By: Ron Peck, Esq.
Between Friday and Saturday I was feeling under the weather. By Easter Sunday, my chest was terribly congested, my nose running, breath wheezing, and more. My assumption was that on this holiday, I wouldn’t be able to find a provider – and given my breathing issues – I might find myself in the ER. I contacted my local Urgent Care anyway, and – lo and behold – they were open. 30 minutes later I was being tested for flu, and hooked up to a nebulizer to ease my breathing. The quality care I received, on this holiday, aside… I want to address the global issue as I see it. I knew which options were available to me, and made an effort to pursue the option that was best for me AND my employer (as well as our self-funded benefit plan), because we have made efforts to ALIGN THOSE INTERESTS. I was educated, aware, and incentivized to check the urgent care option before rushing to an emergency room.
Too many employers, that wisely choose to self-fund their health plan, assume that once they pick a claims processor and broker, they are off the hook and some third party will take over. This dereliction of fiduciary duty saddens me. Being self-funded means more than funding claims directly. It means taking ownership over your staff… your team… your second-family (for, indeed, I consider my co-workers to be a second family; who else besides family occupies so much or our time?), and ensuring they understand the options available to them. Making sure they understand how different choices impact the company, the plan, and their own financial bottom lines needs to be a priority for the employer.
Ask the average American employee if their health plan is self-funded. They don’t know. There is a greater than 60% chance they are self-funded, but they will instead quote the name of their network. Ask how much a visit to the ER costs, compared to their primary care or urgent care, and they will quote the co-pay.
Employers! Self-funders! This is a call to action. Stop passing the buck. Start explaining how your plan is funded, and take proactive measures to align employee and employer interests. Information is power. Furthermore, don’t resort to a high deductible plan – again passing the buck – (this time onto the employee). How is any employee supposed to “shop around” if they have no access to the cost of care? As an aside, I think it’s hilarious how we gripe over the ACA, and how “Obama” focused too much on “who” is paying, and not enough on “how much” is being paid… that shifting the burden onto insurance doesn’t solve the issue of cost… and then we turn around and increase deductibles; ignoring the cost and instead shifting the burden. When we simply pass the buck instead of addressing the cost head-on, we are just as bad as the politicians we complained about!
To that end, transparency is king; regardless of whether the plan is paying dollar number one and incentivizing employee behavior, or the employee is paying the first few thousand dollars via a high deductible. That’s why I’m excited by organizations like The Free Market Medical Association, and the recent surge in subscription based direct primary care. By investigating trends like these, educating employees about their plan’s funding mechanism, and actually incentivizing them to behave in a way that benefits them and the plan, we will begin to see real change – just like I did this past Sunday.