If employers arent at the table where healthcare reform is being hashed out, theyll be on the menu. That was the message at the 12th annual National Business Coalition on Health conference, held in picturesque Scottsdale, Ariz.
Mark Smith, chief executive officer of the California HealthCare Foundation, and other speakers said employers need to get off the sidelines and use their purchasing power to make change or they will continue to get stuck paying rising premiums.
The people who pay the bills have to understand that its not about cost, its about value, said Mark Fendrick, co-director of the University of Michigan Center for Value-Based Insurance Design.
Fendrick and others pushed the idea that lower costs dont necessarily equal savings, but value does. When did cheap become good? he asked the audience.
Why pay a nurse $65 an hour to tell a person to take a drug that person wants to take but wont because he cant afford the copayment? Fendrick said this type of waste drives employers crazy, and can push them to intervene to make change, he said.
But employers still arent as involved in healthcare as they should be, said Andrew Webber, president and CEO of the National Business Coalition on Health, the conference host. The group is a not-for-profit organization of nearly 70 employer-based healthcare coalitions nationwide that seek to provide employers with tools to become more savvy purchasers of healthcare. The regional coalitions represent more than 7,000 employers and 34 million workers and their dependents nationwide.
Its been very hard to get the level of engagement, Webber said in an interview. This is an area where employers really do need to come together.
One employer at the table is Hannaford Bros. Co., the largest supermarket chain in the Northeast. Hannaford, based in Scarborough, Maine, pushed for changes in surgical standard practice in Maine hospitals toward less-invasive techniques. Because minimally invasive surgery for hysterectomies, appendectomies and gastric bypass can shorten the length of hospital stay, reduce complications and speed up return to work, Hannaford wanted to make these procedures more available to its workers.
For every medical dollar saved, we could save two to three dollars in absenteeism and productivity, said Peter Hayes, director of associate health and wellness at Hannaford.
Hannaford worked with Eastern Maine Healthcare Systems, based in Brewer, on the project. Surgeons at the systems 337-bed Eastern Maine Medical Center in Bangor now use minimally invasive surgery as the default for hysterectomies and a number of other procedures, said Erik Steele, the systems chief medical officer.
Steele suggested that employers bypass health plans and instead work directly with local hospitals to implement such programs.
Weve got to stop nibbling around the edges, Steele said. Pick a project where you save money and we (providers) dont lose our shirts.
Providers have an incentive, too. Hannaford employees are going to Singapore unless I figure this out, Steele said.
He wasnt kidding. Hannaford pays all expenses and time off to employees who choose to have certain medical procedures done in Singapore instead of New England. The company says the quality of a knee or hip replacement in Singapore is the same or better for a quarter of the cost, and workers are signing up.
The level of distrust between insurers, employers and providers is high, and Hannafords approach of working with Maines hospitals could help remove barriers to change, Webber said.
I love that message, Webber said. Its time we talk directly to providers of care.
Close to 500 peoplerepresenting insurers, business groups, employers and providersattended this years conference, up about 100 attendees from last year. The Westin Kierland Resort and Spa, with its desert climate, rolling hills, enticing golf course and fire pits at dusk, may have helped.
Its the venue, stupid. Its Arizona in November, Webber said opening Mondays session. But we cant afford it anymore. We wont be back.
Next year, the NBCH will convene in Washington, just one week after the 2008 presidential election, where members will be sure to be at the table.