1. How To Be A Better Health Care Consumer

2. What is The Alliance?
Employer-owned, not-for-profit health care purchasing cooperative.
Freedom to choose from more than 90 hospitals and 18,300 professional service providers.
Creates resources to help you and your family become more informed about health care choices.

3. Today’s Goals
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 better educated health care consumer
Help you maximize the effectiveness of each health care appointment
Here’s the goals of today’s presentation …

4. What is Health Care Quality?
Doing the right thing
Doing it at the right time
Doing it the right way
First, there is the question of what exactly is health care quality? Although we know much more about health care quality today than we did ten years ago, the concept is still difficult to define.
To achieve the best possible results, health care quality is:
Doing the right thing
At the right time
In the right way
This can involve getting the medicine, tests and counseling you need, when you need it, and with your health care providers using the appropriate tests or procedures.

5. Quality Problems Underuse Overuse Misuse
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.
There are three health care quality problems: underuse, overuse and misuse.
Underuse is when care that would benefit patients isn’t given – a great example is the use of Beta Blockers, a type of medication for patients who have had heart attacks. Heart attack patients who take beta blockers reduce their risk of death by 25%. This is clearly an effective medication, but according to recent studies, only 25-40% of patients receive it.
Overuse is care that is unnecessary or where the risks outweigh the benefits. As an example, 21% of antibiotic prescriptions are written for viral infections; but antibiotics are ineffective against viruses. That amounts to 50 million prescriptions for children alone! In addition to the wasted cost, there is another impact of this form of overuse. We are creating antibiotic-resistant strains of bacteria. We now face the real public health risk of developing bacteria against which no antibiotics are effective.
There are also lots of health issues and complications caused by patients who do not follow doctors’ orders—for instance, not taking all of their prescriptions, diabetics not following their diet, etc. These also complicate the system and make health care more expensive. Over 50% of prescriptions are taken incorrectly or not at all according to a 2011 study by Consumer Reports.
Problems don’t solely exist in hospital settings. One study suggests that, in the United States, adults receive only 55% of recommended care while in the doctors office or clinic.
McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(: PMID

6. 30% of health care is not necessary
Check out the Avoiding Unnecessary Care page on our website
Hard decisions about cancer
5 tests and treatments to question
Using caution when taking antibiotics
Deciding when you need a test
Info on 19 common health tests (e.g. allergies, colonoscopy, imaging tests, bone-density, etc.)
30% of health care is not necessary. Source: Institute of Medicine. The Healthcare Imperative: Lowering Costs and Improving Outcomes-Workshop Summer Series Summary February National Academy of Science Press.
Choosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations about the overuse of health care services and help patients make smart and effective care choices. Specialty societies and Consumer Reports have joined the campaign to provide these patient-friendly resources.
Hard decisions about cancer: 5 tests and treatments to question … This was Consumer Reports’ most-read article.
Antibiotics … Due to the overuse of antibiotics, drug-resistant infections have risen. “Resistant bacteria cause infections that are harder to cure and more costly to treat.” “Drug-resistant infections kill at least 23,000 children and adults in the U.S. every year.”

7. 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.
Your employer self-funds the medical plan offered to employees.  A self-funded plan is one where the employer assumes the financial risk of providing health care benefits to its employees.  Essentially, your employer acts as the insurer by paying for medical claims out-of-pocket as they occur instead of paying a pre-determined premium to an insurance carrier.  

8. 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.
There are some things you can do today to get safer, better health care.
Sharing in medical decisions is a very important part of the patient/provider relationship. Most importantly, let your provider know that you want to be an active partner in your care and you will be aiding in decisions regarding your health.
Do your own research. Ask your provider if there are any websites or other information available pertaining to your disease or illness. Have a healthy skepticism of providers.
Ask, “Why?” If a medical test, medication, or treatment is suggested, there are various questions to be asked as you see in your toolkits.
State your preferences. You can tell your provider which option you prefer based on your desires and values. You need to feel comfortable with the decisions that are made pertaining to your care.
Compare your expectations with those of your provider. Talk about your recovery period. You may have a completely different expectation for your recovery time period than your physician may have. Make sure that you and your physician understand each other’s expectations for your illness, prognosis, and recovery.
Finally, accept responsibility for your health care. If you share in the decision-making process, both you and your provider must take responsibility for the outcomes.

