The hospital delivery model has changed. With the implementation of alternative payment models as mandated by the Affordable Care Act, hospitals are being forced into an insurance model. And with the shift to the insurance model, staffing firm sales teams have been forced to adjust.
Why do we call it an insurance model? Well, hospitals are being forced to convert Medicare patients into Accountable Care Organizations and bundled payment programs. Much like Medicare Advantage plans and HMOs of old, in these models, the payer, which is now the hospital in many cases, receives a flat amount (per diem) at the beginning of each month to pay for each member’s care. After paying for necessary care, whatever cash is left at the end of the month is called profit. In short, cost is everything in the insurance model; it is the dominant driver in purchasing decisions.
Enter the staffing industry sales team, which now must approach hospitals in a different way. Has your sales team adjusted? Here is a series of questions to help you answer that:
- Have you identified who makes the buying decisions now?
- Does your prior contact now have to seek approvals before purchasing?
- Do you know there spending limits?
- Do you know the clients fiscal year end date?
- Do you know when pay day is for employees and how that impacts cash flow and spending approvals?
- Who is your internal champion? How many physician allies do they have?
- How much clout does your champion have in the board room?
- Who are the two most influential executives at the board table beyond the CEO?
- Are you wasting your time targeting the CEO & CFO?
- Is the hospital a for-profit, academic or not-for profit hospital?
- Do you know the decision sequence based on hospital type? Which is more of a priority?
- Operational flow
- Service & responsiveness
- Do you know the not-for-profit secret?
- Have you seen the hospitals required community needs assessment?
- Is peer-to-peer selling necessary when targeting nurses or doctors at this hospital? If so, do you have nurses or doctors on your team? Have you considered some creative ways to add a nurse or doctor to your team and stay under budget?
When the insurance model came to the fore, staffing providers that were traditionally higher quality and price-point vendors were finding themselves left out of sales they had routinely closed simply because they did not offer the lowest price. After multiple requests from solution providers for guidance on how to move the conversation past price, the not-for-profit National Readmission Prevention Collaborative created The Selling to Hospital online Masterclass.
Last week’s SIA Healthcare Staffing Summit in Las Vegas featured my “Selling to Hospitals” preview session. Attendees of the event, and now Staffing Stream readers, can complete the masterclass at a discounted rate of $299 by entering code SELL$100 when registering online by Dec. 10.
Former Hospital CEO turned PopHealth Expert and healthcare affordability advocate Darrell Moon steps into Dr. Luke’s Waiting Room: The Healthcare Authority Podcast to be interviewed by his alter ego, former hospital CEO, PopHealth Expert and affordability advocate Dr. Josh Luke
With insurance costs sky-high and reform questionable, other insurance options are popping up and become first choice for more people. Most families struggle to afford $700-$2,000 average monthly payments, sometimes paying more for health insurance than their house.
Diane, for example, is totally disgusted and very typical insurance shopper. At 27, she has a good job, lives in a decent apartment, and is finally getting her life settled. But, her job doesn’t offer health insurance, so she’s left alone to pay for it on her own.
Like many other young professionals, she’s faced with a huge decision:
Nearly $1,000 a month for health insurance she will barely use or go without.
But, if she ever ends up in the hospital, she could be faced with a lifetime of crippling hospital bills.
Facing this kind of dilemma is a daily struggle for millions of people and families throughout the US. Including mine. We went through a job transition and chose to go without health benefits for half a year. My wife and I had three kids in middles school at the time but with no stable income we just could not fathom paying almost $1,500 a month for COBRA benefits.
Different Ways Around Health Insurance
Like millions of other people in the United States, we’re looking at various ways of affording hospital bills without having to resort to high-cost healthcare. It’s not an easy choice, because some of the options do not cover extended hospital stays or treatment for diseases and some only provide discounts.
But, these are the options I want to make people know and use because they work.
The uncertainty in the health care economy prompted a resurgence of alternative health insurance models people are flocking to by the millions. No longer fringe movements, many of these models are now standards in certain areas.
You can also find more details on these alternative insurance models in my book Health-Wealth for You: 11 Steps to Save Big & Live Healthy throughout Part 3.
Health Savings Accounts
Many employers are opting for Health Savings Accounts (HSA) for their employees. These are specific employer-provided savings accounts that set aside a certain amount of the employee’s paycheck and/or employer contribution for the sole purpose of helping pay for medical bills.
These became a much more popular option as insurance premiums skyrocketed. Employers began choosing higher deductible plans and setting up HSAs to offset the deductible. When employees paid for their medical care, the health savings account reimbursed them.
Will This Work for Me?
If your employer offers insurance and an HSA, most financial advisors will encourage you to contribute significantly to the HSA. It helps offset costs and used for many services such as nutritionists, massage therapists, and alternative medicines.
Some banks and credit unions will allow you to set up an HSA without your employer under certain conditions. This works very well for the self-employed or for those whose company does not offer health insurance.
Cost Sharing Community Models (CSCM)
One of the next steps away from traditional health insurance is having cost-sharing models that prioritize the use of virtual doctor’s visits, apps and technology, and remote monitoring. Many CSCMs help their members by offering discounted services, especially for patients who are paying cash.
