One of the most common things that we run into is the question: “Can plan members help to control plan costs?” and furthermore, is there a conflict of interest?
With most things, there is a fair amount of debate. But with this question, my answer is explicitly “yes”.
In fact, most plan members are really looking for help from their employer because after all, they provide the plan and they are the ones that tell me that I have an increased premium next year.
Suffice to say, our industry is pretty loaded with various cost control methods and the plan member doesn’t even realize the full extent of their premium cost (taken directly out of paycheck). An example of these cost saving mechanisms is the restrictions that carriers place on the doctor networks or prescription formulas that you have access to.
While carriers and third party groups work to keep costs down (they do this so that they can stay competitive, by the way), there are a huge number of things that people can do on an individual level. And when you take into account that most companies are a fairly large group, minimal behavior change starts to add up to serious money saved.
First and foremost, the idea of “care intelligence” is the most important thing you’ll hear this year (it’s my term, cut me some slack). Before I get into it, think about this – who cares more about your outcome than you? Simply put, by understanding the way that the medical system works, and your role in it, your outcomes are significantly better. It’s a simple equation: The less you know the longer it takes to get better. The more you know the quicker you get better. And care costs money. A lot of money.
Its not that doctors can’t do their jobs, or that they are money hungry corporate fat cats. They just can’t do all things for all people all the time. You just need to know how to help the doctor figure out which of the 1,000 reasons you’ve got that headache.
Ultimately, it comes down to your level of comfort with each step in your treatment. While I can’t tell you how to get the best care on the planet, all in one 500 word essay, I can tell you this:
You have more power than you think you do