Heartland Health Research Institute

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Employer Perceptions on Healthcare System – a National Perspective

By: David P. Lind

National Healthcare PerceptionsDeloitte Consulting develops thoughtful studies on nationwide employer practices, specifically relating to employee benefits and healthcare issues. Their 2013 Survey of Employers study is no exception. Results from this particular study provide a great framework to the findings we will be releasing in April.

Deloitte’s topic within this report? How employers perceive the healthcare system. Their findings are both interesting and concerning for all of us. I’m not surprised, nor should you be.

The cliff notes from this survey reveal the following:

  • Employers view the healthcare system as wasteful and expensive.
  • Keys to improving the system are increased transparency around pricing of specific medical products, services and procedures. In addition, employers want “clear, accessible information about the performance of care provided by doctors.”
  • Despite almost four years into implementation, employers still do not understand the features of the Affordable Care Act (ACA).
  • Only 22 percent believe the ACA will reduce costs by 2019, and just 19 percent think the law will improve quality-of-care during that time.
  • Only 33 percent of employers grade the performance of the healthcare system as “A” or “B.”
  • 38 percent rate our healthcare system a “C,” and 29 percent rate it a “D” or “F.”

The big takeaway is that employers are frustrated over a perceived lack of ‘value’ in the price they pay for health coverage. The healthcare system is underperforming in numerous ways.

Keep this topic in mind and visit our website in April, as we will be releasing Iowa-specific information that reveals employer perceptions on 11 different performance indicators, in addition to the ‘trust’ employers have in their hospitals and physicians. I will also be releasing a white paper titled, “Voices for Value: Iowa Employer Perceptions of the Iowa Healthcare Provider Community.”

Stay tuned as this topic will only gain greater traction over the next months and years to come.

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Employers and Health Data – Who is the Trusted Resource?

By: David P. Lind

Health care data Resources in IowaLast week’s blog discussed a new module of questions we have included within our 2013 Iowa Employer Benefits Study©. Within this new module, employers are being asked to rate hospitals and physicians within their communities. Probing further, we included another battery of questions to gauge how employers feel about another health-related issue – identifying a reliable source to supply specific health care information to employers (and to their employees).

Frankly, these questions boil down to just one word – Trust.

Which resource does the Iowa employer trust when accessing and evaluating health care information for their employees? Would it be insurance companies? Maybe the medical provider community is most trusted, such as hospitals and/or physicians. The federal government is yet another possibility (I’m a bit suspicious, however). Perhaps, none of the above mentioned stakeholders, but instead, a trusted third party that has yet to emerge in this new evolving marketplace. Logic tells me that employers would like to use a combination of the above resources – not just one source. Much of this, I suspect, will also depend on the type of medical data that is desired by employers.

A large portion of the questions found in this particular module come from the Iowa Hospital Association (IHA). Transparency of health costs and effective health outcomes information is becoming a trendy discussion these days, with special thanks to the Affordable Care Act (ACA). The IHA has a great deal of interest in understanding how Iowa employers perceive these critical issues, and in learning more on how such information can be conveyed in a meaningful conduit of media (electronic format being the most likely culprit).

I applaud the IHA for their desire to find new ways to communicate and educate a major stakeholder (the employer) regarding local health care information. The healthcare snow globe in which we live continues to provide new opportunities for those willing to take the plunge to make our current health care ‘system’ a better place for all of us.

This particular survey module will provide us with additional insight on who should be providing this important information to Iowa employers, and what this critical information should convey.

The results of this survey will be published early this Fall by our new, sister organization, Heartland Health Research Institute.

To learn more, we invite you to subscribe to our blog.

Iowa Employers to Rate Health Care Providers

By: David P. Lind

Rating Iowa Health Care ProvidersIn our 2013 survey, we are asking Iowa employers to rate hospitals and physicians within their communities on 11 important performance measurements. Without a doubt, this particular module of our 2013 Iowa Employer Benefits Study© will be quite fascinating. To the best of my knowledge, Iowa employers have never been asked to rate health care providers in their communities – until now.

