Self insured may be biggest winners in health reform
Why? We know what can cut health care costs:
- Intervention in maintaining wellness.
- Payments based on patient count, not procedures.
- Using comparative effectiveness to point toward cost-effective treatment.
- End of life care that focuses on comfort, not just life extension.
Republicans have successfully demonized all these ideas and kept them out of the bills now moving toward a vote. Sound end of life care is a "death panel," for instance, and comparative effectiveness is "getting between you and your doctor."
But just because these ideas aren't in the legislation, and even if health insurers don't put them into policies, there is no reason why a company that self-insures its risks can't apply them.
Start by offering a "lifestyle" plan that promises interventions aimed at making employees healthier and keeping them alive longer. Dietary help, regular counseling, gym memberships, wellness coaching, all free.
The risks of serious mishap are insured under the plan, but comparative effectiveness research then defines the treatments.
Duke University saved big money with the first approach and former chancellor Ralph Snyderman (above) is now selling the second through his company Proventys. (He's smiling in this picture because he's probably going to become very rich. I hope he does.)
If you have retirees in your pool give them the end of life counseling, and don't forget to have a plan in there for medical tourism.
It will be hard, in the short run, to get things like medical tourism, wellness coaching, comparative effectiveness or end of life counseling rated through state insurance authorities. But if your company is large enough that you can self-insure your risks, we know these techniques, taken together, cut your medical inflation costs to the bone.
Once you succeed with them, you'll be a hero, lauded in the media, and then insurance companies can offer these plans as options to everyone.
But this is how real health reform is going to happen, with hard-headed businesspeople running big pools of employees looking seriously at their cost structures and taking action government can't.