Key Drivers & Proven Antidotes
With poor plan design, more than half the workforce is one minor medical issue away from financial ruin. Wise plan design eliminates cost-sharing for smarter health care decisions. Enovation Controls, a Tulsa-based manufacturer, made smart decisions free (eliminating copays and deductibles when using high-value surgical hospitals) and bad decisions expensive (going to low-quality providers who have higher complication rates, poor outcomes, and overtreatment).
Progressive benefits programs weave non-opioid options into both clinical and non-clinical settings. A well-informed health plan document should include policies spelling out certain steps to be taken before and after administration of opioids – such as trying Physical Therapy for back pain – and also placing a time limit on how long an employee can be authorized to take the medication.
Value-based primary care organizations ensure clinicians receive education on – and have in place – viable, quantifiable treatment options that maximize value and come from unbiased sources. They also provide the time to explain to patients how non-opioid treatment options are more effective.
In a value-based primary care model, patients have the proper amount of time with their doctor. An increase in patient interaction time shuts down some of the on-ramp to opioids, whether it’s inappropriate opioid prescribing or unnecessary and excessive surgeries that are typically followed by opioid prescriptions.
Even when a physician appeals to an insurance company to approve treatments that may help the patient, several months or even years can go by, especially in worker’s compensation cases. By then, the patient may be on escalating doses of opioids just to function as a result of increased tolerance. Good plan design eliminates this market failure.
Behavioral health issues are particularly short-changed in the rushed, “drive-by” appointments that are all too common in volume-driven primary care. Evidence-based benefits plans ensure behavioral health is woven into primary care and isn’t an afterthought.
Evidence is mixed on whether patient satisfaction correlates with improved outcomes. Wise employers contract with health care organizations focused on other metrics—for example, the Net Promoter Score (NPS), a measure of customer likelihood to recommend a product or service and more likely aligned with holistic approaches focused on keeping people well.
Appropriate use of drug testing and regular checks of state prescription drug monitoring reports can help identify a substance use disorder and start the process to wellness earlier.