To cut costs, every health plan needs a Robin

One of the tools that begs to be injected into the messy, somewhat superficial national debate on the delivery of health care is that of a care navigator.

Those are the professionals who help patients to make good decisions on treatment options and on keeping the cost of those treatments under some level of control.

In our office at Serigraph, that person is Robin in our Human Resources Department. No co-worker in the company would think about navigating the Medical Industrial Complex (MIC) for a major procedure without consulting Robin.

She is the major reason why our company delivers first-rate care at about $7,000 per person, compared to a national average of $11,000.

Other astute companies in the private sector provide high-quality care at the same level.

Note to the big thinkers on health care at the national level: best- practice private payers spend about 40% less than the national average. That’s a huge difference, out of which flows several major conclusions:

1. About 10% of the U.S. population still goes without health care coverage. Obviously, if all payers had a Robin and followed best practices, the 40% savings would be way more than enough to cover the uninsured – without raising taxes.

2. Controlling health costs, the number one political and economic issue in the country, is mostly about management science, not political science. Costs can be managed.

3. The main reason health care inflation has dropped from double-digits 15 years ago to about 4.5% today is the collective efforts of private employers to put the clamps on outrageous medical and drug prices. (In contrast to ObamaCare – government action — drove prices up, not down.)

4. The main beneficiaries from taming out-of-control costs are American citizens, who are bearing an ever-increasing share of the health care burden through higher premiums, coinsurance and deductibles. The employee share is now more than 40% by some estimates. Further, outrageous bills are now aggressively pursued by some hospital corporations, to the point of driving families into bankruptcy.

There are other tools in the war against soaring health costs, but smarter consumers at the ground level is the most powerful. That’s where the care navigators enter the battle.

It was long thought that more transparent pricing would empower consumers. But even mandated publishing of prices, which President Trump has been pushing for, hasn’t moved the chains. Health care pricing remains in a fog bank. It’s just too complicated for the average American to sort out.

Bills usually come as an unpleasant surprise. Only providers that combine their charges into one bundled bill can be understood by individual consumers. Example: $28,600 all-in for a joint replacement (market average is about $50,000 without a fixed price).

Unfortunately, only a few providers, and almost no major health systems, offer transparent pricing. They love the fog.

The navigators have access to many prices. Robin first checks to see if our company has negotiated directly for a fixed price. Then she compares it to discounted prices through our health insurer. She also uses whatever quality data we can access. She then lays the hospital comparisons in front of our co-worker. The co-worker then makes an informed decision. He or he is a real consumer.

High-priced, low quality providers lose the business to high value shops. As it should be. It’s that navigator assistance through the health care maze that makes the difference.

Robin-like services can also be out-sourced to companies like Alithias in Milwaukee. It is high tech in cutting through the pricing puzzles and high touch in dealing with each employee’s situation. (Disclosure: I am an investor and director.)

The sound-bite politicians running for high office could do something real by insisting on the availability of an objective care navigator for every American who needs to make a costly health care choice.

They should meet Robin and visit Alithias.

Then they will want to push every health plan to make a Robin available.

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