After more than three decades of writing about employer-based health care delivery, I have a pretty keen sense of where the bread crumbs of innovation are leading. Of all the exciting trends and practices that have taken hold, one really stands out. It’s a simple solution to an overly complex marketplace mired in perversity, waste and inertia.
At a time of rising costs with no end in sight and embarrassing inefficiencies, we’ve been beholden for far too long to health insurance carriers, pharmaceutical manufacturers and pharmacy benefit managers that answer to their shareholders at the expense of patients.
What’s lacking is transparency. When shopping for coverage is a completely transparent process, health plan participants make far better decisions and can drive down the cost of medical services by helping force greater competition across the healthcare supply chain.
Seven years ago I started to dig into the weeds of self-insurance and within the past year I’ve had the pleasure of connecting with an industry thought leader who’s creating a new category of innovative solutions he calls transparent health benefits. Lester Morales, CEO of Next Impact LLC, says THB can help employers cut their health care costs 20% to 40% cost savings while vastly improving the quality of care being accessed.
It’s a multi-pronged approach with several key components that include direct contracting with facilities, direct primary care (DPC), a 2.0 version of reference-based pricing that eliminates obstacles associated with that approach, more meaningful Rx strategies devoid of opaque contracts and eye-popping revenue-sharing arrangements, bundled and cash payments.
His goal is to help benefit brokerages and advisories take control of the biggest P&L expense after payroll, as well as turn employees and their dependents into better healthcare consumers.
I know we’re on the right track after seeing an interview Adam Russo, co-founder and CEO of The Phia Group, LLC who currently serves as chairman of the Self-Insurance Institute of America, did with Ana Christina for the May edition of SIIA News + Views.
He validated our work by citing three key innovations that are expected to have a game-changing impact on employer-provided health plans. The first is pure transparency of cost and quality information on specific medical procedures, as well as patient reviews of doctors that are easily accessible on multiple technology platforms.
Russo, who I have interviewed several times, also mentioned the importance of understanding the cost and efficacy of pharmaceuticals prior to paying for drugs at the pharmacy counter and DPC physicians who act as more efficient gatekeepers for a flat monthly rate without insurance claims.
As politicians struggle to find enough middle ground to reform the nation’s ailing health care system and litigate their strategic vision, I take solace in knowing there are many market innovators who aren’t waiting for a government solution or consensus. If enough of these disruptors keep at it, then hopefully we’ll all be able to turn private insurance on its head, unleash competitive forces and find better solutions that save both lives and money.