It’s about time.

Asking Iowa employers to rate health care providers will be important for a number of reasons. Two key reasons are:

  1. Employers contribute a considerable portion of the medical insurance premium for employees and their families. From our 2012 Iowa Employer Benefits Study©, the average employer contributes about 80 percent of the employee-only premium, or about $4,400 annually. The employee contributes the other 20 percent, or $1,065 annually. For employees with family health insurance coverage, the employer pays about two-thirds of the annual family premium ($8,900), while the employee pays the other one-third ($4,657). Needless to say, the average Iowa employer is very generous when picking up the health care tab for their employees.
  2. Despite annual premium increases, Iowa employers have CONSISTENTLY absorbed escalating costs since 1999 (the first year our Study began).  Employers make this ‘investment’ to maintain and improve the health and well-being of their workforce. The illustration below compares Iowa to the national average on employee contributions for health coverage since 1999. The national numbers come from Kaiser/HRET.

Average Percentage of Premium Paid by Covered WorkersThe two reasons above help illustrate the necessity of having Iowa employers provide input on the “value” they receive from this considerable outlay of money to our health care provider community. How Iowa employers perceive the performance of health care providers will cast an important light on measurement area(s) that may need improvement. Our new module of questions will help us understand just how satisfied employers are with this perennial investment. We do realize, however, that there are other external influences that must be accounted for when assessing the provider communities – such as public policy issues, insurance vendor arrangements, patient engagement, etc.

The 11 performance measures will be based on a 1 to 10 scale, where 1 means “failing” and 10 means “excellent.” The performance measures for both hospitals and physicians include:

  • The transparency of costs
  • The transparency in medical outcomes
  • The coordination of care among providers
  • Keeping costs reasonable
  • Consistent quality of care
  • Focus on wellness and health promotion
  • Access to services
  • Electronic health records
  • Efficiency
  • Concern for patient satisfaction
  • The ability to engage patients

Finally, employers will also be asked to provide feedback on how much they trust (or don’t trust) the medical provider community in which they operate. As mentioned in previous blogs, TRUST is an extremely important measurement to any industry, but absolutely critical in the health care world.

The results of this important survey will be published early this Fall by our new, sister organization, Heartland Health Research Institute and will be shared with the public.

To learn more, we invite you to subscribe to our blog.

 

Variation in Health Cost Prices – What a Mess

By: David P. Lind

Health Cost Transparency - A Big MessOver the last few months, some major ‘events’ have developed regarding medical cost transparency issues. Now is the time to channel our collective outrage to change how we pay for health care in the future.

In March, Steven Brill wrote a compelling (and disturbing) article in TIME magazine, “Bitter Pill: Why Medical Bills Are Killing Us.” For the first time ever, TIME dedicated almost the entire publication to just one particular article – due mainly to the complexities baked within the hospital pricing method(s) currently in place in our country. When you have time, this is definitely worth a read. Whatever a hospital will charge for a particular service, the actual payment will vary tremendously by the payer community left with the tab – Medicare, Medicaid, private insurers, or individuals without insurance coverage, etc.

Also in March, the International Federation of Health Plans released the 2012 Comparative Price Report showing just how extraordinary the costs of various health procedures are in this country versus the costs found in many other developed countries. After the Brill article, few of us need to question the validity of this particular report. The price differentials between the U.S. and all other countries are abhorrently grotesque.

On May 8, the federal Centers for Medicare & Medicaid Services (CMS) publicly released hospital inpatient charge information from hospitals in the U.S. The data released was the first time the federal government provided this information publicly. According to the CMS website, “As part of the Obama administration’s work to make our healthcare system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.” Without question, CMS unleashed a great deal of data showing how diffused and opaque hospital charges are for inpatient services, even within our own cities!

