Employers are the ‘sleeping giants’ in battle to control health costs

New York employers should take on a larger role in restraining the growth of health care costs, David Sandman, president and CEO of the New York State Health Foundation, said Friday at a Crain’s health summit.

“You as the business community are a sleeping giant,” Sandman said. “You have so much power and you really have not flexed your muscles yet, but you can and you should. You should because you’re paying such a big part of the bill.”

Employer-sponsored health insurance premiums for New York families increased 51% to more than $21,000 in 2017, compared with costs in 2008, according to the Commonwealth Fund.

“If you’re going to pay that kind of money, you should ask a lot more for it in return,” Sandman said. “You should demand greater transparency so you know what you’re paying for. You should be asking why the prices vary so much from one place to another and are those differences justified. You should ask what’s in those contracts between payers and providers that inhibit competition.”

Of course, some patients don’t have the luxury of choosing where to get care in emergency situations. But when they’re searching for a doctor or hospital to provide a nonurgent procedure, test or scan, employers could offer information on where to go.

Some organizations have moved in that direction already. The building workers union 32BJ, which covers more than 200,000 people in its benefit plan, has a team of eight data analysts examining claims to determine where to send its members for higher-value care.

Sara Rothstein, director of the 32BJ Health Fund, said its members don’t have the right information or the time to distinguish between different health care providers for planned procedures, so the fund has stepped in.

We as a plan administrator can do some shopping on behalf of our plan participants,” Rothstein said. “We can take a look at cost and quality data across the market and say, ‘Here’s a good place to go for primary care, a hip replacement, gender-affirmation surgery, bariatric surgery or to have a child.’”

There are a number of tools being used to inform employees about what they could expect to pay. Kathleen Harris, vice president of benefits at Warner Media, said her company is using Castlight Health to allow members to pick a health care provider based on what they could expect to be charged.

The Clear Health Costs website, founded by Jeanne Pinder, a former New York Times journalist, is using a combination of reporting and crowdsourcing to share what health care providers are charging for services. Nonprofit Fair Health has created to share cost estimates based on a database of millions of insurance claims.

Ultimately, patients should be seeking out medical care that’s high quality, not just the cheapest available, said Dr. Zeyad Baker, president and CEO of ProHealth Care, a Lake Success–based medical group with about 1,000 health care providers. He gave as an example ProHealth’s radiology services, which might be more expensive than some of its competitors’ but would use better equipment that could improve the chance of an accurate diagnosis.

“Price is a problem in health care,” Baker said, “but believe me: Most patients will tell you, ‘There is nothing I would rather spend my money on than my and my family’s health.’ It’s incomplete to think of it as the price we need to disclose or the price we need to solve. It’s really value.”

SOURCE: Section Page News – Crain’s New York Business – Read entire story here.