Today, when you read about healthcare, you read about reform. There is no doubt that the healthcare industry is changing, and demand for quality outcomes plays a big role in this change.
Value-based medicine and value-based benefits design are here and it is time for health plans to leverage their long-held mantra that improved clinical results also result in economic efficiencies.
General surgery is one area of healthcare that has evolved, specifically, with the growth in minimally invasive surgery (MIS), which provides benefits not only to payers, but to patients and providers alike. Typical MIS patient benefits include faster healing, less pain and scarring, and quicker return to normal activity.
By implementing a well designed benefits plan that reflects the value of MIS, health plans can continue to advance patient care and overall outcomes, as well as reduce costs related to health benefits.
A case in point is the Colorado Springs School District 11 (D11), a K-12 school district representing the majority of students in the Colorado Springs area and "home" to 3,400 employees, with a self-funded and governed medical plan that covers a total of 6,000 individuals.
D11 needed to decrease the escalating costs of healthcare benefits, in large part brought on by an aging workforce and an increase of chronic illnesses. The escalating healthcare costs were hurting the district in more ways than one—it reduced the flow of money that went directly to education and hindered the district's ability to offer competitive salaries and hire qualified teachers.
In collaboration with its third-party administrator, D11 revamped its health plan to emphasize and promote the benefits of minimally invasive surgery to its members over more invasive, open surgeries when appropriate.
For five pre-selected surgeries, the health plan offered a member who opted to undergo a minimally invasive surgical procedure over open surgery a reduced co-payment: $400 less for an in-patient surgery and $200 less for an outpatient surgery—a monetary incentive for patients in addition to the physical benefits of MIS.