3 Ways to Bring Value to Healthcare Benefits
There are times in everyone’s life when you hit the proverbial wall—a moment when being direct is your only option. This is one of those times.
About a year ago, I provided an overview in my Human Resource ExecutiveÒ column of value-based healthcare and value-based insurance design, along with a rationale and practical steps to help benefits leaders implement this approach in their healthcare design. I commonly use an educational approach when I’m introducing a less-understood topic but, to be honest, I secretly hope I inspire people to act on the shared information. (That’s probably unreasonable on my part.)
To be completely transparent, I’m actively involved with others in my home state to bring value-based healthcare to our residents. I’m also pleased to say we are making progress—especially when it comes to ongoing work by the state of Connecticut. But here’s the thing. Our efforts are taking too long—and the same can be said about similar initiatives across the U.S.
The linchpin to moving people to a value-based healthcare model is you, dear readers: human resource executives and benefits leaders. While some of you are definitely on board, we need more. According to a recently published Willis Towers Watson survey, 6 percent of employers said they directly negotiated with healthcare providers in 2017 for both quality and cost outcomes (the 1-2 punch needed to deliver value), while 22 percent of them indicated they planned to negotiate directly or would consider it in 2019. A good start, certainly, but for someone like me, this feels like too little. And here’s why.
In my private life, I coach and counsel people who are dealing with difficult diagnoses. This is not a formal arrangement, and I do not dispense medical advice. This volunteer work developed on its own when people who’d either heard me speak about healthcare or read my writings asked if I could walk a relative or friend through how to read research and advocate for themselves. At any given time, I’m in contact with two to four people in active treatment. All of them are working-age adults who are juggling job demands, family and their health.
A few days ago, a woman I’ve worked with for the last year shared new information that rocked me to my core. She was diagnosed with rheumatoid arthritis. At first blush, this may seem sad but hardly earth-shattering news—further evidence that life is almost never what it appears to be on the surface.
Almost 10 years ago, when Cynthia (the person’s name is changed for privacy reasons) was approximately 40, she saw an orthopedist for bilateral foot pain that was so severe she stopped running, hiking and taking long walks. In order to fall asleep at night, she iced her feet before bed.
Unfortunately, the physician dismissed Cynthia and her reports of pain—something that happens to women more frequently than men. Since that visit, she consulted eight other physicians over seven years with her continued foot complaints and new symptoms of elbow pain and hand numbness.
Last year, Cynthia felt something odd in her breast. Her gut feeling told her this wasn’t a benign cyst and she was right. Cynthia had stage three triple-negative breast cancer, an aggressive form of cancer that affects approximately 20 percent of breast-cancer patients and has the lowest survival rate.
Cynthia chose treatment at one of the National Cancer Institute’s 49 comprehensive cancer centers and was given a somewhat hopeful prognosis.
Cynthia began neoadjuvant chemotherapy, with the hope of shrinking her tumors before surgical removal. The tumors responded to treatment immediately, but one main complication developed over time. The pain in her feet became worse. Chemotherapy-induced peripheral neuropathy in the feet and hands is a common side effect of her treatment protocol, and the oncologist believed this was the cause. Cynthia did not believe she could tolerate any more pain in her feet, so her medical oncologist took her off this plan, since she’d already made good progress. She then began a more traditional approach to chemotherapy.
This time, Cynthia did not respond well. Her tumors began to grow again while she was receiving the new chemotherapy, which is an unusual response. She had an emergency mastectomy to improve her chances of longer-term survival.
Cynthia recovered well and was able to return to work and horseback riding, the only activity she could participate in without worsening her foot pain. Her medical oncologist placed her on a pill form of maintenance chemotherapy to prevent progression of her disease. But Cynthia’s body rebelled again, this time giving her severe hip pain. Her oncologist stopped the treatment plan.
When Cynthia’s hip pain didn’t resolve, her medical oncologist referred her to a neurologist who diagnosed her with rheumatoid arthritis. Her medical oncologist is distraught because Cynthia twice stopped effective treatment for her cancer because of symptoms related to her undiagnosed RA. Her concern for Cynthia is two-fold.
First, physicians can most effectively treat RA when it is diagnosed early. Cynthia’s presenting symptoms seven years ago were classic for the disease.
Second, Cynthia’s missed diagnosis of RA negatively impacted her best chance for long-term survival of triple-negative breast cancer.
You may read this story and believe Cynthia’s experience is rare. Your assumption is wrong.
In 2015, the National Academy of Medicine reported that most people will receive an incorrect or late diagnosis at least once in their lives, sometimes with serious consequences. It cited one estimate that 12 million people—about 5 percent of adults who seek outpatient care—are misdiagnosed annually. The report also noted that diagnostic error is a relatively undermeasured and understudied aspect of patient safety.
In April 2017, Mayo Clinic researchers reported that nearly 88 percent of patients who sought a second opinion went home with a new diagnosis. Results showed only 12 percent of the cases had diagnoses confirmed, 21 percent of the diagnoses were completely changed and 66 percent of patients received a refined or redefined diagnosis. The total costs for cases where patients were given new diagnoses were significantly higher than costs for cases where the diagnoses remained the same or were refined or redefined.
So, I need you to do three things to improve both the quality and cost of healthcare.
Learn more about how you can move your employees to value-based healthcare. You might want to start by listening to a podcast I recently conducted with Dr. Steve Schutzer, president of the Connecticut Joint Replacement Surgeons, the physician executive for the orthopedic service line at Saint Francis Hospital and Medical Center in Hartford, Conn., and the physician director of the Connecticut Joint Replacement Institute at Saint Francis. It will ground you in the basics through the use of clear and easy-to-follow examples. (You can also read the transcript of our conversation.)
Talk with at least some of the healthcare providers who care for your employees and their dependents. Ask to see their outcome data. And, when they seem unclear about how to give you the information, point them to a case study published by Schutzer and his collegues in NEJM Catalyst in December.
Finally, work with your insurance broker or consultant on how to bring value-based healthcare into your health-insurance-benefit design.
Your employees and I are counting on you.