Using digital solutions to lower healthcare costs

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For more than a decade, large employers have wrestled with providing quality healthcare to their employees and dependents while controlling costs. They have looked to plan design, burden sharing, value-based arrangements and digital apps — or sometimes all of the above.

Unfortunately, large employers still find themselves contending with high costs and poor outcomes. In fact, a recent study found that the average total cost of employer sponsored health coverage for a family plan has now passed $20,000 a year.

The root of the problem is that benefit leaders are stuck choosing from solutions that are not designed to be compatible with how their businesses are run. They are trying to solve a 21st century healthcare problem with 20th century solutions. But if we want to deliver world-class healthcare to the workforce, we need to deliver primary care to them in a way that uses the communications channels and technologies they use today in every other part of their work lives.

The evidence is clear that primary care is essential to keeping people healthy. Yet, studies show an average 29-day waiting time to visit a primary care provider, with a 109-day average in Boston, compared to 42-day average in Los Angeles. Without a primary care doctor, many employees get lax in managing their chronic conditions, and if and when they or others have a medical issue, they end up in urgent care (or on a telemedicine app) with a healthcare provider who doesn’t know them. Other times they have no choice but to go to the ER.

Moreover, without a trusted link between providers and patients, it is nearly impossible to do even the most elementary population health interventions. Even if you have several point solutions for conditions such as diabetes, prenatal care or behavioral health, engagement is challenging and ROI validation nearly impossible for users and administrators alike. Ultimately, employers end up paying for “sick care” instead of preventive care, which results in more work days missed and higher costs.

Many employers have responded to this by providing onsite or near site health centers. But this ignores the reality of how the modern workforce is organized. Employees today are scattered throughout the country and they may be working from home or in a shared office space. For them, the doctor’s office may be an airplane ride away!

Even if there is a nearby office, doctor’s visits are relics of another era. Think about it: if you are not feeling well, you are expected to pick up the phone, call your doctor’s office, make an appointment and go for an in-person meeting. Once you have filled out your medical history on a clipboard, the doctor sees you, they may give you a course of treatment and in most cases, that is it. There is very little follow up to see if any of it actually worked.

This is not how people work or live today. If you are working on a project with a team, you may start by using Slack or another chat program to share information and ideas. If needed, the team may move to a phone call or a video conference. Then, if necessary, the interested parties will meet in person, bringing with them all the relevant information from up until that point. Once the project is underway, the team leaders may check in — via Slack or email — to assess progress and troubleshoot problems until the project is completed, as defined by clear metrics.

There is no reason that healthcare could not be approached in this same way and with this same multi-modal approach.

We need to stop treating the “office visit” as the building block of healthcare delivery. Instead, we need to look at the entire “episode of care,” from the time a patient reaches out – through whatever media – to their provider until that issue is resolved. We need to take a project management approach to healthcare.

To make this happen, an employer will need a primary care group that can operate in a digital-first way — seamlessly integrating virtual care and in-person care across specialties such as behavioral health and physical therapy.

In addition to a digital-first gateway, they will need to have a network of primary care health centers close to the largest employee sites as well as relationships with high-quality providers across the country to provide the right mix of care online, in person, and anytime. And employers will need to set up a value-based arrangement with these providers; this approach only works if the goal is better health.

Enterprise healthcare can be a driver for better health. But to do so, it must be modeled after how modern enterprises are run today — not on how healthcare has always been run.

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