As more employers consider a value-based care model for their benefits package — that is, shifting to options that reward providers for delivering value instead of volume — a central question remains: How do you encourage employees to see the primary care physicians and doctors who prioritize the outcomes over volume?
Finding providers who have a solid track record of optimizing and improving patients’ health is crucial to improving employees’ wellness and cutting costs. Blue Cross Blue Shield data shows that effective value-based care can lead to better outcomes, including:
- 7 percent better HbA1c testing for diabetes patients, which helps them better manage their condition and avoid costly complications
- 5 percent better medication adherence for patients with cardiovascular disease, which helps improve treatment outcomes and manage risk
And nationally, value-based care decreased cost trends by 35 percent.
As health care costs continue to rise (they increased an average of $255 a year for individuals and $622 a year for families between 2016 and 2017), those kinds of savings could make all the difference in building smart, effective benefits solutions that your employees want and your company can afford.
Finding High-Value Providers
High-value providers may be easier to identify than you think. As more people see the benefit of models that deliver value, it’s easier to find high performers than ever. You just have to know where to look.
Centers of excellence are one great way to find quality care. These are hospitals that have achieved high outcomes for complex procedures, and they’re saving money for employers like Walmart, which found that using centers of excellence lowered expenses by preventing hospital readmissions and delayed treatment. High-performance and “tiered” networks work in a similar way, promoting providers who deliver high-quality care at a lower cost.
Special network types are another route to great care. In 2017, about one in three large employers featured high-performance networks — which are limited only to high-performance providers — or tiered networks — which include a mix of high-performance and other providers at varying price points — in their benefits programs.
Each of these kinds of networks features clear categories of providers that deliver on quality rather than quantity. Once identified, the only major question concerns how to make sure employees are taking advantage of your high-value offerings.
And finally, many third parties list opportunities to find high-value providers, such as this report card tool from the National Committee for Quality Assurance (NCQA).
Getting Employees to Choose High-Value Providers
Many employers have made a concerted effort beyond network selection to encourage high-value provider use among their workforces. These efforts often include communications that get at the heart of a compelling benefit: better health at affordable rate.
How would your employees’ lives be impacted by improved health and well-being? Ask questions like these in internal communications — and provide statistics on how high-value care can help employees maintain their health and keep chronic conditions from getting in the way of their lives. To make it easier for employees, provide access to special tools that help them assess their chosen providers, such as the NCQA’s report card tool.
You could also make your own tool, following in the footsteps of organizations like the Health Improvement Collaborative of Greater Cincinnati. The group custom-created resources during open enrollment in order to spread awareness of high-value options with employees, with all materials leading to an online report where workers could access information, tips and tools for getting value-based care. Your insurer might also have their own advanced tools that help employees choose a doctor based on quality scores, experience with relevant conditions and demographics.
Beyond those means, incentives can also play a role. These could include positive incentives, such as lowering costs for employees who receive high-value care (11 percent of large employers did this in 2017, with that number expected to rise to 50 percent in three to five years). They could also be deterrents from taking a traditional volume-based approach to their care, such as increasing costs for employees who use clinically inappropriate services, like extra medical tests or procedures. At the least, teach employees how to ask their doctors about outcomes for recommended services and advocate for options with the highest value.
You won’t be alone in working to convince employees to seek out high-performing providers in pursuit of a value-based care model, and it’s not always easy. Just don’t lose sight of the end goal: to provide better care at a lower cost.
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