Gibson’s Wes Mantooth, Principal and Consultant in the Employee Benefits Practice, shares his insight on what 2018 may bring for the world of health care.
At last, the waiting game is over. Jeff Bezos, Warren Buffett, and Jamie Dimon are here to save the day! Our health care crisis could be over soon! Finally, the saving grace to cut medical care and prescription drug costs in half…or, maybe not?
The administrative burdens of health care reform may have kept you in the doldrums for a few years. The light at the end of the tunnel may still be hard to see. The hopes of the current administration making the reporting migraines disappear has been a bit dashed, but not without effort. That said, optimism remains that employers will regain control of the healt hcare programs offered to employees.
Over the past few years, many have taken the “wait and see” positon on what the government does next. For those of you in this category, I hope the waiting game is imminently in danger of coming to an end soon. You don’t have to be a big fish in a small pond to speak up for what you believe in. It just so happens that Amazon, Berkshire Hathaway, and JPMorgan Chase are huge fish in a gigantic pond and recently made a very clear statement…’We are not waiting anymore!’
Of course, the health care and prescription drug “crisis” won’t be solved overnight. However, doesn’t it feel good to have companies this well-known supporting your efforts to curb rising health care costs and completely out of control prescription drug costs?
The conversations about deductibles, coinsurance, funding arrangements, and insurance negotiation are stale and archaic. Let’s be honest, they’re boring. Much of the recent rage is about tiered physician networks, on-site/near-site access to care, buying consortiums, tweaking of pharmacy programs to mitigate impact of specialty medications, maximizing prescription drug rebate retention, and on and on.
Each of these areas has a purpose, but all have a common theme…manipulating the current system to make it cost less and, some might say, make it more efficient. At the end of the day, they are band-aids on a wound that isn’t healing and is getting 5-10-15% worse every year.
It is American to want and have the best health care. But we lost sight of the cost of getting there. Access to health care is not just a problem, it is one of the largest problems in the United States. The absence of a gatekeeper in so many “insurance” programs creates a free-for-all, leading to overutilization, over diagnosis, and consumers who are extremely overprescribed.
It is a well-known fact that many physicians have no idea the cost of the drugs they prescribe. That seems to be quite a luxury…directing someone to a purchase with no regard for cost. Before you point fingers, whose fault is that? I’m inclined to argue it’s the multiple layers of profit-centers touching the medication before the rep brings it to the physician’s attention.
Physicians are human and can only retain so much information. Researching or remembering the cost of medications isn’t something we expect from our doctors. Free and easy resources exist like Goodrx.com. But it takes desire and ownership for consumers to want to understand.
As an employer, remove the insulation of copays that prohibits your employees and their family members from seeing the true cost of the drugs they consume, if you didn’t already do that years ago. Then, find a different distribution channel to supply the medications to your population. It’s happening now.
Medical tourism is here and, no, not talking India or Bangladesh or anywhere like that. It exists in the continental U.S. We have many of the best health care centers in the world. Ten years ago, paying for an employee’s/member’s flight and hotel to receive treatment at the Mayo Clinic seemed a bit crazy. It’s happening quite frequently now. Indiana has some of the best of the best, so the need to travel far is rare. The point is, it’s time to start telling your employees where to go and stop enabling them to go wherever they want. Minimize access and provide direction.
The topic of disruption has arrived and has done so in a big way with big names who have big money and big ideas and, most importantly, the proven ability to execute on many levels. I have no doubt that these big three will be successful and create a unique health care and prescription drug platform that will be a game changer. But, why wait for them? It’s time to get uncomfortable and be different.
