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Coordinated Health/Care(TM) Saves Participating Employers $1000+ per Employee in 2008
Date:5/18/2009

Because so few in the industry can do this, many employers instead focus on discounts and cost-shifting to lower current healthcare costs, and disease management and wellness programs to deliver healthier employees who will, theoretically, use less healthcare in the future.

"Over-reliance on discounts and piecemeal wellness programs is ultimately not very effective, and cost-shifting has reached its limit," said Trott. "While these are legitimate tools, all too often the larger opportunity to reduce or eliminate claims by assisting patients is minimized or even overlooked."

According to Trott, national studies estimate that up to 33% of all healthcare services are the unnecessary result of duplication and delay in America's highly fragmented healthcare system.

"The first source of fragmentation," she said, "is the healthcare process itself - a confusing maze of physicians, specialists, hospitals, home healthcare, payers, etc. At the center is the often-frustrated patient, who doesn't know where to turn for help or what to do next.

"The second problem is fragmentation within health plans operated by most insurance companies. Patients covered by employer-provided plans often have to deal with the claims payer, an HR department, the provider network, a pharmacy benefit manager, and perhaps disease management and wellness companies. None of these has the capability to view the patient's full health picture. Instead, these siloed resources see only a sliver of the patient's information and thus are unable to coordinate overall assistance to help patients with the 'process'."

The waste and duplication that results generate vast incremental costs in the industry. As an example, proprietary consumer research conducted by Quantum Health found that patients self-referred to specialists 41% of the time and 61% of those self-referrals were to the wrong specialist, resulting in an average of $3,500 in
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SOURCE Quantum Health, Inc.
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