The new health care economy: A clinical perspective
If benefits advisors and employers are not involving clinicians and physicians in health care plan design, they're not getting the full picture.
The BenefitsPRO Broker Expo has always been the place to be to discuss the latest innovative and disruptive benefits ideas. A few years ago, a newcomer to the space realized that something was missing from these conversations: health care providers.
“I’d go to conferences like this and I wouldn’t see many clinicians,” said Mark Testa, who worked as a chiropractor before eventually becoming executive vice president of Regenexx. “How can we fix health care without clinician involvement, and without clinicians speaking into this world?”
Well, this year, he and three of his colleagues got their chance, presenting a panel on how brokers can work with clinicians to impact health care cost and quality.
“If you want to address what’s wrong in your health plan, you have to know what you’re looking at,” said Kimberlee Langford, vice president of clinical services at Specialty Care Management. “Data is the pulse of your plan. Knowing how to interpret that, finding hidden risks, the 3% to 5% of your population that looks okay right now but could become your biggest spend.”
Despite their drive and thirst for learning, benefits advisors can’t match the years of education and training that go into becoming a medical professional. As such, these professionals offer invaluable insights into the latest developments in clinical care and diagnostic tools. Cristin Dickerson, founder of Green Imaging, offered a couple of examples from her space, including mammography technology and cardiac diagnostics.
She noted the advent of two relatively new diagnostic tools to the market: 3D mammograms and breast MRIs. Because of their recency, there’s little long-term data on their efficacy–for now. “We’re starting to put that together, she said, and the evidence is just not there to support the cost of these tests. “It’s a shame. These people are buying expensive machines, and they have to pay for them. They push them, and all the women want them.”
On the flip side, she gave the example of a couple of new tools in cardiac diagnostics. “Cardiac MRIs and coronary artery CTs are becoming the gold standard,” she said. Despite the usefulness of these tools, “people are doing stress tests because the cardiologists still have them in their office. The best screening is a coronary calcium CT. It’s $175 and a quick scan and will stratify risk better than these old stress tests. We have to get away from paying for the cheap stuff to the tools that will diagnose faster and more accurately.”
Lauren Roberson, head of nurse advocacy at Connect Healthcare Collaboration, also shared how a clinician can offer a more holistic view of a patient’s care needs. “We had an employee reach out and ask, ‘Can you help me with this health condition?’ He had been prescribed a medication and wanted to know if it was covered under his plan.”
Not only was she able to confirm it was, she helped him understand the other medications he was taking, and why. One medication he was taking for neck pain caught her attention. “I noticed in the last year he has had opiate misuse, and he tells me the doctor is now referring him back to pain management,” she recalled. “That’s the last place you want him to go. Long story short, we got him into a Center of Excellence program… he’s now on a conservative path for his neck pain.”
These were just a few examples the panelists shared with the audience, who responded with their own questions and perspectives, further demonstrating how valuable the clinical perspective is becoming to designing health care plans that actually serve the needs of users.
“As clinicians, we know the protocols, we can see things coming that we can intervene on proactively instead of waiting until next year,” Testa said. “By having clinicians more involved, we can be way more proactive.”