Sedera Health is one program. Members of Sedera Health self-pay for the health care costs, and Sedera helps negotiate what the patients will pay. This bill negotiation process can significantly reduce the cost of many standard and emergency procedures. It’s also excellent for people who take a small number of regular prescription medications. Similar models exist for dental and vision programs.
I regularly speak to organizations and businesses that want to offer their employees options to expensive and complicated insurance programs. Personally, I am a member of Sedera through a cost sharing model called Fit Health. If you’re going to explore this cost-saving measure in your workplace, please visit http://wearefithealth.com//drluke to learn more.
Will This Work for Me?
For people who are in general good health and do not often need to see the doctor, a CSCM works very well. It can significantly reduce your costs for health insurance. As new regulations are taking place and basic, emergency only insurance begins to re-emerge, the cost-sharing model will become more popular.
Faith-Based Cost-Sharing Models
Faith-based cost-sharing models are becoming more popular in the Mid-West to the West Coast of the US, although they are available through most religious organizations. Membership is usually limited, having to be part of the organization’s faith, and members are often required to live by specific standards. However, if this option is available to you through your church organization, it’s an option that can benefit you in the long run.
Most faith-based models have members pay a regular monthly due to a community account. Then, as members incur medical expenses, they apply to this community account for reimbursement. Members take a slight risk of not being reimbursed, depending on the status of the fund, but usually gain their money back.
Will This Work for Me?
If you belong to a faith-based community that offers these programs, it is worth your time to investigate how large fund typically is and what the repayment policy is. Currently, there are hundreds of faith-based cost-sharing models throughout the United States and well over a million people belonging to these groups. They are successful at helping people with bills and costs. Christian Care Ministry gives a great break down of their service and how it would work for you.
Value-Based Insurance Design (VBID)
VBIDs are specialized health care tactics that prioritize high-value, proven procedures. This model emphasizes shopping around for the best value for specific procedures, not always the lowest cost.
Because the provider of this type of insurance requires prices and clinical outcomes to be specific and transparent, patients can choose between different providers and procedures. Because the rates, co-pays, and cost of the patient are available for review, healthcare costs are driven down with the right type of choices.
For example, the company Walmart has chosen the VBID for many of its procedures. When it comes to knee problems, Walmart fully supports its employees opting for knee replacement surgery. However, they’ve negotiated with various institutions to provide high-value services for the lowest cost. Employees can choose to use Walmart’s selected facilities, often with minimal co-pays, or other facilities with a higher co-pay. For some people, it’s a natural choice, but for others, they may have to travel a significant distance to use a preferred facility.
In Episode 21 of my podcast Dr Luke’s Waiting Room, Doctor Bill Hennessey, founder of Pratter, Inc. created a tool for companies to know how much they spend on various procedures at different facility. It helps people price shop and know the real value of their surgery.
Will This Work for Me?
If you’re part of this type of system, it can save you money. You’ll have to do more work before procedures to choose the most cost-effective and highest value treatments. In the long run, for higher-priced services, it can save significant amounts of money.
Private Membership Programs
As insurances are driving up the clinic cost of many routine medical procedures and requiring extra personnel to submit insurance claims, many of these small clinics are opting out of accepting insurance altogether. For some, they face the choice of abandoning insurance or going out of business.
So, many created their own third choice: they’re offering a self-pay membership program. This is one insurance option that I support and belong to.
These membership programs offer a set number of services for the members to take advantage. Many of these programs charge a fixed monthly fee and provide routine health checks, urgent care visits, minor in-office surgeries and procedures, and other accessory medical needs. Membership to many of these doctor’s offices ranges from less than $50 per month to several hundred.
And it’s not just small doctor’s offices that are offering the service. Larger hospitals are also exploring this option and may be able to provide a broader range of services. Most of the time, the doctor’s websites will inform you if a membership option is available.
Will this work for me?
For most people in decent to good health, this is a very reasonable alternative to health insurance. People can get the routine medical care they need, the prescription medications, and minor procedures.
Catastrophic Health Insurance
With all the options available, and with changing regulations, catastrophic insurance may become an option in the near future. Coverage that supplies just emergency medical treatment, lengthy hospital stays, and extensive surgery, without providing any routine care, may become an option again.
If you choose an alternative health insurance model, be sure to have funds set aside for emergency care. Most alternative models do not cover emergency care, although they are perfect for routine care.
With the rapidly changing landscape of American health insurance, we can only guess where things will go. Remember, in the last decade, we’ve seen insurance costs rise nearly 1000%, force everyone to have insurance or be fined, take medical procedures they won’t ever use (maternity), and have over a thousand different regulations enacted and redacted.
We can only wait and see what the future will hold. Taking control of your Health-Wealth maybe the only secure financial decision you can make.
Fellow crusader on driving down the cost of healthcare, Ron Barshop,
founder of Beacon Clinics and host of the Primary Care Cures Podcast steps into Dr. Luke’s Waiting Room: The Healthcare Authority Podcast to discuss how price transparency is the first step to solving America’s healthcare hyper-inflation crisis
We continue the theme of #healthcare pricing transparency in Dr. Luke’s Waiting Room: The Healthcare Authority Podcast with guest Thomas Farmer, Founder and CEO of the website Healora.com which lists the price of surgeries and procedures online so you can shop and save up to 80 percent over hospital prices.