Originally appeared on Forbes.com

Apple, Amazon, Google, Walmart, and Tesla are among the global brands that made significant changes in 2018 to start curbing corporate and employee healthcare costs for the company and employees. 2018 shaped up to be the year that many American businesses and families declared war on out of control healthcare costs by seeking out more affordable options. Those companies, employees, and families are now being rewarded by seeing thousands in savings already.

Health insurance and benefits are the second highest expenditure behind payroll for most American businesses. For individuals and families, healthcare is likely the fastest growing expense year over year, even as each dollar buys less care as benefits are being reduced! Has your company or family declared your tipping point on out of control healthcare costs? If not, now is the time and this article will provide a few simple starter ideas on where to begin in 2019!

Simple tips to save thousands on healthcare in 2019:

For Individuals and Families

There has been rapid growth in cost sharing plans whose premiums can be 60% less than traditional insurance. Many are familiar with faith-based cost sharing plans such as MediShare (Medishare.com) that have been providing a more cost-efficient alternative to Christian members for years. The key to cost sharing plans is that the plan is not regulated by the Department of Insurance and members pay significantly less in premiums. Members pay cash prices to doctors on the day of appointment and later seek reimbursement from the provider, and also have no guarantees that major claims will be reimbursed. There is a “leap of faith” factor involved.

For those who are not comfortable joining a faith-based cost sharing program, there has been rapid growth from individual providers like Sedera Health (Sedera.com) that allows non-faith-based organizations to create their own product. One of the more unique but rapidly growing groups that offer a program through Sedera is Fit Health (WeAreFitHealth.com). Fit Health simply asks that members commit themselves to living a healthy lifestyle and in return are included in a group that is offered significantly reduced premiums and share of costs.

Originally published on Forbes.com

Let’s flash back to 2010. It made so much sense that any healthcare reform act would include a mandate that required hospitals to aggressively implement electronic medical records (EMR) so patients could finally have access to their own personal health data.

There wasn’t much push-back from either side of the aisle on this condition known in the Patient Protection and Affordable Care Act (PPACA) as “meaningful use.” After all, the information age was upon us yet hospitals were still photocopying records, charging patients for the copies, and telling the patient they needed to come back in 72 hours to retrieve the records. Hospitals frowned upon the process as it usually symbolized a potential lawsuit on the horizon.

It seemed that Americans as a whole were united that meaningful use was a positive step to empower the patient to be involved and educated in their own health management. But one year went by and then three or four, and, despite the threat of penalties for missing implementation deadlines, the hospital industry lobbied successfully to limit these requirements to implementing components of the EMR that helped them maximize revenues.

The top three EMR vendors became so powerful, it was not uncommon for them to pass up on opportunities to work with small and midsized hospitals and health systems. I know, as I was one of the CEO’s who was told, “You’re not big enough for us to justify working with you.“ What about those big hospitals that did work with these top vendors? They were often boot-strapped for years and unable to fulfill other priorities as a result of the cost allocated to their EMR implementation. It was a highly publicized nationwide epidemic for many hospitals.

Despite great profitability for the vendors, little was done in regard to making a patient’s personal health record more accessible and most hospitals made almost no progress in the initial five years after PPACA passed. In 2016, as a handful or EMR vendors rose to the top and captured the majority of the core hospital market, Congress called several of their leaders back to Capitol Hill to address the lack of progress and implemented new, heightened expectations around implementation and compatibility.

It makes sense if you break it down into a timeline:

• Congress requires EMR implementation in PPACA in 2010. The EMR space explodes in 2011 as a result, and hospitals are the sole payer to EMR vendors
• Despite ObamaCare prioritizing patient access, population health, and staying healthy at home, hospitals had little financial incentive to enhance access or keep patients healthy at home into 2015.
• Prior to 2016, almost no hospital dollars were spent on EMR vendor software that supported access or population health, and therefore the EMR vendors had little incentive to prioritize these needs as well. Then Congress stepped in by 2016 and asked EMR companies and hospital leadership to focus more on compatibility and access.

But in early 2018, just as health systems started shifting their meaningful use priorities toward patient access, a strange thing happened. A few technology companies much larger and influential than those in the EMR space entered the electronic patient record discussion.

Have you ever heard of Apple? What about Amazon or Google?

These companies have a global reach that makes the EMR vendors’ footprint look almost irrelevant. In January 2018, Apple announced a partnership with several major health systems to make patient records accessible on their mobile phones. In that same month, Amazon announced it was partnering with JP Morgan and Berkshire Hathaway to rethink how healthcare benefits are offered to employees. Within a few short months, Google made a number of announcements and key hires as it moved into the healthcare delivery space as well.

While its unlikely Apple, Amazon, and Google will prioritize becoming major EMR providers in coming years, it’s not at all unlikely that this goal is within their long-term plans. More importantly, these global tech giants realize that the EMR is not the most critical information available in the healthcare process. Much more important than the EMR is the HIPPA-compliant, cloud-based parallel that allows patients and caregivers to converse and get educated from their mobile device. Think of a group text, or the Slack Application, specific to healthcare. There are already several effective patient management apps out there. These applications vary in scope, but Stellicare, MeUCare, and LoopdIn are all examples of applications currently available to the consumer that help manage a patient’s sensitive health information.

