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Strategies for Staving Off the Healthcare Crisis

Content provided by IBM-ForwardView eMagazine .

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For many small and midsize businesses (SMBs), spiraling healthcare costs that are increasing 7 percent annually have made it more and more difficult to provide comprehensive employee medical care. Yet without healthcare coverage, employee productivity can rapidly decrease. So how does an SMB company solve this problem?

ForwardView recently posed this question to Paul Grundy, MD, director of healthcare technology and strategic initiatives at IBM, where his research helps drive company health benefits policy. ccording to Grundy, healthcare in North America—both Canada and the United States—is fast ecoming unsustainable, and will require a massive overhaul in the next few years to remain

Yet, says Grundy, there are a number of things SMBs can do now to reverse trends that have made the United States sink to 37th and Canada to 30th overall among all industrialized nations in healthcare. These include helping employees become better consumers of healthcare, along with becoming more informed about and participating in healthcare policy discussions.

Look for health plans with a strong doctor/patient relationship

According to Grundy, employers of all sizes need to take a close look at the overall value that health plans provide to employees and the company. For Grundy, the best value often comes from plans that encourage a strong doctor/patient relationship—a trait he says characterizes the world’s best healthcare systems.

These relationships can often prevent catastrophic and expensive medical situations, he says. “A relationship with your provider that’s meaningful should be directed toward preventing disease and promoting health,” Grundy says. “Plans that are directed toward promotion, prevention and primary care provide the most meaningful, long-term potential savings.”

Yet not every healthcare plan emphasizes a close doctor/patient relationship. Some plans do not offer this relationship at all—one of the reasons, Grundy says, that many people go to emergency rooms for non-life-threatening health incidents.

That’s why evaluating relationships with healthcare providers and insurer should include:

Looking closely at service-level agreements. Like any kind of service or financial product, healthcare packages and insurance are not created equal. Premiums and copay amounts are only part of the story. Deciding on the trade-offs between payments and access to healthcare will help drive a sense of what constitutes value for an SMB.

Seeing if there is an emphasis on preventative care. This is critical in an era in which approximately 80 percent of coronary heart disease and more than half of all incidents of cancer could have been prevented through lifestyle changes. If the plan has incentives for healthy living, it is likely to provide preventative care options that can help stave off major medical procedures.

Making sure there is a strong emphasis on using technology for record keeping. “We’ve reached a point in medicine where it’s just not possible to manage some chronic diseases without the assistance of clinical decision support and electronic medical records,” says Grundy. “If you’re seeing a doc that is still writing on paper, you’re not getting the maximum benefit from what he or she can deliver.”

By closely examining medical plans and health insurance policies, Grundy says that SMBs can become better negotiators of healthcare—which will help drive costs down while increasing service.

Preventative healthcare begins at home and in the workplace 

Driving healthcare costs down also requires that SMBs and their employees become better consumers of medical services. New healthcare models in the United States and Canada often provide more benefits, such as increased physician access, when patients take more responsibility for their own health.

SMBs can help their employees make intelligent choices by implementing relatively inexpensive programs that can pay off in the long run. For example, many companies reward employees who quit smoking, or encourage staff to take short walks during breaks.

Technology can also help with personal healthcare records (PHRs). By giving employees a way to record things such as diet, weight, exercise and vital signs such as blood pressure, SMBs can encourage them to start taking more responsibility for their own health. “These are of value because they give our employees a place to really interact with the healthcare system in a
meaningful way,” says Grundy of PHRs. “We think they will increase in value as more and more of the healthcare system becomes computerized and goes online.”

According to law and medical ethics, PHR information must be completely confidential, and this assurance of privacy can help employees honestly assess their health. To ensure both privacy and management of PHRs, many SMBs opt to use outsourced records providers to oversee these programs. Once in place, these records can help physicians and other caregivers provide
better medical attention.

Help write the Rx for healthcare change

A report recently released by the IBM Institute for Business Value confirms Grundy’s observations about the state of healthcare for all businesses. Entitled “Healthcare 2015: Win-win or lose-lose?” the report recommends that businesses of all sizes become more informed about the issues and get involved as vocal participants in healthcare policy discussions throughout the United
States and Canada.

As a starting point, both the report and Grundy strongly urge SMBs to learn about current healthcare legislation on the federal, state and provincial levels. In some U.S. states, for example, legislatures are introducing ways to cover much of the population with healthcare—plans that will ultimately require trade-offs. To become even better informed, Grundy suggests that SMBs
become familiar with medical associations, such as the American Medical Association and the American Academy of Family Physicians, which offer information on the current status of healthcare legislation and news about developments in healthcare management.

Looking at how governmental agencies buy healthcare can also help SMBs stay abreast of issues, as Grundy says that half of all healthcare spending derives from the government. In the populous Canadian province of Ontario, for example, the report reveals that unless current trends are changed, healthcare will account for 50 percent of governmental spending in 2011, two-thirds
by 2017, and 100 percent by 2026.

“In addition to putting pressure on plans to deliver really meaningful care, another very important aspect is to put pressure on the government to buy meaningful care,” Grundy says.

Armed with knowledge about healthcare trends, both Grundy and “Healthcare 2015” say that companies of all sizes should actively participate in healthcare policy by contacting elected representatives with concerns and becoming involved in trade associations with healthcare agendas.

Many SMBs are hesitant about getting involved in what can appear to be a contentious political debate. But as Grundy and the report make clear, healthcare policy will follow the lead of groups that voice their concerns—and SMBs should have as much of a voice about healthcare policy than any other stakeholder. And by being part of the conversation, SMBs can be in a better position to provide their employees with cost-effective healthcare for the foreseeable future.

Content copyrighted by IBM Corporation.

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