Why Building A More Complex Plan May Lead To Better Advocacy

Healthcare should be simple, right? 

Providers have been pushing this message for years and constantly redesign their plans to make it easier for members to access healthcare. And to a degree, they’ve been successful. At this point, if we have insurance, most of us don’t even think about it. When we need care, we go to the doctor. It’s that simple. However, simple doesn’t always mean better.

Alternative Reimbursement: You Can’t Pay Less For Healthcare Unless You Pay Less For Healthcare

Thursday, June 10, 2021, 2:00 PM ET / 11:00 AM ET

The only way to pay LESS for healthcare is to pay LESS for healthcare. This simple statement sounds obvious but is ignored by most employers as reflected in their health benefits. For years, we have depended on the carriers to negotiate the price we pay for healthcare, having a more direct and transparent reimbursement (provider compensation model) is the key to immediately lowering your health benefits cost.

In a post-COVID world, even zero change in employees’ healthcare costs will likely still result in them spending a greater percentage of their income on healthcare. Why? Most household incomes are down so the focus shouldn’t be on maintaining the status quo, but on fighting to reduce overall costs and expenditures.

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The trouble with this excessive simplicity is that you are unique and so are your healthcare needs. Problems arise because your insurance plan is there to cover you, not necessarily find you the best care. By focusing on making healthcare “simple,” providers have inadvertently caused a decline in quality for patients and an increase in cost for employers providing plans. 

By making it “simple” to access healthcare, there’s no guarantee that you will get your needs met. You may have to go from doctor to doctor or location to location until you get the care you need, all of which costs time and money. If you “just go to the doctor” when you have an issue, how will you ensure they have the experience and training to properly treat your issue? How can you be sure your insurance will cover their service? Will they have availability to see you on your schedule? And finally, are you positive you won’t get hit with large medical bills after receiving your care? 

These are just some of the problems experienced by many when they just “go to the doctor.” Finding the right doctor isn’t easy and proves why easier isn’t always better. This is why advocacy is key.

Finding quality healthcare is incredibly complicated. Luckily, advocates are trained to “look behind the curtain.” Healthcare advocates know the ins and outs of the system and your needs which means they’re able to find all the options available to you, not just the “easy” ones. 

By matching the right patient to the right doctor at the right time at the right cost, patients get better care, more quickly, see fewer doctors and recover faster. Because of this dynamic, advocates are able to increase the quality of care for patients while lowering costs for employers providing plans. That’s a win-win.

Despite what providers may say, accessing quality healthcare isn’t simple. Luckily, with a healthcare advocate, you’ve got someone on your side.