How are employers and providers collaborating in the new health and care experience in surgery?  - MedCity News

As employers seek to manage healthcare costs, they are increasingly working with healthcare providers to deliver a new surgical care experience. New digital health companies can help them identify programs to reduce the cost of care by identifying where expensive surgical interventions are needed. But employers are also consulting with providers and leading provider organizations that can provide a new type of healthcare experience that can improve employees’ overall quality of life and reduce costs, absenteeism, patient financial stress, and more.

Dr. Kathryn McLean is the Chief Medical Officer at Hospital for Special Surgery (HSS) based in New York City. This role is also part of a broader trend among healthcare providers. Similar to how it works with regional employers, HSS is partnering with Transcarent to help employer clients help their employees navigate surgery options to achieve the best outcomes.

“Basically, my job is to make sure that HSS provides the highest quality care in the most cost-effective way,” McLean said. “When considering the cost-effectiveness of a provider, you have to ask the question, ‘What is the impact of the care provided by a hospital or health system in terms of the total cost of care?’

To illustrate his point, McLean offered a scenario where two hospitals charge the same amount of money for a procedure. One of the hospitals has a much higher complication rate than the other, which raises the overall cost of care. So employers will be directed to the hospital with a lower complication rate.

In addition, HSS also evaluates patient outcome measures such as quality of life before and after the procedure to determine if their patients are actually improving.

Another component that is more difficult to measure is avoiding unnecessary tests or imaging that can increase costs, and especially avoiding unnecessary surgical procedures. This may seem counterintuitive for a hospital with surgery in its name. But as MacLean explains, providers spend a lot of time reviewing whether the procedures will offer better results than a less invasive approach.

“We spend a lot of time measuring whether the procedures being performed at our hospital are appropriate and understanding the impact on both patient outcomes and the overall cost of care,” McLean said. “The majority of patients with HSS receive nonsurgical treatment.”

She noted that data from some studies show that many patients receive unnecessary surgical procedures because there are doctors who will provide them, whether it is best practice or not.

“As a center recognized for its expertise in orthopedics, many patients who have been advised elsewhere that they should undergo an orthopedic procedure come to HSS seeking a second opinion,” McLean said. “About a quarter of these patients are advised by an HSS surgeon that non-surgical care is the best option.”

Spine surgery tends to have the highest complication rate among musculoskeletal (MSK) procedures, so it is a motivating factor to explore less invasive alternatives such as physical therapy. For example, MacLean notes that there are some conditions, such as lower back pain, that can benefit from therapy before they become chronic conditions. Although some states require patients to be referred to a physical therapist by a primary care physician, in others, such as New York, those appointments can be made directly with a PT—in person or virtually. HSS has its own team of physiotherapists, some of whom may be the first point of contact for patients rather than a surgeon.

So how does HSS work with Transcarent?

As part of the collaboration, self-insured employer beneficiaries will have access to HSS’s world-leading orthopedics and MSK specialists. Transcarent will service all member referrals, facilitate travel and cover the cost of certain orthopedic surgeries. Transcarent will also provide access to HSS’s new virtual care programs.

“At a high level, we’re working very closely with Transcarent to really think about how we measure, produce and promote high-value musculoskeletal care,” McLean said. “As part of our ongoing discussions, we are sorting out ways to identify patients with musculoskeletal problems and get them to the right practitioner or the right clinician for that problem, rather than sending them straight to the surgeon.”

Along with access to a leading surgical care experience, Transcarent provides 24/7 personalized health and care support through the use of Health Guides for virtually all of the most common and challenging needs. Among these essential services are urgent care, lower-cost drugs, personalized behavioral health care, home care, cancer treatment and expert second opinions.

“Leading employers remain dissatisfied with the access to, quality and cost of our healthcare system, particularly the surgical experience for their employees and their families,” said Glenn Tullman, CEO of Transcarent. “HSS has long been a recognized leader in the orthopedic care industry and we are excited to partner with them to bring Transparent surgery care experience for people across the country who need high-quality, affordable care.”

The social isolation of the pandemic has helped draw attention to the need for more accessible and widely available behavioral health resources for employers. The use of virtual care helps address this demand, especially in areas with relatively few therapists or where demand cannot meet supply.

Courtney Blondino, senior associate, Total Health Management at Mercer, described what she’s seeing in terms of market trends.

“I know we’ve had some analytics showing that we’ve seen a spike in behavioral health via telemedicine in 2020 and 2021. But what we’ve also seen, at least at the end of 2021, is that those numbers aren’t actually going down . We see that people certainly use their virtual behavioral health consultations, but we also see that they are actually very beneficial to the employee. If they work from home, they continue to work in counseling sessions in the comfort of their own home; they don’t have to leave in the middle of work to get that support. This actually increases access. So employers think about it too.

Blondino said that depending on the client and the decisions, employers tend to review two to five behavioral health providers. If an employer is interested in replacing their employee assistance program, then Mercer works with employers to focus on which vendors and suppliers will support employers’ current needs and the gaps they would like to fill. Mercer then provides recommendations on who might be the best fit.

Collaborative relationships between providers and health technology providers to optimize and deliver effective treatment and desired patient outcomes that meet the needs of employers and employees is the new paradigm for healthcare. Surgery and behavioral health are just a few areas that have a significant impact on both employee quality of life and employer budgets. The ability for employers to have an informed understanding of how they can get the best patient outcomes for their workforce and ensure that employers meet their budget needs will make a big difference in companies’ ability to hire the best staff. to remain competitive.

picture: stefanamer, Getty Images

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