Tag Archives: Employee Benefits

Saving on Employee Health Benefits: Would you Hire this Consultant?

Over the years as an HMO executive and later founding a disease management and Healthcare IT company, I have analyzed a lot of medical claims and quality data. One of the largest was an analysis of a State Medicaid program with about 675,000 beneficiary lives with two years of inpatient, outpatient and pharmacy claims. The pharmacy file alone contained about 15 million prescription fills.

More recently I became certified as a Professional by the Care Innovations Validation Institute and sit on their Advisory Board. This certification tested my ability to look at data and decide whether the outcomes reported were likely to be valid or not.  As you look for vendors or consultants I would suggest you start with the Validation Institute. The following example is a good reason why.

Cruising around the web looking at various healthcare consulting firms and company websites I came across  a company that is targeting employers and claims they  have vetted and can bring in vendors to lower the costs for a company’s self funded health plan. Their website says they can identify, evaluate, oversee, manage and report on the vendors they propose.

On their home page is a chart used to show the savings an employer can expect to see by implementing their various cost saving approaches.  Can you spot the flaw(s)?

 

high-performing-network-chart1

 

Let’s start with the first and most glaring error and its on the first line. Continue reading

Advertisements

Leave a comment

Filed under Healthcare Costs

Employers, unions look to direct contracting for health system contracts

Brian Klepper and I just published a piece entitled:

Employers, unions look to direct contracting for health system contracts

Some key points:

“Industry denials notwithstanding, reducing healthcare costs is fundamentally against nearly every healthcare organization’s perceived economic interests.”

“Florida’s Gov. Rick Scott, former CEO of Hospital Corporation of America, pointed out at a venture capital conference a few years ago, ‘What business wants to make half this year what they did last year? That’s why the healthcare industry won’t fix the healthcare industry.’ “

So purchasers beware. You can read the article by clicking the link to the story at Employee Benefit News:

ebn

And if you’d like to learn ways to lower your healthcare costs, contact Brian or me at Health Value Direct

HVD

Leave a comment

Filed under Healthcare Costs

Update to: The Dodo Bird and Employee Wellness Programs – The Phone Call

11/6/16

News Flash, The Dodo Bird is Still Alive:

Well another year has rolled around and I was talking to the person who’s experience with their wellness program I had discussed below. Lo and behold, the problems I had originally documented continue. This is a common example and explains why so many wellness programs should be discontinued.

It was time for next years enrollment period for her insurance and she needed to get a number of points, schedule a coaching visit and get her biometrics and lab work completed to qualify for the premium differential.

The lab work requirement upset her as she had just gotten all the lab work done by her PCP the month earlier, but no, those lab results couldn’t be used. So the vendor repeated all the lab work her PCP had done and more, most of which were absolutely unnecessary based upon USPSTF guidelines. But hey let’s go ahead and waste some money and do a few unnecessary tests.  That’s become the norm for many a wellness program.

As for getting the points, she recorded her exercise by selecting the boxes to document 30 minutes per day. That was the correct answer. Wink…

She was also required to speak with a coach so she had previously set that up, and when asked by the coach if she could take up some new behaviors,

said “oh yes that’s a good idea, I will.”  Wink..

The coach asked if she could follow-up in 3 months

“of course” she said

During the follow-up call, she dutifully reported to her coach that in fact the suggestions were a good idea and yes she had changed her behavior. Wink, wink…

“Congratulations” said the coach as she documented her successful intervention in the wellness vendors system.

Premium differential achieved.

I know exactly what this vendor’s annual report will look like. They’ll be touting all the calls they made, engagement they got, and behavior change achieved.

Don’t you just love self reported data.

Perhaps the vendor involved should call the Validation Institute and get some suggestions on how to measure their program so they can actually understand that their reported results are just plain wrong.

I can hear Al Lewis saying “I told you so”, but perhaps more interesting would be calling this vendor to testify and document why their program should be continued as part of the AARP lawsuit against the EEOC.

For the original story keep reading

Original Post

Given todays news report that the Feds say “Smokers are Lying on Obamacare Enrollment Forms” I thought I would publish this post written well over a year ago.  Seem’s it’s not just those enrolling on the exchanges who may be misrepresenting this important information, probably in ways you’d never think.

We have a crisis in the wellness program industry.

Continue reading

2 Comments

Filed under Uncategorized