On June 3, the CMS yet again publicly released additional data on hospital outpatient charges, in addition to Medicare spending and utilization. It is quite apparent that federal officials are deliberately making health care costs more transparent for public consumption (and scrutiny). Health Datapalooza is an annual gathering in Washington D.C. that focuses on health data transparency. Now in its fourth year, Health Datapalooza has grown from about 50 attendees to more than 2,000. The idea is to have entrepreneurs take this massive data and create applications to help the public navigate through a seemingly complex world of healthcare costs.

This deluge of data becoming publically available allows a greater dialogue about the transparency of health costs and its impact on those who pay the bills.

A little bit of sunshine can be a great disinfectant – don’t you think?

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New Era in Iowa Healthcare (Needed)

By: David P. Lind

Value in Health Care DeliveryI’ve recently been visiting with healthcare providers around Iowa discussing how employers view health insurance and the value of healthcare delivered to their employees and family members. The discussion has been both open and honest. In fact, Iowa hospitals and physicians appear to be both interested and concerned with what they are learning.

My presentations evolve around four key observations that I have made over the past 29 years, both as a benefits consultant (my past life) and as a researcher. The intent of sharing these observations with the provider community is to convey the ‘pain points’ experienced by Iowa organizations regarding exorbitant health care costs and to begin a new dialogue of collaborating resources to find meaningful solutions in our health care world. After all, we are all in this mammoth problem together, right?

Here are my four observations:

  • Observation #1 – Health insurance premiums for Iowa employers have increased by 164 percent from 1999 to 2012. A great deal of uncertainty exists about the future of the health care ‘system.’

Year-after-year, employers continue to pay a handsome portion of the insurance premium. We know that take-home pay continues to erode for employees, as cost-sharing continues upward through increased payroll deductions and benefit plan alterations that include both higher deductibles and out-of-pocket maximums. This is clearly unsustainable for ALL of us. For communities to remain healthy and vibrant, employers must find solutions to this escalating problem.

  • Observation #2 – Iowa employers continue to embrace wellness initiatives, as they desire to have a healthier and more productive workforce.

Gradually we are morphing into a new social conscience of embracing healthier lifestyles – as more Iowa employers continue to assess and implement wellness efforts. We also have the Healthiest State Initiative and Blue Zones Projects™ in the news. The statewide Capital Crossroads Community Wellness Study reported that Iowa employers are open to partnering with community-wide wellness programs. For those employers currently without wellness programs in place, only three percent feel that wellness programs don’t work! This is encouraging.

  • Observation #3 – Lack of transparency in health care is a major concern and frustration to Iowa employers and their employees. Health insurance has become a major distraction to employers.

There is a growing belief that the ‘market’ approach does not work for ‘buyers’ of health care. In the next few years, will we see a gradual shift by employers to a more defined contribution approach by limiting financial support for employee premiums? Will value-based benefits begin to take hold that will nudge employees to use ‘higher value’ health providers and utilize approved medical procedures requiring less out-of-pocket exposure? Transparency of costs and outcomes are essential for the private market(s) to exist as health providers WILL definitely be held more accountable in the future.

The Accountable Care Act (ACA) will not solve the cost issue for employers and their employees. In fact, the ACA adds greater complexity in the insurance markets, forcing employers to search for opportunities that will relieve tensions and uncertainties. A ‘Provider Renaissance’ is sorely needed to deliver great value for the insurance premium being paid.

So what does all of this mean to the healthcare provider community?

Employers want to TRUST that hospitals and physicians will:

  1. UNDERSTAND the employer perspective, which is the need to be competitive by having a healthy workforce. Health providers must have the employers’ best interest in mind.
  2. CONSISTENTLY provide quality outcomes at reasonable costs – i.e. receive greater value for the dollar paid.
  3. COMMIT to do these critical things on an on-going basis – long term.

As mentioned in a prior blog, our fragmented delivery system is really not a “system,” but rather a concoction of multiple temporary or expedient remedies that attempt to solve our problems as we confront our health care needs. No one is at fault, yet we ALL are.

Now is the time for employers and the healthcare provider community to work together – starting with a meaningful and trusting dialogue that will result in concrete solutions.

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