Steven Strongwater, MD is the President & CEO of Atrius Health, a nonprofit healthcare leader which delivers a system of connected care for more than 740,000 adult and pediatric patients in eastern Massachusetts.
The greater Boston community is the envy of many cities. Major corporations have selected Boston and are shaping our promising future. However, to remain profitable, these companies must manage health care benefits, a significant portion of total expenses.
Massachusetts has among the highest health care costs nationally. Reducing health care costs while delivering world-class care for which Massachusetts is known will help our business community continue to thrive. Employers as purchasers of health care can actively collaborate with the health care community to control costs.
Employers can work with providers to improve employees’ health. The lifestyle decisions employees make impact the total cost of care and are borne by employers through higher insurance rates. Ideally, employers can motivate employees to make healthy lifestyle choices, with strategies to avoid obesity related disorders, give up smoking, lower stress and avoid risky behaviors.
Ideally, this better behavior would be supported by insurance products that closely link employees to primary care providers to incentivize prevention and manage chronic disease. Instead, insurers and business have been forced to shift costs to employees through high deductible health plans (HDHP).
HDHP may lead employees to avoid care until deductibles are met; then there seems to be a perverse incentive to use more services. It would be better to change the way care is provided to realize more value.
Like Medicare, employers can align their needs with healthcare systems that are paid to focus on value. Value refers to paying providers for better outcomes and lower total medical expenses through alternative payment methods (or APMs) rather than paying for each unit of service (FFS), which encourages higher utilization of potentially unnecessary services.
A health care system committed to lower TME can direct care to high-quality, lower cost facilities – for example, community hospital instead of academic medical center, physician office or urgent care center instead of emergency department. Under the right payment system, providers can routinely use strategies to increase employees’ time at work, e.g. telehealth and other services linked to employers’ needs.
Many of these services are not billable under FFS, but make sense under an APM. Atrius Health has a successful track record of assuming full risk for the total cost and experience of care while providing high-quality care to hundreds of thousands of patients by embracing these tactics. Our focus is on proactively addressing patients’ preventive needs, to avoid the need to treat avoidable acute. Employers can realize savings by incentivizing providers to offer effective prevention programs and to lower TME.
Employers should insist on insurance products with coordination of care through networks paid to increase value . Plans that encourage the use of value-based insurance products will lower TME. Most commercial plans are trying, but can make more progress. Working together, employers and health care providers can address rising health care costs while making greater Boston a healthier and more attractive place to work.
Steven Strongwater, MD is President & CEO of Atrius Health.