Brookfield Basics

Consumer Driven Health Care

Posted by Tom Gehl on Jan. 29, 2010

Ah - the joys of turning fifty..........

I had a colonoscopy in December.  For those of you who know what is involved - enough said.  For those of you who do not, it's really not that bad.  To paraphrase Tom Petty, "the fasting is the hardest part".  

In addition to my postiive test results, I am pleased to report that this expensive procedure cost our family budget not a penny.  Is this because I have an obscenely expensive health plan funded by my employer, or a supplemental plan secured at my own expense?  No - neither is the case.  

The company I work for has a consumer driven health care plan, the foundation of which recognizes two compelling realities.  The first is that over eighty percent of health care costs in America are associated with five primary diseases.  The second recognizes that early detection of and behavior modification relative to those diseases, are foundational tools in preventing both catastrophic physical and financial consequence.

A further reality of the plan recognizes that health care is subject to the laws of supply and demand.  Our company has secured an arrangement with The Milwaukee Endoscopy Center in Greenfield, such that any employee who has a colonoscopy there pays nothing for it. To qualify, you must be either fifty years of age or have a family history of colon cancer.  Why this singular arrangement with this one provider? 

Because colon cancer detected early not only gives the best chance of successful treatment, it also significantly reduces the company's long term financial exposure.  Our Human Resources Department actually SHOPPED for this procedure and learned that because this clinic specializes, it can offer it at a significantly lower cost.  If I had gone to almost any hospital the total cost would have been much greater, leaving me with a significant deductible and my employer with a hefty balance.  So the company incentivized me to go this clinic, thus lowering the cost for BOTH parties.  I was not required to choose the MEC - just incentivized.  Imagine that - I was actually engaged as a consumer of health care.

Other notable aspects of this consumer driven plan include an on-site nurse practitioner, chiropracter, and dietician.  Perhaps most important - an annual health screen involving a blood draw and a comprehensive and confidential report to the employee.  The company pays the cost of the screen, which again is premised upon the value of early detection.  The test is not mandatory, but those who do not participate pay a substantially higher percentage of the cost of their health insurance, a market-based pricing mechanism that is as simple as it is logical.  Only the employee sees the results; and the assumption is they will pursue appropriate care and behavior modification in light of them.  I know of a young person who shared his story.  Though exhibiting no symptons, he learned via the screening that he has diabetes.  This individual has subsequently made significant changes in diet and habits, and is well down the road towards not only living a healthier and longer life, but saving the company tens of thousands of dollars at the same time.  

What about the question of sub-standard care?  Our dealings with this clinic were superb; Barb and I were treated with courtesy, care, and professionalism, and we were on our way less than three hours after arrival.  There is no doubt I received the highest quality of care at this clinic with respect to equipment, medication, and expertise - all provided at about one third of the average total cost of our area's providers.

Certainly there are some systemic issues with health care that a consumer driven plan does not obviate, such as the ever expanding list of medications and procedures from which we choose and consume.  But the reality of health care in America today is two-fold:  personal behavior and habits have a profound impact on the total cost of health care, and any attempt to slay the dragon of cost that is not founded upon this reality will ultimately be inneffective.   

I am not suggesting people are "at fault" if they become sick, and certainly we all know of tragic cases where healthy people who have cared for themselves contract disease.  I am suggesting that the manner in which we live our lives and make our choices is the greatest "physician" we will ever have.  Basic decisions such as not smoking, controlling our weight, avoiding excess, exercising, and getting enough sleep will take an awful lot of cost out of the system.  

The second reality is that not all health care is the same in terms of cost.  There is a menu of procedures for which lower cost providers have been found, such as colonoscopy, mammogram, major joint replacement, and general check-ups and care via an MD. The cost differences involved from provider to provider are often staggering - some measuring in the tens of thousands for the SAME procedure.  People and providers of insurance need to SHOP for such choices, rather than just accepting the first place they are referred to.  And the only way we will shop is if we are incentivized to do so.  That's not a political statement - it's a simple reality of human behavior.  

The company combines this approach of the annual health screen, consumer selection, and on-site providers to engage employees in the life-long practice of managing their own health and the health of their families.  I believe my employer does this for two reasons.

Because it cares about its employees.  And because it cares about financial survival.