Last week I wrote about improving healthcare literacy. It’s an important and worthy goal. However, I always juxtapose this with something a highly respected physician colleague and friend said to me a few years back. It really resonated with me back then and still does today.
He said that the push for improving the public’s health literacy and increased consumerism is good. The more knowledgeable people can become about their healthcare the better. However, he also cautioned that the expectations of predicted great gains in cost savings and improved system efficiency from increased consumer knowledge were a bit unrealistic. They needed to be tempered. Healthcare is so dynamic and so complex that as a physician he had to really work hard to stay on top of best practices, new developments in medicine, the cost and outcome implications of various types of treatment, etc. His point was that if he, as an experienced physician with years of training and treating patients had to work so hard to stay on top of the latest developments and trends, then it is unrealistic to expect that consumers with day jobs and no medical training at all could understand the complexities of our healthcare system.
We know from years of analyzing data and our experience that the most experienced doctors with good teams around them deliver the best possible outcomes – clinical, functional and financial.
So I think the best bet – whether it’s you, your family members, or your employees – is still to do your homework and choose the best and most experienced doctors around.
Last week’s post in case you missed it…
Health Insurance Literacy: Too Complex For Some?
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- Tom Barrett
- September 19, 2014
- best, costs, experience, hospital, medical, outcomes, physicians, research, teams, treatment
- 0 Comments
Something’s gotta give…….. and apparently it is.
Patients want to receive quality care from familiar providers on a timely basis at lower costs.
Doctors and hospitals want to maintain and increase current levels of reimbursement.
Insurance companies needing to comply with the new ACA requirements and control costs are squeezing provider reimbursement rates and eliminating those providers that won’t accept lower rates.
With all this going on employers and their employees are more concerned than ever about cost, coverage, and access to doctors and hospitals. Some feel cornered and are starting to take action.
A lawsuit was recently filed by some new customers of a major California PPO. The outcome of the suit, and others like it that are to follow, could signal how things will take shape down the road in terms of reliable and continued access to a given doctor or hospital at any point in time.
According to the suit filed against Blue Shield of California, the customers did their homework before signing on with one of Blue Shield’s narrow network products. Before purchasing their plans they checked the insurance carrier’s website directory and called the insurance carrier, the respective treating providers, and the providers from whom they would be seeking treatment to confirm participation in the specific network. Later they came to find out that those providers were either dropped from the network without notice or were never considered in the network at all.
In layman’s terms the lawsuit appears to center on a combination of misrepresentation, false advertising, and lack of good faith effort to communicate changes as it pertains to provider network composition and how services will be covered.
We’ll report back on anything significant as this story plays. In the meantime look for a series of posts from us highlighting pragmatic and creative approaches taken by some engaged employers to maintain employee and dependent access to key providers without increasing costs. If you have something you’d like us to address or have your own story to share please drop us a line.
You can read more about the California lawsuit in “When a PPO isn’t.”
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- Tom Barrett
- May 23, 2014
- ACA, Blue Shield, California, homework, lawsuit, Narrow Networks, Obamacare, PPO, providers, research, satisfaction
- 0 Comments