Health Rosetta

The blueprint for 21st century health benefits.

Results of implementing the Health Rosetta

20-40% lower costs

Organizations that implement elements of the Health Rosetta sustainably outperform the status quo. Better benefits too, like no deductibles on major procedures and unlimited free primary care.

Better outcomes

They're not just cutting costs though. They provide better benefits that keep people healthy and get the best care possible when it's needed.

Better experiences

Patients, caregivers, family members, doctors, nurses all tend to be far happier and more satisfied with Health Rosetta-based benefits than the status quo.

Based on real life experience

No theory. We created it by studying the highest performing health benefits purchasers. It's built on their successes, letting others stand on the shoulders of giants.

Can be incrementally implemented

It encompasses 18 separate elements we've surfaced from the purchasers we've studied. It can can be implemented over time or all at once.

Independent Support

We're building the ecosystem of people, products, best practices, and blueprints necessary to implement it.

18 Elements of the Health Rosetta

Most organizations strategically pair elements to maximize impact.
However, most can be implemented individually.

1. Transparent Medical Markets

Wildly variant, opaque pricing for items such as scans, surgeries and other medical services. If there is any price/quality correlation, it’s inversely correlated. Sometimes “transparency” solutions are available giving the best, bad deal while still having co-pays, deductibles, the oxymoronic "Explanation of Benefits", etc. and all the other things that make for a horrible consumer experience.

The good news is there is a solution to the most vexing problem healthcare has had -- pricing failure.

  • Fair, fully transparent price to employer/individual at high quality centers who readily accept quality reporting such as Leapfrog.
  • Providers able to set a price that works for them while avoiding claims/collections hassles and accompanying receivables.
  • No charge for individual going to these providers. No EOBs, bills, etc. -- just a thank you note.

2. Concierge Style Employee Customer Service

Employees left to navigate an extremely silo’ed and uncoordinated healthcare system receiving conflicting and often non-evidence based recommendations.

Having resources to help you navigate the system that can draw on expertise for quality and cost including understanding benefits plans, best provider options, etc.

3. Value-based Primary Care

  • Flawed reimbursement incentives have turned primary care into “loss leaders” that are like milk in the back of the grocery store (i.e., low margin designed to get people to high margin items)
  • Short appointments due to not investing properly in primary care
  • Primary care shortage due to making primary care discipline unappealing
  • Long wait times to get in can lead to small “fires” blowing up
  • Medically unnecessary face-to-face appointments clog the waiting room and delay care for people who truly need face-to-face encounters
  • Record levels of dissatisfaction & burnout amongst PCPs
  • High Net Promoter Scores
  • Quadruple Aim leading organizations
  • Ounce of prevention is worth a pound of cure
  • Same or next day appointments for issues not addressed via email/phone
  • Extensivist (for the sickest patients) has smaller panel allowing proactive care management & coordination.
  • Can reduce issues 40-90% and spending 20-50%

4. Access to World Class Acute Care for Complex, Expensive Procedures

6% of employees at large organizations typically account for 80% of medical costs.
  • Quality and prices vary widely
  • Studies find 40% of transplants are medically unnecessary
  • High rates of complications at community hospitals who don’t do high volumes of complex procedures

Due to the infrequency of these procedures (transplants, neurological procedures, cardiac, spine and other six-figure or more procedures), the Transparent Medical Network is a good tool to pair with this since those procedures happen more frequently. It raises the visibility and understanding how there is wide variance in value between different provider options.

  • Second opinions at no charge for employee at world class Centers of Excellence facilities (e.g., Mayo & Cleveland clinics)
  • Unit cost often higher but lower complication rates & avoidance of unnecessary procedures makes it have a strong ROI.

5. Aging & End-of-Life

  • Individuals and families left to fend for themselves at the most stressful moment in their lives.
  • Healthcare delivery systems and community goals not in sync

6. Retirement Healthcare Costs

With pensions mostly gone, a very low percentage of Americans have healthcare savings for living or healthcare costs (estimated at $300k per household not covered by Medicare).

By avoiding wasted costs, companies are able to fund HSAs (triple tax benefit) and more broadly fund 401k matching funds.

7. Quality/Safety Embedded in Provider Network

  • Varied participation in 3rd party safety reporting such as Leapfrog
  • Culture of shame/secrecy when errors are made

8. Active ERISA Plan Management

  • Many ERISA plans have “holes” that expose employers unnecessarily
  • Pay for high cost ASO networks
  • Fully-compliant ERISA plans that protect companies from abuse
  • ERISA fiduciary oversight and review at least as strong as 401k oversight and management
  • Use TPA networks focused on high quality providers and geographic coverage

9. Actionable Analytics

Everybody produces data but very few produce actionable information.

