In the case of a self-funded health plan, TPAs can work with employers to put the very best cost containment tools in place – but without employee education, those efforts may not be overly effective.
Consider a member who was just told she needs hip replacement surgery. Maybe your health plan includes a medical advocacy program that will help her identify the most cost-effective (and high-quality) options for where to receive that procedure. But if this member isn’t aware of that employee benefit or doesn’t understand how it works or who to reach out to, she could easily choose the hospital that’s closest to home simply because it’s convenient. And what happens then? This hospital may not specialize in hip replacements, so getting the procedure done here vs. another facility just a few miles away could carry a huge price tag, both financially and in terms of patient outcomes!
Adding to that, what about alternative treatments? In the case of any elective procedure, plan members should know about their other, non-surgical options and have tools to help them through the decision-making process. Think of how costly it could be – both price- and healing-wise – if someone has a procedure that isn’t medically necessary or doesn’t fully address the problem.
Telemedicine is another example of how employers are trying to contain costs. If your workplace has recently implemented a program like this, have employees been made aware of the cost per consult or know what conditions they can use it for? Do they realize the advantages of connecting with a provider from home (or office) through a tele-consult versus walking in to an urgent care facility to receive treatment?
While TPAs work hard to help health plans implement the best cost-saving solutions out there, the only way to get the most value out of them is by educating employees and making them aware of how these tools can help. Health care is a bit of an anomaly in that it’s one area where consumers don’t always shop for the most cost-effective options or do their homework in comparing services.
If educated about the ways they can save though, people are much more likely to be proactive about seeking out the most cost-effective care.