Ask anyone, healthcare is too confusing. Let’s take a simple example: physical examinations. The Affordable Care Act (ACA) made the bold change of mandating free physicals. But are they truly free?

Viewpoints from Craig Hasday

First, the problem of colonoscopies. A colonoscopy is covered as a preventive service unless, of course, there is an abnormality. If the doctor finds and removes a polyp, that preventive service becomes an expensive procedure (particularly with a high deductible plan), not that there is much additional work involved. Okay, maybe the polyp biopsy adds some additional cost but not that much. Secondly, I was told recently by my new health plan third-party administrator (TPA) that an electrocardiogram (EKG) performed as part of a routine exam, would not be covered. Their explanation: it is diagnostic and not preventive. It was only $75, so I didn’t fight too hard – however, I couldn’t intellectually understand this. After all, isn’t everything about a preventive exam diagnostic? Aren’t the tests intended to find an abnormality? So, I called around and found that about half of the insurers in my informal survey agreed – EKGs should be covered. Finally, last week, I discovered that my plan covered a flu vaccine at a pharmacy but didn’t cover the administration of the vaccine. To get that covered, I had to go to a doctor’s office. That one was too stupid for words and I had the plan amended to cover the administration as well as the vaccine at the pharmacy. All this for simple preventive services.

So what if things get more complex?

No wonder there is waste in the system and additional costs – because needed preventive tests are avoided.

Traditional insurers are working hard to simplify care access but other major players in the healthcare ecosystem are not lying idle.

Walmart will roll out a trial platform that hooks up a patient to a primary care doctor. In Colorado, Wisconsin and Minnesota the trial introduces telemedicine at $4 an appointment, while locations in North and South Carolina will test out a healthcare concierge that will help with billing and even appointments. Central to this model is helping patients choose the most efficient doctor for their specific medical condition at the time they most need it. This makes sense. The conventional way of pushing people to an online directory requires savvy access to technology and is not condition-specific – all this at a very stressful moment when care is needed.

Humana has paired up with Microsoft in a seven-year deal to make medical records for Medicare patients more available in order to view employees’ health more holistically. So, for example, a treating provider might see that their patient has not gotten a flu shot or is overdue for a tetanus booster. Microsoft is also pairing with Walgreen to connect the records in all their clinics, aimed to create stickiness and make visits more meaningful.

Apple with its device care integration and even Best Buy, the electronics store, with its new focus on medical devices are also making inroads. Healthcare is, after all, almost 20% of the economy.

Simplifying care is part of the key to getting costs under control and reducing system stress.

CraigHasday-ContactTile
Craig Hasday

President, National Employee Benefits Practice