The health care industry is never short of growth and innovation. Our bodies are always in need of tune-ups, if not more intensive repairs. Thankfully, breakthroughs continue to pour in, introducing new methods and research targeting the prevention of disease, injury and illness. Similarly, technology has proven a vital resource for facilitating care. However, we often forget the simple truth that in all of health care’s many iterations, there are three core parties that cannot be overlooked: the patient, the provider and the payer. In the western world one party stands directly in the crossroads of all three: the modern employer.
Total health and dental care costs have become burdensome to both the employer and employee who often blend the roles of payer and patient. Furthermore, the total cost of population health to employees and employers has expanded beyond acute needs and into the soft costs of time spent physically away from work and the time distracted from work due to nagging or debilitating illness.
Let’s explore three key elements to consider when looking to streamline the care delivery model.
While everyone loves to hitch their wagon to the word “innovation,” not everyone is willing to go along with the disruption that may accompany new and creative ways to save money to both the payer and patient. Large employers have several stakeholders that may already be deeply involved in the conversation — and cost — associated with employee health needs. These individuals include, but are not limited to, a representative from human resources and/or benefits, a privately contracted consultant or broker and a large insurance carrier chosen to administer the current or future health plans adopted by the employer. Each person represents a different but overlapping set of objectives and responsibilities when it comes to managing the health needs of a specific employee population.
New solutions should be positioned and justified as an upgrade to the people who matter most, the patient and the payer. Change worthy of implementing often comes hand-in-hand with disruption. In the health care arena it is important to look for solutions that drive toward each stakeholder’s objectives and desired outcomes. Ideally, everyone in the room just wants to do what is best and most cost effective, but if that isn’t the case, be aware. If a stakeholder feels these improvements are a threat to their value and role — get out in front and take note. Solutions can often be found by incorporating everyone’s skillsets, though it may require some time to get everyone onboard and create the type of cooperation necessary for long term success.
Whether focused on a B2C patient experience or the B2B value proposition, quality of care speaks volumes across every business model, but none more than health care. When the quality and longevity of an individual’s life is at stake, the patient’s experience at every level matters. And when the patient knows the provider is working directly with their employer, that comment card can go a long way. From the care itself to the look, feel and function of the health care setting, no stone can be left unturned when it comes to quality control.
Similarly, recognize the layers of value important to a large payer. An employer or payer’s role in population health goes well beyond simple access to need-based care. Employers are now focusing more intently on instilling healthy practices that lessen the need for care overall. A solution directed at large groups will not only provide the care that is needed on an ongoing basis, but also speak to a strategy of changed wellness behaviors. It is also important to show aligned monetary incentives between the provider and payer relationship. Large ACO’s are doing this by agreeing to a new capitation structure that rewards provider teams when they keep a population healthy instead of incentivizing what can be unnecessary and costly procedures that may only have temporary effects.
We can all recognize that the provider plays a key role when it comes to keeping any individual healthy and happy. The core focus of any provider should be the patient they serve. Yet to pull back the lens and examine population health initiatives more broadly requires a more holistic perspective.
Data talks. The key stakeholders involved in population health require and expect certain core aspects of data collection and reporting. Someone stepping into a role of facilitating health care mustn’t underestimate the need to bring a fresh perspective and unique access to data that can be digested for current and future analysis. Metrics on utilization, treatment trends and patient satisfaction and health outcomes are important components for an employer dedicated to curbing overall health care expenses over time.
Company president, Charles Lusk, launched Huston-based Dent-Well in 2011 and has guided the company since inception. In doing so he has blazed the trail for high quality, turnkey dental wellness platforms located at large corporate and university campuses. If an expert is defined as 10,000+ hours spent within a single discipline, Charles has doubled down when it comes to business models that depend heavily on a both B2B and B2C elements. He can be reached at: firstname.lastname@example.org.
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