I stumbled across the May 2018 Reader’s Digest recently. Other than making me feel like Edith Bunker (those who know, know), I found the headline interesting. “50 Ways to Survive The Hospital.” The implication here, just based on the title, is that there are at least, 50 ways that a hospital stay can kill you. Quite the opposite reason from why one would generally go into the hospital to begin with.
The point of our medical insurance system should be to help with the financial burden of a high-cost medical event. Many take for granted, that through the insurance credentialing process, state health commissions, and hospital review boards, all hospitals are safe and sanitary, meeting the high standards of the Joint Commission, AMAP or NCQA.
Yet here is this list, out in the open, the cover story of a popular magazine.
In reading the list, I found 25 out of the 50 ways where an employer, through their group health plan, could help mitigate the risk, resulting in ,not only a more successful outcome from a hospital stay, but also, in the long run, a less expensive stay.
What would be the motivation for an employer to provide more than just the funding mechanism for employees to afford a hospital stay? Well, other than being simply the right thing to do, it would help in getting their ailing employee back to their regular life more quickly, healthier and stronger than if they did not.
I sense the eye rolls of decision makers at organizations that offer health benefits. They might be thinking “not only do I have to play the insurance charade; now we must look at how I might impact the quality of a hospital stay for those enrolled on my plan?” The short answer is, yes. When the plan sponsor (the employer) is making the health financing decision other people, it would seem more logical to provide guidance on inpatient stays, than to not. What has been happening is the equivalent of selling a model car with thousands of pieces, but not providing any instruction on how to put it together.
Out of the 50 ways, to me there appears to be 25 can be impacted by an employer with the design of their group health plan, here is a shortened summary list:
- Offer advice to employees on the facilities that performed a particular procedure most
- Which ICU’s have critical care specialists?
- Rates of infection in an ICU
- Easy access to a second opinion
- Access to case management team for complex conditions
- Access to flu and pneumonia shots
- Assistance with note tracking and follow up to questions asked of the care team
These are just some of the ways a health plan could be enhanced by some non-insurance based advocacy and medical coaching. With the increased complexity in the healthcare system, many solutions have been developed around these value added benefits. The costs to implement are reasonable and in the value is in the long term avoidance of complications and shorter amount of time an employee has to be out of work.