Posts Tagged ‘patient advocacy’

What’s Wrong With This Picture?

September 9th, 2010

American Healthcare Magazine - September 6, 2010 - Nick Jacobs, FACHE - HealingHospitals.comThe Modern Healthcare edition of September 6, 2010 has a cover headline that reads: “Passing the Buck,” and the descriptor goes on to explain that “Yet a new report says workers’ share of benefit costs is skyrocketing.”  The actual opening line of the article starts with “Workers are shouldering more of the costs of health coverage than ever before amid stagnant wages and a weak economy”…

A few weeks ago, I wrote about Patient Advocacy, a subject about which I am passionate. So, this blog is about patient and employee advocacy that also provides additional resources for hospitals to help them address the current economic challenges.

Every year when we looked at our medical insurance costs at my hospital, a politically incorrect friend would jokingly suggest that we begin an annual, required participation August Tennis Tournament for our high-utilization employees, but only after the temperatures reached at least 95 degrees.  “It would be a thinning of the herd,” he would jokingly say with an elf-like smile on his face.  We would then get serious and dig into a long list of creative ideas aimed at helping contain these costs so that we would not have to lower benefits or pass the charges on to the employees.

Included in these lists were some rather simple ideas such as offering, in a structured manner, the wellness options covered under our health insurance umbrella and generally rewarding our employees for taking better care of themselves.  We significantly reduced fees for the workout facility (1/3 of the regular cost ), provided personalized counseling from our dietitians, had a weight loss contest and gave rewards for taking classes on stress management, smoking cessation, diabetes control and exercise.

We offered psychological counseling for our employees who were suffering from stress related issues.  Our food service vendor, CURA, made sure that “no transfats” were a part of the hospital’s meals, that there were always low-fat vegetarian choices on every menu, that snacks were reasonable and that our vending machines had healthy choices. We also celebrated life and work on a regular basis.   We had cook-outs, off-stage break rooms, massage, aroma, Reiki, pet and music therapy.  We provided drum circles, non-denominational spiritual services and meditation classes; kick boxing, Pilates, pool therapy, and employee parties.

So, short of forced tennis matches, how else can we control these costs?  The following is a summary of a program that SunStone Consulting is currently offering with two other business partners, CBIZ and InforMed.

Over the past 6 years, the average annual health insurance cost increase for InforMed-supported patient advocacy programs has run at 4.5%, compared to the 10-12% trend for all employers.  In the case where a hospital with 1,500 employees is paying out about $10,000,000 a year for employee health insurance, a 5% savings over a three year period would generate $3.3 million in savings.  Let me repeat that:  By lowering those  premium increases by 5%, there would be over three million extra dollars available for hospital financial needs and co-pays and deductibles for the employees would not have to continue to escalate by 13 to 15% annually.

The Patient Advocate logo (California) - Nick Jacobs, FACHEThe care management “engagement” rate of all the major insurance companies is about 30%. That means that the insurance company-based “help programs” are about 1/3 effective in even reaching the employees.  This non-insurance company based program, however, has a 70% engagement rate of identified large claimants, more than double the insurance company’s rate, and with over 1 million employees in this program, they produce a 98% patient satisfaction rate.

By employing local, trained, patient advocacy nurses, paying physicians a monthly stipend out of the savings to help manage these patient/employees, and then helping those high utilization patients legitimately navigate through the nine to fifteen physicians with whom they interact on an annual basis, health systems are seeing tremendous savings.  (Kind of the Best of Managed Care scenario.)

These are clear, actionable items that will positively change a bottom line quickly and permanently without having to increase the financial burden on the employees.

Why not try it?  It works.

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Posted in Hospitals, Leadership, patient-centered care

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Could We Do It Better?

August 8th, 2010

Several months ago, I met a white-haired gentleman of average stature at a meeting.  When I asked him what he did, he replied, “I’m a patient advocate.”  “So am I,” I said. “I even wrote a book, ‘Taking the Hell out of Healthcare’ about it.  “Yes,” he continues, “but I found a way to make a living from doing this.”  His name is Harry and he is an actuary.  In those yin and yang posters, that would put us at opposite ends of the proverbial left brain/right brain spheres.  He had analyzed health care records for about thirty years and could prove what we all know, that between 5 and 7% of our employees use up about 80% of our healthcare dollars. That, my friends, is not rocket science.   All you need to do is hang around some sick people for a while, and you’ll realize that “our system” is set up to keep doing things to them over and over again.  Usually, it’s not to help them eliminate the problem, but to maintain their life in a chronically challenged situation.

Ryan Is An Actuary. Look It Up. Flickr photo credit: evaxebra - © all rights reserved

Flickr photo credit: evaxebra © all rights reserved

So, I asked Harry what he does, and he indicated that he hires nurses, pays doctors and employs “MANAGED CARE’S GREATEST HITS.”   Now every health insurance company in the world will claim the same thing, but everyone who has ever been turned down for anything by any health insurance company knows that: 1.) the bottom line reason was usually their bottom line, or: 2.) it’s a nurse against your doc, and your doc has not employed all of the verbal and intellectual tricks to convince him or her to allow you to have the test or take the drug that he thinks you need.

Harry went on to explain that these “5  percenters”  usually have anywhere from nine to fifteen docs with whom they interact on a yearly basis, and, not coincidentally, these physicians usually don’t do a great deal of interacting with each other, hence the need for patient advocates.  This is where Harry’s nurses come into the picture.  He assigns a nurse to each high-risk patient, allows the patient to pick their “favorite quarterback doc,” and then pays that physician to help hold down the duplication of unnecessary tests.  Makes sense, huh?  I can just hear my Internal Medicine physician saying, “Nick, you don’t need those 13 other chest x-rays this month, the first one will do fine for all of us.”

Interestingly enough, this system WORKS, and it works pretty darn well because it’s not about saving money for the insurance company;  it’s not about depriving the patient of needed tests;  it’s not about controlling the patient, or preventing him or her from having what they need, but it is about eliminating wholly unnecessary tests, meds, and procedures.  Harry had letter after letter from grateful patients, families, and employers thanking his people for helping them navigate their way through the maze of this very complex, sometimes-disconnected, procedure-oriented system.

The other interesting thing is that Harry likes to go to a town and start first with the hospitals, because their employees are the most comfortable with using everything, and have the easiest access to the most doctors.  It’s a great way to prove  the system works.  From that point on, he then works to bring all of the major employers into the fold, and ties them into the primary hospitals.  It’s something that only an actuary could have accomplished, because, as Harry readily states, “It’s taken me about 30 years to perfect this system.”  The patient is protected from being over-tested in an indiscriminate manner; the hospitals or businesses save a considerable amount of money, thus limiting reases in their annual healthcare costs, and the savings are cumulative over the years.  So, why not try something that will improve the employee morale, patient satisfaction, and quality?

If you are interested in learning more about this program, give me a call.

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Posted in Healthcare, Hospitals, patient-centered care

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