The last few posts have been on the way that self-insured employers purchase healthcare for their employees. Jeff Hogan has deep experience in this space and here he provides some insights on the topic.
The biggest issue is that employers don’t own their own data and it isn’t actionable. Further, in the past they’ve relied on the broker as their truth source to help them interpret their problems and to help them procure services. Brokers are paid guns for the insurance companies. They receive commissions based upon the increase in spend and decreases in spend pay them less. They also receive contingent compensation (more revenue) for placing volumes of groups with the specific carrier and for retaining those cases with specific carriers.
In short, the way that employers procure their services is inherently flawed and contrary to the new fiduciary standard.
Fiduciary procurement would assume that the employer has reviewed their data, seen variations in cost and quality and even how they pay multiples of Medicare for bad quality outcomes…….and that the employer has an objective process for procuring services that are appropriate or warrantied.
Fiduciary procurement would also assume that the employer has a trusted person or resource capable of understanding bad clinical pathways, poor quality or non-optimal therapies. In this world, I see the broker being replaced by a fractional medical officer who can review the data and make direct recommendations to the employer on who to contract with and how to optimize care paths. I also see employers contracting with reporting and data vendors who can intake their information including utilization and can help to interpret it into a format that is actionable. These vendors can also recommend OMT and other paradigm standards of care that the employer will procure.
The CAA promises to be one of the most, if not the most, impactful pieces of healthcare related Federal legislation in decades. The cloak of secrecy in this space will finally be lifted. Jeff Hogan, Co-Founder of the Moving To Value Alliance, is a national leader advocating for and promoting transparency in cost and quality. If you don't as of yet, follow Jeff on LinkedIn to learn more about how the healthcare ecosystem is transforming. https://www.linkedin.com/in/jeffhogan06