Better Benefits For Less: A Quick Study

You don’t have to do a lot of research to understand that healthcare in the U.S. is…complicated. Even the most common procedures can be difficult to procure and pay for, but what if there was a way to make your experience of receiving and paying for healthcare easier? What if your business had someone to help navigate the system for your team? 

Take for example this scenario: A patient in Idaho needs surgery to repair a torn rotator cuff. While not a particularly complicated or unique procedure, there are few care options in the local market. Because of the lack of options, even after shopping around, the best price they can find is $44,000 with the patient guaranteed to be balance billed.

You Can’t Impact The Past: ↑ Advocacy + ↑ Quality = ↓ Cost

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Thursday, May 20, 2021, 2:00 PM ET / 11 AM PT

Unlike most things, healthcare services have an inverse relationship between cost and quality: the better the quality, the lower the cost. Unfortunately, the current health benefits market is completely opaque and lacking any meaningful, realistic transparency. Additionally, we have always been taught that easy = better when designing health benefits programs for employers and their employees. However, the cost and quality of healthcare can vary dramatically within the same city. Utilization Management for example, where your members access healthcare, is one of the single most important additions to your health plan design.

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However, when using a healthcare advocate, things changed. The advocate was able to secure a world-class surgeon to perform the surgery in Las Vegas for a bundled rate of only $12,500. After paying for all travel expenses, including a $2,000 stipend so the patient could relax and recover in Las Vegas, the plan saved over $25,000 on the procedure. 

World-class care, a Vegas vacation to recover, and over $25,000 in savings? It sounds strange, but this is healthcare in the U.S. and this is what advocates do.

Another example: Two similar hysterectomies with vastly different results, in care and price. 

Patient A used their insurance carrier’s website to find a surgeon in-network, assuming they would be paired with high-quality providers. Unknown to Patient A, the hospital had a C-average rating on Leapfrog and a higher rate of accidental cuts and tears than the average. 

This led to a 2-hour procedure followed by second surgery 8 hours later to stop internal bleeding, resulting in a 3-day in-patient stay and a hospital bill of $57,000 for which Patient A was required to pay $4,000 of out-of-pocket. 

Patient B worked with an advocate to schedule their hysterectomy. The advocate was able to find a high-quality surgeon and bundle the procedure so the total cost was only $12,000 to the plan. After a 1.5-hour procedure and a 45-minute recovery period, the patient was discharged the same day, returned to work three days later, and paid nothing out-of-pocket. 

It’s strange, but when it comes to healthcare in the U.S., higher cost doesn’t mean higher quality. If you work with a healthcare advocate for your team, your business can secure world-class care and incredible benefits, for less.