Looking Out For You: How to be a Better Health Care Consumer

What is The Alliance? > Employer-owned, not-for-profit health care purchasing cooperative. > Freedom to choose from 63 hospitals and 10,365 professional service providers. > Creates resources to help you and your family become more informed about health care choices.

Today’s Goals Discussion >Increase your awareness of the safety and quality of our health care system and its impact on you. >Provide tools to help you become a wise health care consumer. >Help you maximize the effectiveness of each health care encounter. >Health Care Quality and Cost. >What You Can Do Today. >How to Make the Most of Each Health Care Visit.

What is Health Care Quality? >Doing the right thing >Doing it at the right time >Doing it the right way

Quality Problems >Underuse  Care that would benefit patients isn’t given. >Overuse  Care that is unnecessary or where the risks outweigh the benefits. >Misuse  Complications caused by patients who do not follow doctors’ orders & doctors who misdiagnose their patients. In doctors’ offices and clinics, adults receive only 55% of recommended care (preventative, acute and chronic)!

Cost In Perspective >Self Funding  The employer assumes the financial risk of providing health care benefits to employees.  The employer pays for employee medical claims out-of-pocket as they occur.

Share in Your Medical Decisions >Let your provider know that you want to be an active partner in your health care. >Do your own research:    >Ask why? >State your preferences. >Compare your expectations with those of your provider. >Accept responsibility.

Did you know? 8 out of 10 Internet users have searched online for information on at least one major health topic. That translates into about 95 Million American adults who use the Internet to obtain health information. * 2011 Pew Internet Project and California HealthCare Foundation

Ask Questions >3 Good Questions to Ask:  What is my main problem?  What do I need to do?  Why is it important for me to do this?

Bring a Friend or Family Member >A personal representative, or health advocate, can:  Get information and ask questions when you can’t.  Remind you about instructions and help you make decisions.  Find out who to go to if you are not getting the care you need.

Remember… >Let your doctor, nurse, or pharmacist know if you still don’t understand something. >You don’t need to feel rushed or embarrassed if you don’t understand something. >You can ask your doctor, nurse, or pharmacist a question as many times as you need to. >Be honest with your doctor, don’t tell them what you think they want to hear. Asking questions helps you understand how to stay well or get better!

Did you know? >A survey of 1,100 patients revealed…  68% of patients said that they would not inform their physician that they had failed to comply with a prescribed drug therapy.  83% said that they would never communicate with their physician that they did not plan on buying a prescribed drug.  1/3 of all hospital admissions are due to poor medical adherence. This equates to $300 Billion annually. *The Adherence Estimator, McHorney CA. Curr Med Res Opin, in PubMedMcHorney CA

Keep and Bring a List of All the Medicines You Take >Give your doctor and pharmacist a list of all the medicines you take, including non-prescription medicines.  This includes vitamins and herbal supplements. >Tell them about any allergies you may have. Medication errors are the most common type of medical error!

Did you know? The average doctor to patient interaction during an office visit is less than 10 minutes. Often clinics will schedule office visits as short as 8 minutes in a physician’s calendar to maximize the number of patients they will see in a day.

Making the Most of Each Visit -Before the Visit- Before you go, bring along all of the following information: >Current insurance card >Social Security number >Emergency contact information >Employer information >A referral or order, if required >Any previous x-rays, if requested >An interpreter, if needed

Making the Most of Each Visit -During the Visit- >State your main concern first. >Describe your symptoms. >Describe past experiences with the same concern. >Ask questions about things you don’t understand. >Take notes, even if you understand what is being said.

Making the Most of Each Visit -At the End of the Visit- >Am I to return for another visit? >Am I to phone in for test results or login online? >What side effects or concerns should I look for? >When do I need to follow up? >Anything else I need to know?

When You See a Specialist >Know the diagnosis or suspected diagnosis. >Learn about basic treatment options. >Make sure the specialist has all test results and records on your case. >Make sure you know why the tests are being done.  Ask: Are these tests necessary?  Don’t repeat tests!

If You Are Facing Surgery… >Most surgeries are not emergencies. >This means that you have time to make sure that this surgery is the best treatment for you. >Refer to the toolkit to see important questions you should ask if facing surgery.

QUALITY and COST vary in ways that affect your life and your wallet.

Putting Quality in Perspective Number of Americans who die each year from: >Accidents and Diseases:  Breast cancer: About 39,500  Motor vehicle accidents: About 43,000 >Quality and Safety:  Medical errors: About 98,000  Infections acquired while in the hospital: About 90,000 > 25 – 75% of these infections could be prevented

Cost Matters Too Cost varies:  You could pay more for the exact same type of care depending on which hospital you choose. What you pay is not related to the quality of your care.  High-quality care don’t always cost more.

QualityCounts Inpatient Hospital Report >Overall Care for Adults >Birthing Care >Major Surgery  Hip and Knee Surgery  Back and Neck Surgery >Overall Heart Care  Heart Surgery  Non-Surgical Heart Care  Balloon Angioplasty  Bypass Surgery  Heart Attack Care  Aortic Valve Replacement

QualityCounts™ Outpatient Procedures and Tests Report >Surgeries:  Removal of Adenoids  Adenoidectomy & Tonsillectomy  Arthroscopic Knee Surgery  Cataract Surgery  Laparoscopic Gallbladder Surgery  Laparoscopic Hernia Surgery  Ear Tube Insertion >Tests:  Bone Density Study  Cardiac Perfusion Scan  Colonoscopy  Upper Gastrointestinal (GI) Endoscopy >CT and MRIs  Abdominal & Pelvic CT with and without contrast  Brain MRI with and without contrast  Head or Brain CT  Lower Spine MRI  MRI Joint of Lower Extremity without Contrast  MRI Neck Spine without Contrast  Thorax CT with Contrast

Brain MRI (Dane County Example) Specialty MRI Center (Dane Co.) Dane Co. Hospital Total Average Cost$2,304$3,884 EE Deductible ($1000)$1,000 EE Coinsurance (10% to $250)$130$250 Total Employee Cost$1,130$1,250 Cost Difference to EE $120 Total Employer Cost$1,004$2,634 Cost Difference to ER$1,630

Laparoscopic Hernia Surgery (Dane County Example) Outpatient Surgery Center (Dane Co.) Dane Co. Hospital Total Average Cost$5,351$8,812 EE Deductible ($1,000)$1,000 EE Coinsurance (10% to $250)$250 Total Employee Cost$1,250 Cost Difference to EE $0 Total Employer Cost$4,101$7,562 Cost Difference to ER$3,461

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The single most important way you can help get safe, quality care while reducing your costs is to be an active participant in your health care!

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