Provider Quality Counts in Choosing a Surgery Benefits Program

By Mark Stadler, President & CEO

With the high cost of healthcare to businesses and workers, employers must rein in runaway spending. But it’s just as critical to provide workers with the very best care money can buy. This is what value-based healthcare is all about: quality care for less.

Unfortunately, unwarranted variations in care are rampant, and provider quality is uneven in government and employer-sponsored health plans. Overuse and unnecessary care account for anywhere from one-third to one-half of all healthcare costs, amounting to hundreds of billions of misspent dollars.1 One in four Medicare beneficiaries admitted to a hospital suffers some form of harm during their stay.2 No employer wants its employee to choose a surgeon whose patients risk a one in four chance of subpar care. And subpar care can bring readmissions, ER visits and additional treatment — as well as absenteeism and presenteeism — costing hundreds of thousands of dollars. 

In the quest for quality care, businesses are turning to specialized benefit programs for planned surgeries. Employers can choose from several such programs, typically offered by benefit management firms.

But buyer beware. Provider care quality can be spotty. Most programs fail to use an objective, third-party ranking service to select providers for their networks. 

Here’s how a business can shop smart to offer surgical benefits alongside its managed care plan. Look for a program that works only with physicians and facilities rated for providing top-quality care in their surgical specialties. The program should identify these centers of excellence using the best third-party, objective quality measures, such as Comparion’s CareChex and Physician Quality Rating Analysis.

Quality care, as well as cost, should be the program’s top priority. The benefits firm behind the program should clearly demonstrate that it works with all stakeholders, including patients and strategic partners, to continuously improve planned surgery outcomes.

  1. Binder, Leah, “The Five Biggest Problems in Health Care Today,” Forbes, www.forbes.com/sites/leahbinder/2013/, Feb. 21, 2013. 
  2. Ibid.
Share this post