Gaskin: Better management = lower healthcare costs

Massachusetts businesses are experiencing financial strain due to the high cost of employer-sponsored healthcare insurance Rising premiums are outpacing wage expansion leading to increased costs for businesses and prospective financial hardship for employees Americans are often frustrated with their employer-sponsored wellbeing care in terms of the necessary approvals exclusions deductibles and denials The average person rarely looks at their program until they have a anticipated claim which is when they discover the full extent of the concern Japan used Total Quality Management and continuous improvement techniques to build certain of the highest-quality cars in the world There is an opportunity to use continuous improvement techniques such as Six Sigma Statistical Process Control SPC and Lean techniques among others to improve healthcare quality and reduce healthcare costs by analyzing robustness insurance asserts statistics The trouble is largest part employers never do and it is employees who pay the cost Employers often in collaboration with independent robustness benefits advisors and third-party administrators are adapting continuous improvement methodologies to lower healthcare costs for employees While these techniques have been used historically in worker s compensation and manufacturing they are increasingly being applied to physical condition insurance premiums and overall healthcare spending For example Motorola an early pioneer of Six Sigma applied these methods to healthcare vendor selection states figures analysis and wellness effort optimization These efforts resulted in a reduction in hospital readmissions among targeted employee populations saving millions on robustness plans Similarly Boeing implemented Lean and Six Sigma principles through its Boeing Intensive Outpatient Care Effort which focused on reducing hospital admissions and costs for high-risk employees By leveraging SPC tools Boeing identified ER usage patterns and addressed them with telehealth and care navigation reducing ER visits by and saving million annually General Electric GE used its Six Sigma expertise to analyze healthcare proposes details pinpointing high-cost conditions like diabetes and implementing chronic sickness management programs This approach reduced preventable hospitalizations by and improved employee robustness outcomes Toyota similarly applied Lean principles to wellness programs and care coordination reducing high-cost declares by addressing chronic syndrome risks saving an estimated million annually Despite these successes multiple employers struggle to adopt continuous improvement techniques due to several challenges HR and benefits teams often lack the specialized skills such as Six Sigma training needed to implement these tools Without adequate expertise or tools employers may find it tough to get started or sustain such initiatives Continuous improvement relies on accurate timely input but physical condition plans frequently provide incomplete or siloed asserts information Disparate systems for contends pharmacy and wellness statistics impede analysis Quarterly or monthly reporting cycles also limit the ability to conduct rapid improvement cycles like Plan-Do-Check-Act Continuous improvement demands a heritage of process excellence and long-term focus Employers without such a mindset often lack the patience or information to sustain these efforts even when the foreseen cost savings are substantial A large number of traditional brokers don t have the expertise or incentive to learn how to create or manage innovative or custom programs or help employers get access to their details Employers trust brokers and advisors to bring them the best options on the area If the broker is not willing to learn there is a better way whether it is profit driven motive or pure ignorance that is a massive barrier for employers There are also certain brokers who are rejecting this movement towards transparency and actively swaying employers against it citing liability and work load or employee dissatisfaction Disease-Specific States Management When employers begin analyzing indicates facts with a focus on reducing healthcare costs they often uncover insights about contends by infection category This approach termed Disease-Specific Declares Management Targeted Asserts Management or Population Wellbeing Management or Condition-Based Proposes Optimization enables employers to tailor strategies to specific conditions like type diabetes or hypertension For each malady multiple vendor programs are available typically incorporating the following components Identifying high-cost populations and jeopardy factors Connecting patients with care managers to ensure adherence to medication plans Using tools like apps coaching and incentives to encourage healthy behaviors Offering screenings telehealth and remote client monitoring to prevent costly complications Addressing mental physical condition issues that often accompany chronic diseases While these programs offer critical cost savings comparing vendors can be challenging because they use different metrics to prove their effectiveness This lack of standardization makes an apples-to-apples comparison hard Third-Party Expertise Employers often feel unequipped to handle such complex projects foregoing opportunities to save costs This is where third-party consultants can assist These experts help employers assess vendors validate cost-saving suggests and develop a strategy tailored to their workforce Most of smaller employers do not have the time information or expertise to apply Six Sigma to their robustness care spend Preponderance employers want to focus on their core business and do not want to be in the soundness insurance business The best first step for all employers is to request an independent review of their fitness care spend by a fee-based healthcare benefit advisor certified by the Validation Institute or Soundness Rosetta to determine a plan that works for their employee and dependent base and their geographic location Ed Gaskin is Executive Director of Greater Grove Hall Main Streets and founder of Sunday Celebrations