Remember, in the model of the future, when a patient is hospitalized, more often than not it will be a failure of the population health system. The focus of healthcare in the future is on being healthy at home, which requires self-management and caregiver education. These applications enhance those skill sets. I have lived this personally as my mom is currently in the advanced stages of Alzheimer’s Disease. My family has used a group text to accomplish this, but these new applications not only allow us to opt-in any doctor, pharmacist, caregiver, or family member, they also allow us to download instructional videos and resources.

As a result of this excessive EMR spending, hospitals pass the expenses onto the consumer and businesses in the form of rate hikes and the cost of healthcare in America continues to skyrocket. The meaningful use requirement is no doubt one of the contributing factors to healthcare’s continued hyperinflation.

So here’s the good and the bad of President Obama’s meaningful use experiment: big EMR vendors built up power and influence and, just as it peaked, several companies with much greater influence entered the arena and forced the EMR vendor back to the table to re-prioritize. Depending on how quickly Apple, Amazon, Google, and others enter the arena, the success and livelihood of these top EMR vendors may be on the line. EMR vendors’ failure to prioritize population health software and applications may cost them in the long run.

If Apple, Amazon, Google, and others create more effective means of managing and making accessible patient information and records, will Obamacare’s meaningful use requirements prove to be the biggest waste of billions of dollars in the history of American business? Time will tell.

Dr. Josh Luke is an award-winning Futurist, hospital CEO, two-time Amazon #1 best-selling author, and a member of the faculty at the University of Southern California’s Sol Price School of Public Policy. He is a well-known public speaker on the topic of healthcare affordability and transformation and writes regularly for LinkedIn as The Healthcare Affordability Authority. Visit www.DrJoshLuke.com for more information.

Maryland wants residents to know how expensive certain hospital procedures are. The images featured in this post come from a recent advertising campaign.

Believe it or not, this campaign may prove to be a milestone in the long and arduous road to healthcare affordability in America. Simply put, hospitals are thriving businesses and always have been.

Hospitals play on the emotions of Americans who often can’t afford care. Until recently, hospitals were not even required to prove that the patients they admitted met the minimum criteria for hospitalization – leading to massive abuses of the system.

The hospital model, in a nutshell, was simple: find any justification we can to admit every patient we can and then bill the insurance company for payment. This model, known as Fee-for-Service, led to the golden age of hospital success in America. I nicknamed it “The Fee-for-Service Free-for-All.” There was no accountability whatsoever and, as a result, the Federal Medicare fund is expected to be empty in the next twelve-to-eighteen years unless something changes.

The beginning of the end for this methodology was the Affordable Care Act (ACA), or Obamacare. The ACA implemented a series of initiatives requiring hospitals to meet minimum criteria for admission, or payment would be withheld and fines could be issued.  The ACA also forced the hand of hospitals to transform into value-based care models.

Much like the Medicare Advantage model, those who manage care in value-based care are provided allocated dollars for each patient by the Federal Medicare fund. As a result, all costs incurred by an individual patient for care in a month are accounted for by the private Medicare Advantage company as expenses. If any money remains at the end of the month, that residual becomes your profit margin. If you overspend the allocation, then it comes out of your own pocket. In healthcare, we call this a “risk model.” The government is forcing hospitals to enter risk arrangements to reduce over-utilization on patient services and, ultimately, reduce costs.

In short, Obamacare forced hospitals to transform away from a Fee-for-Service model and into value-based care models. This means every patient a hospital justifies for admission becomes an expense to the hospital and not a revenue opportunity. That’s a 180-degree turn!

For the record, this is not a politically-driven issue. The fact is that our Medicare fund is running dry at an alarming rate and the government needed a model that requires accountability.

In comes Maryland!  While most states are slowly crawling towards value-based care with many hospitals doing everything they can to try to get Obamacare overturned, Maryland was one of the first states to adopt a Total Cost of Care Model.

Total Cost of Care takes value-based care way above the level of the hospital or insurer. The state looks at the total Medicare Dollars spent on each provider annually and allocates the appropriate ratio or percentage of dollars of the overall state fund to each provider, including hospitals and physicians.

Think of Total Cost of Care like this: Instead of the hospital getting $1241 each month to be responsible for your mom’s care, as it would in an Accountable Care Organization or full-risk HMO, the Total Cost of care model sees the hospital allocate a specified amount for the year. For example, the state would give a hospital $48.2 million and say, “That’s all your getting from us for all the patients you care for this year. So, good luck!”

As mentioned earlier, while the rest of the country is mid-way through a slow crawl towards transforming to value-based care that began sometime in 2010, and will likely be complete by 2020, hospitals in the state of Maryland were forced to complete the transformation overnight, or risk financial failure.

