your plan’s performance can be challenging. But just like individuals who need the right support and information to navigate their benefits, organizations need the right support and information to find efficiencies and make targeted changes that can help everyone involved.
At Wilson Albers, we’ve helped clients save tens of thousands of dollars—and much more—without sacrificing the quality of their benefits package. In fact, these changes usually boost member satisfaction at the same time, thanks to enhanced communication, streamlined processes, and often, plan revisions that are designed to meet their unique needs.
With Advanced Healthcare Strategies, it’s possible to craft a benefits plan that boosts the physical and mental health of your people—while also improving the financial health of your organization.
