Harnessing the power to change the system

Health care coverage can evolve for the better when your clients recognize their power to create and reward systems that are getting it right. Here are some guideposts to get them started:

Sharpen the focus on primary care. Primary care-centered health plans nurture that critical relationship and set a foundation for better outcomes and lower costs. Increased primary care usage means conditions are less likely to go undiagnosed, resulting in a lower need for expensive, invasive interventions. In turn, patients experience lower rates of emergency department visits as well as avoidable hospitalizations and specialist services, saving them – and their employers – thousands of dollars annually.
Prioritize quality. Curated provider models can provide more access to quality care, ensuring high standards are met while resulting in organic, long-term savings. By partnering only with high-quality providers that are equally committed to charging fair prices, employees get access to great care at warranted costs.
Break down barriers to care. Despite the ever-rising cost of their insurance, many employees find using their coverage flatly unaffordable. Changing the system requires a renewed emphasis on the purpose of coverage: to keep people at their healthiest. That means ensuring people can actually go to the doctor by removing the barriers to care like price uncertainty, excruciatingly high deductibles and confusing "extras" like coinsurance and by putting care prevention and coordination at the forefront.
Demand real transparency. Understanding price variations is instrumental in addressing affordability challenges. But price transparency isn't the whole story. Data transparency is another critical factor in the drive toward affordability, since understanding claims data (like your clients can get with self-funded plans) empowers employers to analyze patterns and plan utilization and adjust strategies where needed.
Get picky about PBMs. While many PBMs are wringing massive profits from the system, transparent PBMs are on the rise. You can help clients partner with those who demonstrate quality service at a fair and reasonable price.

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