As employers look to reign in healthcare costs, they are increasingly working with healthcare vendors to provide a new surgical care experience. New digital health companies can help them identify programs to reduce the cost of care by identifying where costly surgical interventions are needed. But employers are also consulting with vendors and leading provider organizations who can provide a new type of healthcare experience that can improve overall quality of life for employees, and reduce costs, absenteeism, patient financial stress, and more.
Dr. Catherine MacLean is the Chief Value Medical Officer with Hospital for Special Surgery (HSS) based in New York City. This role is also part of a wider trend among healthcare providers. Similar to the way it works with regional employers, HSS is collaborating with Transcarent to help employer clients help their employees navigate surgery options to achieve the best outcomes.
“Basically, my job is to make sure HSS delivers the highest quality care in the most cost-efficient way,” MacLean said. “When considering the cost efficiency of a provider, you need to ask the question, ‘What is the impact of the care delivered by a hospital or health system in terms of the overall cost of care?’”
To illustrate her point, MacLean offered up a scenario in which two hospitals charge the same amount of money for a procedure. One of the hospitals has a much higher complication rate than the other, driving up the overall cost of care. So, employers would be steered towards the hospital with the lower complication rate.
Additionally, HSS also assesses patient outcome measures, such as quality of life pre- and post-procedure, to determine whether their patients are indeed getting better.
Another component that’s tougher to measure is avoidance of unnecessary tests, or imaging that can drive up costs, and especially avoiding unnecessary surgical procedures. That may seem counterintuitive for a hospital with surgery in its name. But as MacLean explained, providers spend a lot of time reviewing whether procedures will offer better outcomes than a less invasive approach.
“We spend a lot of time measuring whether the procedures that are done in our hospital are appropriate, and understanding the impact on both patient outcomes and the total cost of care,” MacLean said. “A majority of HSS patients receive non-surgical treatment.”
She noted that data from some studies indicate that lots of patients get unnecessary surgical procedures because there are doctors who will provide them, whether it’s best practice or not.
“As a center recognized for its expertise in orthopedics, many patients who have been advised elsewhere that they should undergo an orthopedic procedure come to HSS seeking a second opinion,” said MacLean. “About a quarter of those patients are advised by an HSS surgeon that non-surgical care is the best option.”
Spinal surgery tends to have the highest complication rates among musculoskeletal (MSK) procedures, so it’s a motivating factor for exploring less invasive alternatives, such as physical therapy. For example, MacLean observed that there are some conditions, such as lower back pain, that can benefit from therapy before they become chronic conditions. Although some states require patients to be referred to a physical therapist by a primary care physician, in others, such as New York, those appointments can be made directly with a PT— in person or virtual. HSS has its own team of physical therapists, some of whom may be the first point of contact for patients, rather than a surgeon.
So how is HSS working with Transcarent?
As part of the collaboration, the beneficiaries of self-insured employers will have access to HSS’s world-leading orthopedic and MSK specialists. Transcarent will handle all member referrals, facilitate travel, and cover the costs of certain orthopedic surgeries. Transcarent will also provide access to HSS’s new virtual care programs.
“At a high level, we are working very closely with Transcarent to really think through how we measure, produce, and promote high value musculoskeletal care,” MacLean said. “As part of our ongoing discussions, we’re sorting out ways to identify patients with musculoskeletal problems and get them to the right practitioner or the right clinician for that problem, and not send them straight to the surgeon.”
Along with access to a leading surgery care experience, Transcarent provides 24/7 personalized health and care support through the use of Health Guides for virtually all the most common and most challenging needs. Among these essential services are urgent care, lower-cost medications, personalized behavioral health care, care at home, cancer treatment, and expert second opinions.
“Leading employers remain dissatisfied with the access to, quality of, and cost of our healthcare system, especially the surgery experience for their employees and their families,” said Glen Tullman, Transcarent Chief Executive Officer. “HSS has long been the acknowledged industry leader in orthopedic care, and we are excited to collaborate with them to bring the Transcarent Surgery Care experience to people across the nation who need high quality, affordable care.”
The social isolation of the pandemic has helped call attention to the need for more easily accessible and widely available behavioral health resources for employers. The use of virtual care is helping address this demand, especially in areas with relatively few therapists or where the demand can’t meet supply.
Courtney Blondino, Senior Associate, Total Health Management with Mercer, described what she’s seeing in the way of market trends.
“I know we’ve had some analysis showing that we saw a spike in behavioral health via telemedicine during 2020 and 2021. But what we also saw, at least at the tail end of 2021, is those numbers aren’t really going down. We are seeing that people are certainly utilizing their virtual behavioral health counseling, but we’re also seeing that it’s actually really helpful to the employee. If they’re working from home, they continue to work in counseling sessions in the comfort of their own home; they don’t have to leave in the middle of work to go get this support. It’s actually increasing access. And so employers are thinking about that as well.”
Blondino said that, depending on the client and the solutions, employers tend to review two to five behavioral health providers. If the employer is interested in replacing their employee assistance program, then Mercer works with employers to focus on which vendors and suppliers will support the employers’ current needs and the gaps they’d like to fill. Mercer then provides recommendations on who might be the best fit.
Collaborative relationships between health tech vendors and providers to optimize and deliver effective treatment and desirable patient outcomes that meet the needs of employers and employees is the new paradigm for healthcare. Surgery and behavioral health are just areas that have a significant impact on both employees’ quality of life and employer budgets. The ability for employers to have an informed understanding of how they can get the best patient outcomes for their workforce and ensure employers meet their budget needs will make a big difference in the ability of companies to recruit the best staff to remain competitive.
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