Companies use broker for value in surgeries

Gordon Larson

Sending American employees overseas for inexpensive surgeries sounded like a good idea five years ago when BridgeHealth was testing the concept, but there weren’t many takers.

So BridgeHealth, a broker for buying surgeries, shifted to medical tourism in the United States in a revised business model called a “surgery benefit program.”

For an affordable monthly fee, BridgeHealth helps employees navigate through decisions on elective procedures. The process starts with the premise, gleaned from medical research, that some 30% of all surgeries yield no positive results.

Most of the company’s 250 customers are self-insured, including large ones like Albertson’s and All State Insurance.

Step one for employees in the BridgeHealth model is to assess whether surgery is the best bet, despite what “the guy in the white coat” is recommending. Surgeons get paid to cut. Other opinions are sought. Sharp payers make second opinions free.

Step two is to determine whether a less invasive procedure would work.

Step three, if surgery is called for, is to steer the employee to a center of excellence where service, quality and price are top notch. A BridgeHealth care coordinator uses its CareChex rating system to find the best value centers.

In Wisconsin, for instance, it selects top-ranked Aspirus in Marshfield for heart procedures and Gunderson Health in LaCrosse for joint replacements and other procedures. Gunderson is one of the leaders in lean disciplines in the country.

All prices are “bundled,” meaning a single bill for a whole episode of care. That stands in direct contrast to the confusing bills from most providers that show multiple line items from aspirin to rehab, based on based on complex codes used by the federal Medicare program. There is often a series of separate bills from various providers involved in the surgery.

The bundled prices include hotel and initial rehab services.

Gordon Larson said his company has learned that it has to get the worker facing a surgery engaged early on. So it data mines an employer’s claims to unearth early indictors that could lease to a surgery down the road. That kind of early planning heads of last minute decisions, allows for choosing a center of excellence instead of the hospital down the street and, most importantly, leads to better surgical outcomes.

Some companies use incentives to encourage employees to travel for value in procedures. Some make the surgeries free to employees — no deductible charges or co-insurance. At Serigraph, we offer cash incentives, such as $2000 for a hip replacement or $250 for a colonoscopy. We are not worried about over-utilization of the latter.

Large corporations, like Johnson Wax, Pepsico and Lowe’s, are cutting their own direct deals with centers of value. But a broker/consultant can be an equivalent answer for smaller companies.

Prices for surgeries in the states don’t match prices in, say, India, where hip replacements can be had for $5000. But prices vary wildly among U.S. providers, and even within large health systems, from hospital to hospital and clinic to clinic.

So savings from domestic medical tourism can be 30% to 40% or more.

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  • Steve Dunn

    This type of process is at the heart of the people side of sustainability and makes perfect sense both economically and professionally. Why would a firm not want to help preventatively manage the health of its employees? This is not an invasion of personal privacy, it makes good managerial sense and should result in healthier, more productive employees that feel a sense of loyalty to their firm.

    • JohnTorinus

      Steve,

      At Serigraph, we have had no privacy issues that I know of. Our on-site clinic has a separate entrance, and only our medical staff has access to personal health records.
      We do get aggregate health metrics for helping to manage better. For instance, we know how many diabetics we have and have adopted programs to make sure they are under conrrol.