Employers and Employer Coalitions
For the past 50 years employers have tried everything to lower the cost of premiums and thereby lower their contribution to that premium. Throughout all of these phases, we have been working with purchasers, physicians and hospitals to find the right solutions. We have seen all the mistakes of poorly directed managed care gone awry, discounts and caps on provider payments which fail, and now are watching the large deductibles and exclusions of benefits used in an attempt to force employees to use less services which has turned providers into banks financing care the employer does not cover.
The real question remains, and that is, can employers, as a fiduciary for their employees’ health plan, really say the employees and their families are having access to good medicine, the best physicians, hospitals, and pharmacy services? All of the stop gaps to reduce utilization have not worked because there are always 20% of the employees who use 80% of the benefits and when they get substandard care that 20% creates a larger amount spent because that 80% becomes part of a large number.
For example hospital A may be great for Ob/gyns delivering babies but not for orthopedics. Oncologist Dr. Smith may have a good bedside manner but extends chemo treatments even for patients with limited need. Other oncologists, also with good bedside manners, have a better method to watch over those chronically ill patients and truly manage the patients in early stages differently so they get well quicker.