The longest economic expansion in U.S. history continues to provide minimal returns for a large portion of the workforce, with very little wage growth for the working and middle class. Little has been done to boost attainment of the American Dream.
Across the country, American workers are demanding higher pay. And with continued low unemployment, they should have the power to force their point. Unfortunately, the problem for many employers is that while they are seeing revenue growth, much of that new money that could be directed toward employee wages is instead propping up increasingly unaffordable employee benefits.
We just saw this play out between GM and the United Auto Workers union, and more recently between the Dedham, Massachusetts Education Association and the Dedham School Committee. In fact, reducing health insurance contributions was so important to the teachers in this latter group that they initiated a strike — the first in 12 years — even though it was illegal to do so.
Instead of continuing to argue over something all of us want — greater income and higher-quality, lower-cost health benefits — we can create an environment in which all our individual interests are met. That requires doing two things: First, having employers design health plans that are more affordable for them and their employees; and second, refusing to feed local hospital leaders' edifice complex.
Time and again, we've seen outstanding health benefits advisors help employers in the automotive industry, recycling industry, and even entire cities discover the key to giving their employees better health benefits for less. That key is taking back control of their annual health care spend.
Taking back control of their company's health care costs starts with switching to a self-funded plan. This means cutting ties with old-line insurance carriers and using the money they would have paid into the old plan — carrier fees and all — to pay for their employees' health care costs directly. Stop-loss insurance can be purchased to assuage employers' fears about high-cost emergency care, and a carrier independent third-party administrator (TPA) hired to execute administrative tasks and process claims.
For substantial, lasting savings to be seen, this next part is essential. Employers must take the time to identify which health care providers have the best patient outcomes at the lowest costs, then encourage beneficiaries to access them by waiving copays and deductibles. Usually, these health care organizations are value-based, and unlike those stuck in the status quo, they're incentivized to spend more time with patients. Their success is determined by whether they "get it right the first time," not by how many tests they order or how many potentially unnecessary procedures they can perform.
It's especially important for employers to identify value-based primary care physicians. These are the physicians who oversee the entire care continuum, and if employees are able to get thorough advice/treatment here — sometimes an employee's problem can be solved by making simple lifestyle adjustments — it pays off for them and their employer in the long run.
Here is where that second action item comes into play: refusing to subscribe to hospital leaders' belief that big-ticket investments in shiny, new facilities will somehow improve care quality. Massachusetts General Hospital's proposed $1 billion expansion is just one example. The project isn't publicly funded, but it is funded by private donations, which still sucks money out of the local community that could be used for higher and better purposes. Even worse, after the hospital raises the money they need to move forward with the project, its success still depends on something that isn't in residents' favor: residents needing to visit the facility so that it can make money, the "heads-in-beds" mentality that stems from the industry's status quo, fee-for-service payment model.
Instead of making financial contributions to hospital leaders' edifice complex, those who want to make a profoundly positive impact on the community's overall health and wellness should spend their time and money addressing existing, underlying public health issues. When community dollars work in tandem with the efforts made by local, value-based physicians, they have a tendency to improve social determinants of health unique to their area, like access to transportation, housing, food insecurity, and yes, even education.
When these two things simultaneously take place — employers designing high-value health plans and individuals making wise investments in community services rather than "state-of-the-art" buildings — everyone wins. There are fewer things to fight over, and especially in today's heated political climate, that's something all of us can get behind.
Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our health care system. He is also the author of "The CEO's Guide to Restoring the American Dream: How to Deliver World Class Health Care to Your Employees at Half the Cost." (Health Rosetta Media, September 2017).
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