Focus on data ==> information ==> knowledge ==> wisdom Example: MyHealth Access Network (an HIE in Oklahoma) can provide analytics offering advanced decision-support tools such as Archimedes IndiGO. This tool integrates dozens of health/disease determinants to provide previously unavailable treatment guidance based on medical evidence.

10. Value-Based Plan Design

Blunt-instrument High-deductible Health Plans  that lead to unmanaged chronic disease that leads to expensive medical blow-ups.

  • Designed to encourage appropriate health-seeking behavior and avoid over treatment & lower value providers.
  • Strategic use of copay reductions or waivers, premium reductions, and health saving contributions.
  • Leading employers recognize not all incentives are financial — e.g., convenient, no cost primary care

11. Direct Resources to Evidence Based Tools

  • Minimum of 30% of care not evidence based
  • Only about half of that care for which good medical evidence based guidelines exists is actually rendered according to guidelines
  • Massive overuse of imaging (e.g., 80M CT scans/yr in US)
  • Codifying Choosing Wisely & Consumer Reports recommendations
  • Designing EHR systems to provide point-of-care evidence-based decision support: important information must find the physician at decision time rather than the physician needing to find that information.

12. In-Depth Pharmacy Management Woven into Primary Care

  • Pharmacists represent another medical silo frequently uncoordinated from rest of system
  • Frequent duplicative & conflicting prescriptions
  • Adherence issues due to cost, complexity and lack of understanding
  • Pharmacy woven tightly into primary care
  • Patients and caregivers educated on need for particularly drugs and reasoning behind prescription regimens

13. Disease Specific Care Pathways

Disease-specific pathways not codified into many EHRs and responsibility for execution not always assigned.

Creation of specific roles assigned to flight control over patients on pathways (care guidance nurses, health coaches, practice enhancement personnel).

14. EHR Technology

  • Most EHRs are designed around the need for documentation & billing accuracy, and are obtrusive to the clinical visit. Perverse payment incentives trump clinical efficacy.
  • More personal health records have been accessed by hackers than have been made easily available to patients themselves
  • Modern EHRs provide physicians with robust real-time decision support and deliver the interoperability to deliver the value of health information exchanges
  • Secure, easy and open access to one’s own health records will be made as available as other sensitive data such as financial records

15. Community-Based Health Initiatives

Despite being major cost drivers for the corporation, they have little to no involvement in these initiatives. (Note: Only 20% of health outcomes are determined by clinical care).

Employer/union coalitions leverage their reach & spending impact. Coalitions support programs such as Blue Zones to make it easier to have strong well-being in the community.

16. Health Information Exchanges

  • Currently an aggregator of clinical, hospital, imaging and laboratory data including admission, discharge and transfer
  • Users generally must actively fetch data
  • Sequestration of health information at provider or system level may inhibit consumers from seeking care from independent providers providing higher quality and service at lower cost
  • HIE data tightly integrated into individual EHRs to present a global view of patient.
  • Actionable and critical data in HIE must be pushed to those providers able to act on those data. HIE data on diagnosis and medications pushed to first-responders in the field.
  • Analytics capabilities sit atop data repository to provide unique Big Data reports
  • Employers and public health have access to de-identified Big Data to guide planning, regulatory and purchase decisions.
  • Availability of information through HIE allows consumers to seek care based on value without fear of missing information or care coordination failure

17. Coordinated Care

Care may be fragmented in two situations leading to preventable errors:

  1. When a person is receiving care from two providers, especially when that care exists in different places at different times and
  2. During transitions of care when one provider takes over from another.

Examples include a patient seeing several specialists as well as a primary care physician; A patient transitioning from hospital to home, hospital to skilled nursing facility or to a hospital offering a higher level of care.

  • Providers coordinate care by asynchronous communication facilitated by electronic health record systems, either by sharing the same system or through a health information exchange
  • Providers utilize HIE for direct, secure communications between primary care and specialty care, such as Doc2Doc, which can reduce unnecessary in-person consultations
  • Provider provide warm handoffs during transition of care, up to and including POTS dialog when appropriate. Providers commit to thorough and timely documentation, especially for discharge and transfer summaries.
  • Providers and specialists develop treatment compacts that avoid duplicative testing and treatment or conflict

18. Wellness Initiatives

Wellness often purveyed by independent entities not aligned with primary care and rarely focusing on at-risk populations.

An intermediate level of care between ordinary wellness and conventional preventive care: Alignment between wellness and primary care to focus on that portion of population that is well but at increased risk for common diseases such as diabetes. With many specious ROI claims in the Wellness field, independent and credible third-party validation should be part of their program (e.g., Validation Institute).