Measure your complication rates – and hold your plans accountable for reducing them

For the private sector, healthcare costs this year eclipsed $1.4 trillion. That number, if significant improvements in payment and delivery do not occur, will nearly double in 10 years.  In addition, according to our studies $2 out of every $10 employers spend today is spent on treating potentially avoidable complications, which are the results of defects in care and are contributing to escalating healthcare costs. The PROMETHEUS Payment model gives plans the right incentives to deliver more collaborative care, better patient experiences and reduced costs. This, in turn, can lead to better outcomes and healthier employees for your company.

Self-funded employers rely on health plans and third party administrators to administer their claims.  Since they can't implement PROMETHEUS Payment directly, they must equally rely on their health plan administrators to adopt PROMETHEUS.  There are a number of ways employers can bring this about.

As an employer, you can use your decision-making power to encourage episode of care payment models, and become more aggressive about reducing payments for avoidable complications. As individual companies, employer HR personnel can agitate for change with their ASO account managers.  For employers that participate in local business coalitions, questions should be asked of coalition leaders on their strategies to engage plans and TPAs on energetic payment reform. 

Many large and medium sized employers pay consulting firms like Deloitte, Towers Perrin, Watson Wyatt and PricewaterhouseCoopers to help them choose which plans they select for benefits administration.  Employers should encourage their consulting firms to examine how competing health plans move payment and providers to more thorough forms of supply-chain management, or episode of care delivery and reimbursement.