Is the money your spending on employee health care actually helping?
October 2020
“Evidenced-based Medicine”. It means different things to different people, depending on their context to either support or disagree with provider (Doctors and Hospitals) behavior. Wikipedia defines it: “”the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.” The Johns Hopkins Medical website describes evidenced-based medicine: “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values. Evidence-based medicine is an interdisciplinary approach which uses techniques from science, engineering, biostatistics and epidemiology, such as meta-analysis, decision analysis, risk-benefit analysis, and randomized controlled trials to deliver “ the right care at the right time to the right patient.” (Source: AHRQ)”. A colleague of mine who has spent his life in the field of Cardiology “redefines” the term to mean “revenue-based medicine”.
Whether you subscribe to evidenced-based medicine, or functional medicine, or any other forms of healing I think there’s an argument for the altruism of the effort to adhere to (seemingly) known outcomes of treating and healing people. But is it really following the latest known evidence? ProPublica published a compelling article on the subject in February of 2017. https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes#:~:text=When%20Evidence%20Says%20No%2C%20But%20Doctors%20Say%20Yes,2017%20This%20story%20was%20co-published%20with%20The%20Atlantic. And that is actually the point of my message. As an employer who provides health care for employees and their families, is the care they are receiving based on what is personally best for them? Or is it driven by other decisions; perceived best practices without regard to the latest data, revenue generated by the doctor or health system, the myriad of pharmaceutical and medical device influences, or defensive medicine intended to protect against litigation? As the main payor of private healthcare (whether you’re fully insured or self-funded) you need to understand what decisions are driving the care you are paying for. You need to know what your insurance plan and/or care management vendor(s) are doing on your behalf to #1 protect your employees and their families from unnecessary and unhelpful care, and #2 making sure you are paying only for care that will improve their health. If you want to see an example of this look up anything pertaining to Walmart’s health plan on the internet. Obviously, they are the largest private employer in the country, but some of things they are doing can be adapted to any size employer. If your current insurance vendors and broker aren’t bringing those management tools to your desk, call me. I’ll show you what’s possible.