Andy Neary shows how outpatient prices vary wildly for the same procedure. A Denver knee replacement costs $40,000 at one facility but $15,000 at a higher-quality one nearby. He walks through tools like Zero Card and kisex Card to help employees find better value.
Chapters
Welcome back to striking out the status quo, where your health plan is one mindset shift away from greatness. Alright, let's dive into step four of building an unhittable health plan. Today we're focused on outpatient services. Those services perform to the knees, hips and backs. I'm talking about MRIs and surgeries. What are you doing to help your employees navigate the minefield in the price and quality variance that exists in the healthcare system? Let me give you an example. Here's data around knee replacements performed at three different facilities in the Denver, Colorado market. First, we're looking quality. The higher the line is on the quality metric, the better the facility is. So it's obvious you would probably go to facility C when it comes to having your knee replacement because they're the highest quality. Now let's look at what it costs each facility to perform the knee replacement. You'll notice there's not much difference. It costs each facility about the same price to do the surgery. Now, what do they bill you and your health plan and your employees? This is where you're going to be blown away. It costs about twice as much to perform a knee replacement at facility A than it does facility C. And facility C has the highest quality. Here's the thing, you and your employees have no idea about this price and quality variance. If you're just solely relying on the network your carrier gives you, you need to be implementing solutions that help your employees navigate this minefield. You've already implemented medical management from step two, but you can also implement solutions like Zero Card, kisex Card that can help your employees find these facilities like facility C. And also it gives them the ability to see those services and seek those services at no cost. So if you want to reduce the cost of your health insurance while giving your employees better access to the healthcare system, you have to follow through with step four by attacking the price and quality variants that exist with outpatient services today. Until next time, bear down, focus on the target and strike out the status quo.
