Employee healthcare: What you don’t know will cost you.

We’ve all heard that employee healthcare costs are rising. But why? What’s causing the price of care to increase?

We’re rolling out a series that will examine some of the reasons why employee healthcare expenses are so high, including lack of guidance, poor quality, reactive care, and provider shortage. We’ll also talk about ways to address each of these problems head-on.

The first reason that people pay so much for healthcare is that they don’t always know which doctors to see.

Let’s look at an example.

Imagine Susan went to her PCP for an annual check-up. Following her lab work, she gets a call from her physician that her creatine levels are high and she needs to see a nephrologist. Like most people would, she says to herself, “What the heck are creatine levels and what’s a nephrologist?” So, she hops on Google to search for answers.

Through her own research, she guesses that her PCP is recommending a nephrologist because her labs show that she may have some trouble with her kidneys. So, Susan must decide whether she sees the specialist her PCP recommended or find a nephrologist on her own.

First, she calls the recommended specialist, but he doesn’t have any available appointment times in the next three months. So she looks at her provider directory online. But that offers very little information beyond provider location. Next, she searches the internet to read reviews. Most reviews don’t offer a lot of details and the providers aren’t even in her network. Then, she asks family and friends, who unfortunately don’t have any recommendations. In the end, she goes back to the provider directory and just starts calling offices in alphabetical order, trying to find someone who is accepting new patients.

Finally, Susan locates a provider about 40 miles from her house. It’s farther than she wants to drive, but he has availability the following month. She knows nothing about him, except for his name and location.

What Susan also doesn’t know is that this nephrologist is very expensive. And his practice mainly works with patients with late-stage kidney failure who are on dialysis and not early-stage patients, so he may not have the experience Susan needs.

So why is this problematic?

1. Because the office is 40 miles away, Susan will pay more for gas. And she must take off work to make the trip.
2. The office charges are much higher overall than other nephrologists.
3. When you add unnecessary lab work being done because the doctor isn’t as up-to-date on the latest testing for early-stage kidney dysfunction, the costs quickly add up. She’ll spend a lot more out of pocket than she would have with other doctors.

When people aren’t matched to the right doctor for their condition, they (and their employers) often end up paying much more than they should.

How can this be resolved?

A lot of employers are turning to care navigation to solve this problem.

Care navigation empowers people to make the right decisions about their healthcare. Using comprehensive cost and quality data, Care Advocates can identify the best providers for each individual. It’s vital that Care Advocates are clinicians (ours are Registered Nurses) because they’re able to use their medical expertise to make sure that people get healthcare that’s clinically appropriate and high quality. Without that knowledge and experience, it’s really no better than someone doing research on the internet.

Care navigation facilitates quality healthcare while saving employees and employers money in several ways. Here’s how:

Care navigation offers guidance toward the most appropriate type & level of healthcare.

Sometimes people think they need to see one kind of doctor, but they should see a different kind. Through a brief clinical assessment, our Nurse Advocates can let an individual know if it’s right for them, and if not, steer them towards more appropriate treatment.

30-40% of all SentryHealth members are steered in a new direction through our diagnostic analysis, leading to more accurate diagnoses, higher quality care, fewer headaches, and real dollars saved.

Additionally, our Nurse Advocates can refer our members in two ways. First, they can refer to high-quality, affordable, in-network providers, or they can refer to high-quality providers within our own virtual care team. Either way, members get the right kind of care.

There is a strong focus on quality.

Care navigation ensures that people get high-quality care. As a result, they experience fewer complications, readmissions, misdiagnoses, and more. All these things can cost a lot of time and money!

Our Nurse Advocates only refer to the best providers and facilities based on our strict quality measures. In fact, only 20% of physicians nationwide meet our standards.

People benefit from cost-conscious referrals.

It’s important to understand that the most expensive doctors aren’t always providing the highest quality care. For most people, the “best” care means a good balance of cost + quality.

Care navigation puts a high priority on cost, knowing that if care is too expensive, people may not seek the help they need.

In summary, if you want to address the pain of rising healthcare costs that our disjointed and confusing healthcare system causes, care navigation is worth a look.

To learn about how our care navigation can drive lower employee healthcare costs for you, let us know! We’d love to show you what we can do.