Working Well

Price Transparency and Innovation Star at Midwest Business Group on Health Conference

MBGH's annual event focused on where there’s room for improvement and innovation in employer-sponsored health care.

These past several weeks have brought a whirlwind of travel, conferences and webinars, and, boy, my brain is full of too many ideas!

I’d love to share some event-season takeaways and practitioner questions with you before conference season gets even more hectic:

First, the Midwest Business Group on Health held its 38th annual conference at the Mid-America Club in Chicago on May 2 and 3. The theme this year was disruption and innovation in employer-sponsored health care, and I was very impressed with a couple speakers: Dr. Jan Berger, CEO of Health Intelligence Partners and medical director at MBGH, and Mark Fendrick from the University of Michigan Center for Value-Based Insurance Design.

I especially enjoyed Berger’s comments on transparency. She brought something up that — although straightforward and maybe obvious — I find critical to this discussion. There needs to be more consistency in the definition of transparency, she said, and if your company is relying on a nebulous definition for transparency, then that will lead to unclear answers when you’re searching for a solution.

Transparency is such a trendy word in health care right now (and for good reason). Let this be a reminder that when you’re thinking about how to improve transparency in your organization, think about what that actually means.

Berger also touched on transparency tools.

“We are asking people to do unrealistic things,” she said. For example, when someone is having a medical emergency, their first reaction is not going to be, “Hmm, let me sit on my phone and compare prices on my transparency tool.” They’re going to want to get help immediately at the closest place available.

Let’s be clear about the meaning of consumerism in health care, Berger said. My interpretation was that, yes, employees can have more responsibility in their health care, but that doesn’t mean that they can be the logical consumer that employers sometimes seem to expect them to be. Extenuating circumstances might make rational, comparative decisions take the backseat to gut instincts.

This also reminded me of a great op-ed in the New York Times from open enrollment season last year, “‘Choosing a Health Insurance Plan Is Not Shopping.’” It reads like an entertaining, relatable rant but has a lot of logical takeaways as well. “Health care is much more than a mere consumer item, even if we do spend money to get it. It’s fundamental to our lives,” the piece points out.

My food-for-thought for employers: How have you gained employees’ trust in health care? What are your preferred definitions of transparency? And what do you think is the right amount of responsibility or expectations to put on employees for health care decisions?

Mark Fendrick spoke about low-value care and unnecessary care. He started his lecture by saying that when he attends health care meetings, few people talk about health. Most people talk about money. This theme came up a few other times — the difference between health and health care. People sometimes act like they are the same thing. They’re not.

Yes, money and costs and prices are all important in health care, but so is value, Fendrick said. We need to change the discussion about health care from how much we’re spending to how we spend it. He spoke about high-value items that many people can’t afford (not being able to afford to manage their chronic conditions or pay for their medications) versus low-value services that could be cut to improve how people are spending in the health-care system.

These low value services included vitamin D screening, unnecessary MRIs or diagnostic tests, prostate cancer screening for men 75 or older and branded drugs when generic drugs are available, among other suggestions.

He also offered the caveat that no medical service is always low-value or high-value. A couple of noteworthy services that are commonly overused or low-value are colonoscopies and back surgery. But in other scenarios, those are very high-value.

So, how do you decide what is low or high value in your organization?

Finally, all this innovation talk got me thinking about what’s going on in health care. Specifically, one speaker at this conference made a comment about the speed of health care innovation. This caught my attention, especially because an article called “Ethical Dilemmas in Personalized Medicine” has been on my mind.

Without going into too much detail, the article in the February edition of online magazine in-Training analyzes the advantages and ethical concerns of using the personalized, one-size-fits-all medicine that is more widely available today than ever before. It also asks two questions, which I find important but not commonly asked about this topic: “How can we justify the use of personalized medicine, a costly effort with heavy time and resource demands, when millions of American citizens still lack adequate health care coverage? How can we proceed to fine-tune individual treatment plans when millions around the world still lack access to medical basics like vaccines and antibiotics?”

This is more pointed toward health care organizations than benefits directors, but I’d still like to bring it up because that’s where the technical advances are coming from that’s allowing employers to explore new health care options and technologies.

Thanks for reading, and let me know if you have any comments or suggestions on the ideas I mentioned above!

Andie Burjek is an associate editor at Workforce. Comment below or email editors@workforce.com.