The main issues with health care plans
Employers have a set of motivations to work for positive change in healthcare:
- They want to provide health coverage that keeps your employees healthy and productive
- In a time of full-employment, they want employees to like their health benefits
- And they need to manage this very significant operating expense
And it seemed that the efforts deployed by carriers, advisers and employers to curb the spending have produced results in the very last years : its increasing is decelerating since 2011.
|Source: Keiser/HRET Survey of Employer Sponsored Health Benefits 2001-2016|
CARE2CARE is here to help them address these competing objectives.
EMPLOYER SPONSORED HEALTHCARE : PAYING MORE TO GET LESS ?
But a compelling study by the HCCI (Health Care Cost Institute) in January 2018 sheds a very new light on the story. Based on the claims data from 4 of the most important health insurers in ESI (Employer Sponsored Insurance) and covering 2012 to 2016, its results are very clear :
in almost every type of health service, prices soared and utilization declined :
Two examples : 1.Inpatient utilization shrunk by 12.9%, while prices grew by 24.3% ; inpatient spending grew by 8.3%
2. drugs volume grew by 1.8%, but since prices soared by 24.9%, spending growth hit 27.2% in only 4 years !
The conclusion we can draw is that American employers paid more for their workforce to get less. Regarding the level of utilization, this is all the more concerning, since data showed a preexisting record level of unmet care needs due to costs in the United States, especially then it is compared to similar, high developed countries, as it appears in the chart below.
HOSPITALIZATION : AN IMPORTANT SPENDING ITEM AND ITS PROBLEMS
- a. Taking the lion’s share, hospitalization costs represent 56% of the healthcare expenses
The above mentioned HCCI’s study, produces very precise data on hospitalization, in- and outpatient, representing 56% of the total average spending in 2016, once the related costs of professionnal services have been integrated (see chart below).
|Drugs costs amounted to 1.284$ after taking into account the cost of professional services. They represent 23% of the 2016 global average spending|
In- and Outpatient accounted for 3.038 $, or 56 % of the global average spending per person, after taking into account professionnal services
Surgery represents 29% of the 2016 global average spending
- SURGERY saw soaring prices and sharp declining utilization
– Inpatient surgery prices soared by 30%, while utilization declined by 16% ;
– Outpatient surgery prices got up by 19% while utilization declined by 6%.
– Surgery accounted for 29%, in 2016 of the average healthcare spending, (more than prescription drugs : 23%)
– An average episode of inpatient surgery amounted to 41.702 $
- Hospital bills are often unpredictable…
Many of the insured people feel probably (very) uncomfortable about them, as do most Americans
d…And it is difficult to find reliable informations on these prices
While there is a trend toward CDHP’s, urging employees to become savvy healthcare purchasers, in order to draw costs down, little pertinent information on costs and quality to help your employees in this purpose is at hand, as established by a recent (April 2017) JAMA survey
- Surgery prices are far more competitive in France than in the United States.
To give just some examples : a hip replacement will cost 10.700 $ ; a coronary bypass : 23.700 $ ; a heart valve replacement less than 30.000 $, …
We can examine this in detail with you, comparing the prices you payed your claims, to the prices we can obtain in France ; let us just remind that the scale is 50 to 75% less in France than in the US…
- Readmission rates within 30 days are higher in the USA than in France
We give more information on the quality of the French healthcare system hereafter
OUR SOLUTION TO THESE ISSUES CONCERNING HOSPITALIZATIONS (OVERVIEW)
- A selection of the best French hospitals and clinics in different specialties (to get more information on our selection method,
- A second medical opinion possibility in these specialties ,
- Via a secure workflow, your employees can obtain a free medical quotation guarantying a set price for a specific procedure
- Full chaperoning and an all-in-one concierge service to organize travel and stay in France, return to home, including potential follow-up; (for detailed process
Care2Care Medical Travel: Affordable, quality health care, for everyone.
Our proposal, summarized in a few words :
Care2care Medical Travel offers a small network, for high value surgery and treatment in selected facilities, at very competitive prices, in France, a country known for the quality of its Health System and first destination of international tourism, visited by as much as 87 million persons in 2017, among them over 4 million Americans
WHY OUR SOLUTION IS PERTINENT FOR YOUR CLIENTS
First, because surgery is the first spending item in most healthplans, as shown above
Furthermore, the global average spending is highly concentrated on a very small part of their workforce :
– 5% of the people account for more than 50% of the spending ;
– the “Top Spenders had 39.409$ in healthcare expenses in 2015;
– They exposed high Out Of Pocket expenses (3850$)
– hospitalization amounted to 60% of these “Top Spenders” expenses ;
That’s why we propose you to concentrate on this small group of “Top Spenders” :
With our solution :
– they can get the care they need ;
– te employer gets it’s healthcare budget swiftly and easily under control
GOING FURTHER IN THE RESOLUTION OF THESE ISSUES
Our service is innovative, even “disruptive”: to mitigate the disruption we are offering a preliminary assessment of the implementation of our solution, that can be flexibly adapted to the needs of the workforce:
- Analysis of available statistics on claims in order to :
– Select the conditions treatable using Medical Travel (such as Heart bypass, Heart-valve replacement, Angioplasty, Hip replacement, Knee replacement) ;
– show the benefits of the interested parties : management, employees, service providers
- Summary of opportunities and recommendations
- Design of incentive program to enhance attractiveness of the medical travel solution:
- Waive copays (we have seen that “Top Spenders” have high OoP expenses) and deductibles
- Cover cost of travel for employee + companion
- Bonus of x% of the resulting savings up to a cap in $
- …more to be uncovered as we progress, working together with you and your insurer, benefits consultant, broker, etc,
- Design of services for integration into your Healthcare Plans
- Deployment (upgrading of information and follow-up tools, etc.)