As it stands, every patient admitted to the hospital, or provided a service by a hospital, in Maryland is simply an added expense to the hospital’s ledger. It’s a consolidated bottom line. The hospital receives a large allocation from the state annually, and every service provided after that is an expense. It’s an entirely different mindset; the hospital is the de-facto insurer now.

When you see an article stating that a single state in the United States of America is advertising the cost of hospital procedures, expensive ones at that, it may first give you pause. But when you realize that state in question is Maryland, a state bold enough to pave the way on converting to this model, it comes as no surprise.

In an effort to end the long-entrenched practices of over-admitting patients and over-ordering often unnecessary tests, Maryland and its hospitals made the bold choice to transform to the role of the insurer overnight. So the state and its hospitals are now the banker and, every time you access care, it costs them.

When you have a basic understanding of how Maryland is ahead of the game on value-based care, it is no wonder that its state hospitals were the first to say, “Let’s advertise our prices to weed out those patients who may not truly need an expensive procedure.” It’s the same tactic insurers have been using for years.

It’s the right move and the next step in this transformation. Just ask the insurer; it’s the oldest trick in the book, and the program was extended and expanded through 2023.

Dr. Josh Luke is a celebrated speaker, award-winning Futurist, LinkedIn Influencer, a faculty member at the University of Southern California’s Sol Price School of Public Policy, and author of Health-Wealth: Is healthcare bankrupting your business? 9 Steps to Financial Recovery. Drawing on his experiences as a hospital CEO, Dr. Luke delivers engaging and entertaining keynotes that teach audiences simple concepts on how individuals and companies can save thousands on healthcare. For more information on Dr. Josh Luke, please visit www.DrJoshLuke.com.

Original article link is available here.

Health and wealth. Two terms that were not so synonymous in prior generations.

But today, Americans are facing a healthcare affordability crisis both at home and at work. Recently, a few iconic companies have declared they’ve reached their tipping point on paying for healthcare for their employees. And the list is growing.

It started with Amazon, JP Morgan and Berkshire Hathaway in January 2018. Then Disney rang the bell in Florida. Now Walmart and several others have joined in. In fact, Walmart—one of the most efficient organizations in history in terms of managing costs without compromising quality—are making a bid to buy Humana.

If you can’t beat ‘em, buy ‘em.

Though no one knows for sure, it is not out of the question to suggest that Amazon and Walmart could become two of the largest providers of commercial health insurance within the next five years. Or, that might not happen at all. But it is certainly an exciting proposition for those seeking alternatives to the current high-cost insurers.

What makes these corporate declarations particularly striking is that American families have been attempting to declare their tipping point on healthcare affordability for years with little success. Hospitals and insurers have ignored families’ plea for help. Healthcare lobbies are among the nation’s strongest, so little relief has been provided. Capitalism reigns.

With the American family powerless to drive change, corporate America has come to the rescue. And despite their attempts to publicly brush off the movement, hospitals and insurers are taking notice.

Ironic, isn’t it, when a hospital pays for an advertisement with an emotional appeal to the community seeking donations for a new building or facility, yet when community members seek care at that same hospital, they are often unable to afford it?

This is the same hospital that will refuse to post its prices, even when asked directly. What other business in America requires you to commit to and receive services without knowing the price in advance? Further, what other business in America provides its customers so little recourse for negotiation or questioning the quality of service after the fact?

Current statistics show that less than 20 percent of hospitals in America post prices publicly. In the rare case that hospitals do share prices in advance, it is inevitably with a disclaimer stating that prices cannot but guaranteed and actual charges will be based on the specific items that doctors and hospital staff code during the procedure.

Translation: “These prices will change, and there’s nothing you can do.”

As hospitals begin to feel the pressure as a result of corporate advocacy on affordability issues, individuals and families can do their part by engaging in the healthcare process. Engaged Healthcare Consumers (EHCs) understand how to find significant savings both for themselves and their employers.

So how do you become an EHC?

Start by focusing on the 3 P’s: Have a Plan that focuses on Preventative care, as well as Personalized care.

Simple enough, but what does that look like in practice? Have a DNA test done to better understand which medications work best for your body, and identify high-cost drugs you might be consuming unnecessarily. Utilize technology, from Fitbits to Apple’s new Health app that allows you access to your personal health record on your phone. Seek out specialized disease-specific programs to better manage chronic diseases a family member may have. Practice local medical tourism by seeking out Centers of Excellence for all procedures.

To date there has been little evidence suggesting any link between price and quality in healthcare. In fact, those doctors who engage in the discussion about fair pricing often receive higher quality scores than their high-cost counterparts. These doctors and facilities that offer affordable pricing and higher quality are known as Centers of Excellence, often referred to as within the narrow network.

With corporate America stepping up to lead the charge against hyperinflation in American healthcare, it is crucial that individuals and families do their part to join the effort by becoming Engaged Healthcare Consumers.

Dr. Josh Luke is a former hospital CEO, acclaimed speaker, healthcare futurist, and best-selling author of Health-Wealth with ForbesBooks. Learn more at health-wealth.com.

Original article link is available here.