Tag Archives: Health Insurance

Looking to the Validation Institute and Validated Programs as an Employer

Disclosure – I serve as an Advisor to the Validation Institute.

Costs for their employees’ health care have continued to rise even as employers have implemented numerous programs and benefit changes, from raising employees’ deductibles and co-pays, to implementing wellness programs.  While employers pay most of the premiums, which now exceed $20,000 for family coverage, employees now shoulder $6,000 per year on average, a heavy burden.

Here is a look at premiums growth over the years from the Kaiser Family Foundation Employer Health Benefits Survey..

Image result for employer healthcare costs continue to rise

So, what’s an employer to do?

That’s where the Validation Institute comes in.  The Validation Institute or VI does three things:

  • Validate
  • Educate, and
  • Connect

This post will discuss Validation and its importance.

No doubt employers have been looking at their health benefits and listening to their brokers or consultants explain how this program or that health plan is the best way to go and will result in better employee health and lower costs or a lower growth in costs. But how do they know? While most have heard these statements year after year, their costs have continued to rise.

The good news is there are solutions that deliver better clinical outcomes and/or reduced costs. Finding and validating the claims being made has been the hard part. The marketing of health care services has been fraught with all sorts of performance claims and many of the studies and white papers used to support them are just plain wrong.

The VI, through its Validation process, handles that process for you. It rigorously looks at claims being made by companies throughout heath care. 

For a company to be validated, it must submit its data.  The source, measures, analysis and results are reviewed to determine whether the claim being made stands up to a rigorous evaluation. Only after a thorough review can a company place the Validation Institute seal on its website and use the VI certification in its marketing materials.

There are four different “levels” of Validation. They are, in ascending order of rigor:

Calculators

Many companies develop calculators to show prospects their expected savings or outcomes.  If the calculator has been validated, that means  it uses reliable and linked data sources, reasonable parameters and estimates, but allows the users to change certain assumptions. It also means that the calculator produces credible estimates of an intervention’s impact and the intervention has been shown in published literature to be correlated with the impact.

The company may  not have produced a study showing these results, but based upon their calculator and other research, the calculator is likely a credible estimate.

Program Impact – Metrics

In this case the vendor has a credible measure (either from a published source or modeled closely to a standard measure) of the program impact, but the measure has yet to be applied to data from a population receiving the program. The intervention has been shown in published literature to be correlated with the impact.

So, the program has been shown in other cases to be correlated with creating the outcome, they are measuring and doing something similar, but have not yet measured their own results to the satisfaction of the VI.

Program Impact – Outcomes

The vendor has used credible data about a population receiving the program and reliable measures (either from a published source or modeled closely to standard measures) to estimate impact.  The intervention has been shown in published literature to be strongly correlated with the impact.

The program being reviewed by the VI has been shown to strongly correlate with creating the outcomes, and the company has obtained these outcomes on a population with credible data and reliable measures.

Program Impact – Savings

This is the big one. The program has been shown to the Validation Institute’s satisfaction to produce savings.

As a health care purchaser, you want the best for your employees and your company. Look to the Validation Institute and their certified companies to know that what you are implementing for your employees is based on sound studies, measures and/or outcomes and is more likely to do the same for you.

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The Validation Institute – How they can Assist Employers

The vast majority of employers are continuing to experience rising health insurance costs. We know there are areas of healthcare from quality differences to the variation in utilization that can negatively impact an employer health plan and its estimated that 30% of healthcare is unnecessary, waste and/or fraud. To solve this there have been many solutions proposed including wellness, imaging management, PBMs, High Deductible Health Plans, Direct Primary Care, Value Based Care, direct contracting and many, many others. In each of these solutions there is typically some sound belief that the concept will work, but there are also a lot of vendors or healthcare providers out there claiming they have the answer and this is often filtered through a broker who may or may not have your best interest at heart (Read about some the egregious behavior here “Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans“).

So how can one identify providers of services who can achieve results? Well that’s where the Validation Institute comes in. To get a sense of the why and what the Validation Institute can do for you, watch this short video:

 
 

For full disclosure I was involved early with this group and since then have assisted in various capacities. I currently serve as a Senior Advisor, Standards and Compliance and also serve as a Judge for the Health Value Awards which are given annually at the World Health Care Congress to companies, employers and brokers who can show that they demonstrably improve the outcomes for their employees and lower costs. The validated Health Value Awards are also reviewed by the Validation Institute.

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PopHealth Week – Annual Medicare Wellness Visit,Value Based Care and Employers

Gregg and I had an interesting discussion on this week’s episode of PopHealth Week. We covered the Annual Medicare Wellness Visit and how it came to be, as well as value based care and some interesting moves by employers (Walmart and the Utah State Employee Health Plan) and providers (Oschner and their ACO).  Listen in:

PopHealthWeek-logo-TWTTR-sq PopHealth Week – The Medicare Annual Wellness Visit, Oschner and Walmart, Utah Employees and high Cost Pharmaceuticals, a new approach.

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Ridiculous Healthcare Pricing

All over the country people are commenting on the ridiculous pricing from healthcare facilities and providers.  Here is a recent example I came across:

Lab Bill

You’ll note that the gross price for these lab tests is $837.74 and the person was told their out-of-pocket responsibility could be $109.85.  What is so amazing about this is I have heard of wellness companies that purchased lab services for their programs being charged $21 for a similar series, without the PSA, if the draw was done at a laboratory service center and $65 if the draws were done onsite at the employer.

So lets take out the PSA at $148.48/$19.47 and there you have it, gross pricing for these services is almost 33 times what they sell this service to wellness vendors on a wholesale basis (which obviously has a profit in it), and the person getting these tests could potentially pay four times that amount out of pocket with their PSA portion excluded.

I assume that the insurer, Continue reading

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Tom Chamberlain, CEO of EdLogics on PopHealth Week

In attempting to control healthcare costs, improve health and seek better utilization of healthcare services by their employees,  one key area of focus by employers needs to be health literacy. It’s clear that poor health literacy is a strong indicator of health care costs. Here are some statistics:

Health Literacy Stats

 

Tom-pic

Tom Chamberlain, PharmD, the Founder and CEO of EdLogics joined Gregg Masters  and me on PopHealth Week  to discuss their platform and how it works to improve Health Literacy and engagement.

 

From their marketing materials:

EdLogics is an education-based consumer engagement company that provides innovative health education and learning management solutions to employers, health plans, healthcare providers, and government entities. Through interactive game-based learning, multimedia educational programs, innovative gamification strategies, and rewards for educational achievement, EdLogics is transforming the way consumers learn about health. The EdLogics Platform makes learning fun and engaging, measures learning comprehension, improves health literacy, and empowers consumers to take greater responsibility for managing their health.

You can learn more about their platform via this video (http://www.edlogics.com/overview/)and listen to the interview on PopHealth Week below:

 

 

PopHealthWeek-logo-TWTTR-sq

For full disclosure, I am an advisor to EdLogics.

PopHealth Week is Produced by Health Innovation Media

 

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