Several recent articles in the Steamboat Pilot focused on the impact of rising health insurance costs on local residents and city and county governments. The relentless, spiraling cost of health care and insurance premiums bedevils the nation. The content of your articles illustrates a major reason.
The three entities that were discussed in some detail, Steamboat Springs School District, Routt County, and the city of Steamboat, are all self-insured. This means that they function as their own insurance companies, paying the portion of health costs they as employers are responsible for, absorbing whatever those costs might be. And, typically, those costs have been escalating.
The article goes on at length to describe what the various public employers are doing in response to the increasing cost of health insurance. All of the efforts described by those interviewed dealt with chasing cheaper insurance: changing insurance companies; adjusting benefits; raising employee deductibles and co-pays; etc.
There was no mention by any of the self-insured entities of efforts to reduce the costs of care for their employees. There was no recognition of an expanding body of data and experience showing health costs can be controlled and reduced by clinical strategies and programs that help people manage their health problems better, get well more quickly, prevent serious and costly complications -- all of which reduce how much health services get used, and, therefore, how much it costs.
Do any of these self-insured entities have relationships with clinicians and physicians to implement such programs? Since they are paying out huge sums, sometimes in the millions of dollars, in health claims, do they invest anything in clinical leadership or strategies, besides paying some firm to handle the claims?
Self-insured companies and agencies that are not conversant with the relationship between advanced care management programs or prevention programs, and the reduction in health costs, have become part of the national problem, not the solution. They are allowing costs to escalate without even recognizing that there is a broad consensus among clinical leaders nationally that the most powerful tool to reduce costs is to change the way care is provided to the sickest and most complex enrollees, not by eternally tinkering with benefit packages and co-pays.
Current discussions in the community, led by the Chamber of Commerce, to establish a health insurance program, run locally, and with significant attention to developing clinical programs and capacities to better manage illnesses and injuries, are meant to address the above described gap. But whether that effort is launched or not, those companies, governments and agencies that go the self-insured route need to become more conversant with contemporary thinking regarding health care and health costs. Endless shopping for less costly insurance packages is no longer adequate or appropriate, and certainly not state-of-the-art.
Dr. Bruce Amundson
President, Community Health Innovations Inc.