Health Care “Blue Book” to Reduce In-network Variance (7% to 14%Savings on In-Network Claims )

        -Expose the degree in-network price variance that exists

        -Disclose that poor quality providers are part of the network

•Members and /or CSR’s enter the diagnosis on-line and are shown the expected cost for each component provider  i.e.(hospital, surgeon, anesthesiologist, etc). 

•In-network cost variance can be as high as 500% for the same services

•Carriers have performed poorly w.r.t providing members with meaningful cost and quality data. True transparency would:

•Side-by-side provider cost rankings (green , yellow , orange, red) are shown by provider name  along with contact information thereby allowing the participant to value shop immediately.

•Employer’s provider quality metrics can be added in

•Via plan design, members can be incentivized to use the “green” providers thereby minimizing the in-network variance to the plan overall.

• Average claims savings is 7% to 14% with proper member incentives.

A simple value proposition: same injury, two very different paths

Lets take a real example from the data.  A parent is playing soccer with their child in the front yard, falls down and injures their knee.  There are two care paths with similar outcomes, but very different costs:

 

Orthopedic visit       $    105          Orthopedic visit       $    105

 

Knee MRI        $  2,500                   Knee MRI        $    507

ACL Surgery        $ 10,000             ACL Surgery        $  2,691

 

Total Cost        $ 12,605                Total Cost   $3,303   
                                                          Lower cost, same or better clinical outcomes

Low back pain: When are imaging tests needed?

By Tanise Edwards, M.D.

For many people, low back pain is a sore subject. It occurs quite commonly — nearly everyone develops it at some point in life.

In fact, you may have back pain right now. And, maybe, you're wondering whether an imaging test — such as an MRI or X-ray — could uncover what's causing your pain.

But, before you ask your health care provider about testing, there's some important information you should know:

Your symptoms will likely improve with time. Low back pain usually goes away without treatment. Typically, that's in a matter of days. And, until then, over-the-counter pain relievers may ease discomfort. (See the sidebar for signs of back pain that could be serious.)

It's usually best to stay active. You might be tempted to lie in bed. But, studies have found that too much time lying down can actually slow recovery.

Imaging tests aren't without some risk. Health care providers must weigh the need for testing with the potential downsides. For one, test results may not always pinpoint the source of pain. And, sometimes they may be misleading. This can result in treatments that aren't needed. But, there are other issues to consider. Some tests — such as X-rays and CT scans — use radiation. The levels are considered safe. But, it's still best to avoid unnecessary exposure. And, of course, there's the out-of-pocket cost you may have to cover.

When pain lingers
The best way to get to the bottom of back pain that won't go away — or interferes with daily activities — is to work closely with your health care provider. He or she may do a physical exam and go over your symptoms. This is often how back problems are diagnosed.

Your health care provider may decide that an imaging test would be beneficial if your pain persists. Or, he or she may order one if a serious cause is suspected, such as nerve damage, infection or a tumor, for example. Common imaging tests used to diagnose back pain include:

• X-rays. Standard X-rays primarily show bones. They're often used to look for broken or injured vertebrae and spine deformities.
• Magnetic resonance imaging (MRI). MRI scans soft tissue and bones. These images can help reveal if back pain is triggered by a serious condition, such as disk disease.
• Computed tomography (CT). This test creates three-dimensional images using X-rays. It focuses mainly on bones. But, it can also show soft tissue and help diagnose conditions such as a ruptured disk.

Your health care provider is the best resource when it comes to back woes. Together, you can develop a plan to ease your pain — and keep it from returning. For example, your doctor may advise that you lose excess weight, get more exercise and work on your posture.

Dr. Tanise Edwards is board-certified in emergency medicine. She is a medical consultant for OptumHealth, reviewing guidelines and consumer health publications. Before joining OptumHealth, she practiced emergency and urgent care medicine. She is the co-editor of Urgent Care Medicine (McGraw-Hill) and is on the editorial board of The Journal of Urgent Care Medicine.

New cost cutter for Company Health Plans

Surgery Benefit Manager - Avg savings $7,700 / Patient  

       30% of all health care plan costs relate to surgical procedures:

• Cost control services like Pre-Cert, Case Management, Disease Management, etc. are already in place, Yet an estimated 25% of all surgeries still are unnecessary –just like 25 years ago.

• SBM program engages members on-line to learn more about various treatment options to full surgery e.g. minimally invasive surgery, physical therapy, etc) that are to be discussed with the prescribing physician.

• Significant savings occur, as over 20% of the SBM program participants choose a more conservative treatment option

•About 8% of all surgical costs are due to complications which SBM can minimize

•Average savings of $7,700 per participant

•Program can be offered as an additional benefit to the employees,

•Can be easily implemented off-cycle with as little as 60 days lead time.

 Savings materialize within 90 days after communication of the program
  
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