Try this experiment: When a friend (who doesn’t work in benefits) says that she is trying to find the best doctor, ask her what she means by that. While she might value a good recommendation or focus on how much time the doctor spends with her, many of us in the benefits profession have learned to define a quality provider as one who offers the right care, at the right place, at the right time. This is a doctor who will discourage underuse – perhaps by alerting you to a preventive screening you need – and will protect you from misuse and overuse – for example, by recommending physical therapy rather than a back surgery when you present with back pain.
Misuse and overuse of medical services harms patients and wastes money. An Institute of Medicine Study found that about one-third of healthcare expenditures within our system can be classified as waste. Improving quality to reduce waste could be employers’ single biggest opportunity to manage cost. But if waste is an inherent problem in our healthcare system, what can employers do to bring about positive change?
Awareness is key – and so is breaking down the problem into smaller pieces. I want to share with you the approach that Mercer’s Quality Improvement Collaborative has taken to prioritize quality issues for employers to be aware of and take steps to address. (QIC brings employers and healthcare systems together to discuss quality issues.) Because services delivered in the hospital setting – including surgeries and procedures – account for 32% of healthcare costs , we’ve focused on a subset that are often unnecessary, and how we might prevent these. Rather than tackle every single instance of overuse, we’ve zeroed in on 7 areas which are widely acknowledged as presenting an opportunity for improvement:
Before we can improve quality, we have to define it – and then engage in a productive dialogue with healthcare providers about how to move the needle in the right direction.
You can join a QIC chapter to engage directly in conversations with health systems. Contact Sharmila Shankarkumar at 212 345 2746