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Milk Shake

Who’s Drinking Your Milkshake?

“How many businesses do you know that want to cut their revenues in half?  That’s why the health care industry won’t fix the health care industry.” – Rick Scott, Governor of Florida and formerly the CEO of Fortune 100 HCA (Hospital Corporation of America)

Sounds about right doesn’t it?

Think about the players in the health care industry.

You have hospitals, doctors, pharmaceuticals and insurance companies, brokers, PPO Networks and Pharmacy Benefit Managers. Who of these would be financially motivated to assist in decreasing your plan costs?  Even many brokers are compensated purely commissions tied to premiums.  No player listed here is rewarded for reducing your costs.

The Open Solution™ is a partially self-funded health plan (combined with other cost-containment steps) that is the perfect agent to effect change and seize control of spending.  What a plan sponsor must do is embrace this simple solution, which is to move toward paying for medical goods and services in the same manner that they buy everything else – with transparency and upfront knowledge of cost.

It is common practice for many American health plans to pay medical claims based on a percent off billed charges.  But ask yourself…a percent off what charges?  Are those charges even yours?  Did you even receive the services they are charging you for?  Do those charges even make sense?

Now consider an even more troubling reality.  What if the billed charge of the single largest item within the treatment you had was $7,200 for a CT Scan? And what if publicly available information revealed proof positive that Medicare would pay $225 for that CT Scan? Of what true value is the discount?

Insurance companies and preferred Provider Organizations (PPOs) commonly enter into contracts with “no audit” and “no notice of a change in payment terms” provisions.  Many contracts don’t even allow challenges.

A clear-eyed look in the mirror would force any employer to contemplate:

  • What manager, in any business, in any industry, would pay any other type of vendor bill, in this manner?
  • If that manager did pay such a bill in this manner, how much longer would he have a job?
  • If you are tired of waiting on industry or government help, then keep in mind this quote by Dr. James Robinson, professor of health policy at the University of California, Berkeley, “The only way to pay less for health care is to pay less for health care.”

Ready to start paying less?  Click here to access our Financial Analysis to estimate the potential savings you could have when switching to The Open Solution™.