As employers look to control healthcare costs, they are increasingly partnering with healthcare providers to offer new surgical care experiences. New digital health companies can help them identify plans to reduce the cost of care by identifying where expensive surgical interventions are needed. But employers are also consulting providers and leading provider organizations who can deliver a new type of healthcare experience that can improve the overall quality of life for employees and reduce costs, absenteeism, patient financial stress, and more.
Dr. Catherine MacLean is Chief Value Medical Officer at the Hospital for Special Surgery (HSS) in New York City. This role is also part of a broader trend for healthcare providers. Similar to how it works with regional employers, HSS is working with Transcarent to help employer clients help their employees navigate surgical options for optimal outcomes.
“Basically, my job is to make sure the HSS is delivering the highest quality care in the most cost-effective way,” McLean said. “When considering a provider’s cost efficiency, you need to ask the question, ‘How does the care delivered by the hospital or health system affect the overall cost of care?'”
To illustrate her point, McLean presented a scenario where two hospitals charge the same amount for a procedure. One of the hospitals had a much higher complication rate than the other, driving up the overall cost of care. Therefore, employers will be directed to hospitals with lower complication rates.
In addition, HSS assesses patient outcome measures, such as quality of life before and after surgery, to determine whether their patients are actually getting better.
Another more difficult component to measure is avoiding unnecessary testing or imaging that can add cost, especially avoiding unnecessary surgery. It might seem counterintuitive for a hospital whose name is surgery. But as MacLean explains, providers spend a lot of time reviewing whether procedures will provide better results than less invasive methods.
“We spend a lot of time measuring the appropriateness of procedures performed at our hospitals and understanding the impact on patient outcomes and overall cost of care,” McLean said. “Most HSS patients receive non-surgical treatment.”
She noted that data from some studies suggests that many patients undergo unnecessary surgical procedures because doctors provide them, whether that is best practice or not.
“As a center known for its expertise in orthopaedics, many patients who have been told elsewhere that they should undergo orthopaedic surgery come to the HSS for a second opinion,” McLean said. “HSS surgeons recommend that about a quarter of these patients consider non-surgical treatment the best option.”
Spine surgery tends to have the highest complication rates among musculoskeletal (MSK) procedures, so it is a motivating factor for exploring less invasive alternatives such as physical therapy. For example, MacLean observed that there are conditions, such as low back pain, that can benefit from treatment before they become chronic. While some states require primary care physicians to refer patients to physical therapists, in others, such as New York, these appointments can be made directly through PT – in person or virtually. HSS has its own team of physiotherapists, some of whom may be the patient’s first point of contact rather than the surgeon.
So how does HSS work with Transcarent?
As part of the partnership, beneficiaries of self-insured employers will have access to HSS’s world-leading orthopaedic and MSK specialists. Transcarent will handle all member referrals, facilitate travel and pay for certain orthopaedic procedures. Transcarent will also provide access to HSS’s new virtual care plan.
“At a high level, we’re working closely with Transcarent to really think about how we measure, produce and market high-value musculoskeletal care,” McLean said. “As part of our ongoing discussions, we’re looking for ways to identify patients with musculoskeletal problems and send them to the right doctor or the right clinician to address that problem, rather than sending them directly to surgery at the doctor’s.”
In addition to access to a leading surgical care experience, Transcarent provides 24/7 personalized health and care support for nearly all of the most common and challenging needs through the use of wellness guidelines. These essential services include urgent care, low-cost medications, personalized behavioral health care, home care, cancer treatment, and specialist second opinions.
“Leading employers continue to be dissatisfied with the accessibility, quality and cost of our healthcare system, especially the surgical experience for their employees and their families,” said Glen Tullman, CEO of Transcarent. “HSS has long been an orthopaedic care provider. A recognized industry leader in the field, we are delighted to partner with them to bring Clear Surgery Care Experience for people across the country who need high-quality, affordable care. “
The social distancing of the pandemic has helped draw attention to the need for more accessible and widely available behavioral health resources for employers. The use of virtual care can help meet this need, especially in areas where there are relatively few therapists or where demand cannot meet supply.
Courtney Blondino, Senior Associate for Total Health Management at Mercer, describes the market trends she sees.
“I know we’ve done some analysis that shows we’re seeing a spike in behavioral health through telehealth during 2020 and 2021. But we’re also seeing that, at least at the end of 2021, those numbers aren’t really going down. We’re seeing People are definitely using their virtual behavioral health counseling, but we’re also seeing that it’s actually helpful to employees. If they work from home, they continue to have counseling from the comfort of their own home; they don’t have to leave at work to get it That kind of support. It actually increases traffic. So employers are looking at that too.”
Depending on the client and the solution, employers tend to review two to five behavioral health providers, Blondino said. If employers are interested in replacing their employee assistance programs, Mercer will work with employers to focus on which suppliers and suppliers will support the employer’s current needs and the gaps they hope to fill. Mercer then offers advice on who might be the best fit.
Partnerships between health technology vendors and providers to optimize and deliver effective treatments and ideal patient outcomes that meet the needs of employers and employees is a new paradigm in healthcare. Surgery and behavioral health are just some of the areas that have a significant impact on employees’ quality of life and employer budgets. Employers’ ability to fully understand how to deliver the best patient outcomes for their employees and ensure employers meet their budgetary needs will have a major impact on a company’s ability to recruit the best employees to remain competitive.
photo: stefanamer, getty images
