by Dr. Josh Luke, faculty member
University of Southern California’s Sol Price School of Public Policy
It is common for businesses or start-up made a major purchase only to find out later they overspent significantly. How often are they making this same mistake with healthcare? Moreover, it’s likely that employees are making this mistake every day, yet they may not even know they have an option. Unless the organization takes ownership of educating its workforce, it’s likely employees will continue to overspend. And remember, if they are overspending their own money, multiply that by three or four times for its financial impact on the company. For example, a simple surgery can cost the company $30,000 to $40,000 more if the employee does not choose a center of excellence.
It’s very common that one hospital will charge 60% more for the same procedure as a competing hospital, often located directly across the street. To confuse this process even further, the same doctor will operate at either of these hospitals? This is what happens when people are led to believe “insurance will pay for it.” These are the six words that killed American healthcare.
Insurance will not pay for it
When buying a new car, do customers compare features and price? When buying a house, do they shop neighborhoods, school districts and number of bedrooms? Of course they do. Why don’t they do the same when it comes to personal health? Why are Americans afraid to ask a doctor for a second opinion – or even an alternative – when a high-cost procedure is recommended?
Well, the short answer is that they have been led to believe that insurance will cover the costs, so it’s not important. They don’t monitor which facility they choose, and they don’t question recommended procedures. But that’s dead wrong. Each time an employee chooses a higher-cost provider, that cost is added in some form to the following year’s premium cost to the company – which, in turn, is passed on to the employees. Year after year. It’s inflation by design! Not the company’s design, but by the hospitals, insurers and pharma companies (among others) that benefit from constantly increasing prices.
Become an EHC
It is critical that individuals become engaged healthcare consumers (EHCs) How? Start by focusing on the three P’s: plan, prevent and personalize. Create a strategy that focuses on preventive care, as well as personalized care.
P #1 – Have a plan: The first P is to take control of individual health by creating a healthy living plan. That plan includes dietary goals as well as fitness and lifestyle habits. Also, for those who suffer from a condition or chronic disease that impacts their health, their plan should include specialized steps to specifically address those needs as well. Plans also should include several personalized and preventive medicine steps.
Update the plan at least annually, but daily monitoring and tracking of diet and fitness habits are critical in shaping this plan as well. There are plenty of tools available via mobile phone applications to track both diet and fitness. Also, research mobile applications available to support management efforts for any chronic diseases, such as diabetes or hypertension.
P #2 – Personalized medicine tactics: A number of personalized medicine tactics should be considered, including DNA testing and genome sequencing, as well as functional and integrative medicine tactics. The more people can learn about how their body differs from others, how their body metabolizes medication and food, and how their body reacts in general to different foods, exercises and lifestyle habits, the healthier they will be. Implement these tactics into the plan!
P #3 – Preventive medicine tactics: The second key component of the plan is to utilize the tools, resources and technology available to assist in monitoring and improving health. From checking blood pressure to diabetic management to tracking exercise and dietary consumption, a healthy living plan is the first step in practicing preventive medicine tactics. It’s only a matter of years now before science will identify the exact medication that is best for each condition based on personal metabolism, known as polygenic risk scoring. At present, medicine is well on its way to that level of personalization, so utilize the tools currently available.
To date, there has been little evidence suggesting any link between price and quality in healthcare. In fact, those doctors who engage in the discussion about fair pricing often are getting higher quality scores than the high-cost provider. The doctors and facilities that offer lower pricing and higher quality are known as centers of excellence, often referred to as within the narrow network. Once beginning the journey to becoming an engaged healthcare consumer, continue by shopping for healthcare centers of excellence. This will save significant dollars for both employees and employers.
So, while corporate America has finally stepped up to lead the charge against hyperinflation in American healthcare, individuals can do their part by becoming engaged healthcare consumers. The tactics listed above are a simple start down the EHC path.
Dr. Josh Luke is a celebrated speaker, award-winning futurist, a faculty member at the University of Southern California’s Sol Price School of Public Policy and the author of Health – Wealth: 9 Steps to Financial Recovery. Drawing on his experiences as a hospital CEO, Dr. Luke delivers engaging and entertaining keynotes that teach audiences simple concepts on how individuals and companies can save thousands on healthcare. For more information, visit www.DrJoshLuke.com.