Blog // HealthSmart Blog // June 2019

Is it Really Possible to Bend the Healthcare Cost Curve?

6/3/2019 3:01:52 PM

Is it really possible to bend the healthcare cost curve?
The answer is yes, because we already have!

By Alvin Bowser, Vice President, Network Operations

According to U.S. federal government actuaries, the overall U.S. health care spending grew by 4.4 percent in 2017 and is projected to grow at an average of 5.5 percent annually through 2027. Adding to the concern of rising costs is the amount of money health plans are paying for services. A recent RAND study shows health plans pay hospitals, on average, 241 percent of what Medicare pays. And that is the negotiated rate! Hospital chargemasters bill, on average, around 500 percent of Medicare.
With the anticipated growth of healthcare costs and the high costs paid to hospitals by health plans, it becomes a real challenge to “bend” healthcare costs downward.
If you do a Google search on “how to bend the cost curve in health care,” you’ll find a lot of interesting ideas on how to lower costs. At HealthSmart, we recognize these challenges, particularly how they can have a significant impact on an employer who self-funds their health plan. In fact, we put a lot of time and energy into developing solutions that reduce costs while providing outstanding care. One solution in particular has proven to be highly successful in reducing medical spend.
Before we go on, I want to ask a question. If someone approached you on the street and offered to sell you a $10 bill for $1, would you accept their offer? I would imagine most of us would. This is essentially what our value-based care product – MyDecision – delivers for our customers. MyDecision delivers an average ROI of 10:1.
Our take on bending the cost curve
MyDecision is a bundled payment, single source solution that reduces plan medical spend by 4-7 percent on high-cost, non-emergent surgeries and procedures. These procedures include things like orthopedic, spinal and neuro, and general surgery – more than 180,000 procedures in all. Here’s an example of how it works… our MyDecision concierge team actively redirects members from a hospital setting to lower cost but high-quality facility. One example is Ambulatory Surgery Centers (ASCs). Studies show that ASCs are more efficient, have lower readmission rates, lower infection rates, and thus are less expensive than Acute Care Hospitals.
But does this really save money? Across all service categories, MyDecision costs are generally 55 percent below prevailing PPO network reimbursements.  
What about quality?
As consumers, we generally associate low cost with low quality. The MyDecision program is the complete opposite – we make quality healthcare data accessible and available to assist members in making informed decisions. We have established partnerships with providers that are fully credentialed against stringent standards, and rank in the top 25th percentile on the quality scale by a nationally recognized governing body. 
Elevating the member experience 
Healthcare is complex, expensive and difficult to navigate. When a member is dealing with an illness, the last thing they should worry about is whether they can afford medical care and how to navigate the healthcare system. With MyDecision, the worry of cost is a non-issue, because when they make the decision to utilize one of our program providers, they have ZERO out-of-pocket expenses. As far as navigating the process, our member advocates serve as a dedicated concierge throughout the entire episode of care. From selecting a provider, providing member education, or simply alleviating member concerns, we walk through everything with the member and serve them with dignity and respect.
So, do participating members actually like this program? Based on recent survey results, an astounding 100 percent of member survey respondents had a positive experience and would highly recommend the program to a family member or friend.
Value-based care in action
The program has proved to be a very effective cost containment solution for our customers and the members we serve. One example is a municipality with 1,100 employees. In one year, the MyDecision program reduced medical spend by a whopping $1 million!
High quality care at lower costs, satisfied members, and 10:1 ROI. This is just one way we can help you truly bend the cost curve of medical spending.

MyDecision is available in select areas of the country with a very strong presence in Florida, Texas, Oklahoma and Arizona. HealthSmart is assessing future buildouts in other geographic locations based on opportunities.
If you would like to learn more, brokers should contact their HealthSmart VP of Sales, or complete the form to the right and we will contact you.