9. Five Questions to Ask Your Doctor
Free wallet cards are available
You can enhance the quality, safety, and effectiveness of your health care by asking questions about your care, your diagnosis, your treatment, and the medications prescribed to you.
The answers you get can help you make better decisions, receive a higher level of care, reduce medical mistakes, and feel better about your health care.
You can ask questions when:
You see your doctor, nurse, or pharmacist
You prepare for a medical test
You get your medicine
These cards are from ConsumerReports and Choosing Wisely
[Wallet cards are in a box next to the Marketing Flyers]

10. 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.
When you consult with a medical provider, it is highly recommended that you bring a friend or family member along with you. This person is referred to as a health advocate.
An advocate can help tremendously with your care. They can get information and ask questions for you when you can’t, they can remind you about instructions and help you make decisions, and they can find out who to go to if you are not getting the care you need.
Health advocates aren’t able to make decisions for you unless they are your legal guardian or you have given them that responsibility by signing a legal document, such as a health care power of attorney.

11. Asking questions helps you understand how to stay well or get better!
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.
Let your doctor, nurse, or pharmacist know if you still don't understand what you need to do. You might say, "This is new to me. Will you please explain that to me one more time?"
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. You are not alone if you find things confusing at times.
Asking questions will help you understand how to stay well or get better.
Asking questions helps you understand how to stay well or get better!

12. 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.
Give your doctor and pharmacist a list of all the medicines that you take, including non-prescription medicines, such as over-the-counter drugs, vitamins, and herbal supplements. Tell them about any drug allergies you have and ask about side effects and what to avoid while taking the medicine.
Page 4 in the toolkit offers places where you can keep track of your medicine and show you what type of information you should include, such as the dose and how often you take it.
Medication errors are the biggest source of medical errors – keeping a list of your medications will help ensure that your doctor doesn’t prescribe something that will react with another medicine you’re taking.
Medication errors are the most common type of medical error!

13. Medication Checklist Review your medications
Ask about medications that you were already taking.
Bring up cost.
Make sure you can read new prescriptions.
Fill your prescriptions promptly.
Review your drugs with your primary care physician.
Keep an up-to-date drug list.

14. Best Drugs For Less Free copies available
64 pages of science-based comparative drug info
Questions to ask your doctor when starting a new drug
Info on generic prescriptions
8 ways to save big on your medication
What over-the-counter drug labels really mean
Searching for more information on generic drugs?
See page 6 of your workbook.

15. Where Should I Go?
When you’re sick or injured, knowing where to go to seek care can make a big difference
… in how long you have to wait.
… in how much you spend to feel better.
Point out the chart on page 2.
Explain the differences between when to go to: the doctor’s office, Urgent Care/Immediate Care, or Emergency Room. Include telemedicine and/or onsite clinic options if employer’s plan has these options.
Check out our Health Care Needs Guide on page 2 of your workbook for options and information.

16. 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
Now let’s specifically talk about office visits --- a place where you can make a
difference….
Before a visit, you should consult a self-care book.
Please look at page 4 of the Toolkit. Here is a list of information that you will definitely need before going to your provider (read bullets).
For instance, you will need current registration information (medical ID card), a list of medications you take, types of allergies you have, and your family medical history.
This information is broken out on this check-list. Use this as a working document, changing it as your health history changes. Keep this document in your purse or wallet, where it will be handy at any time the information may be necessary. Make copies of this page for future use.

17. 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
Now, you have prepared for your visit and have finally arrived at your provider’s office. Page 3 in the workbook includes the information you should share with your provider.
First, state your main concern and describe your symptoms. Share with your physician if you have had any past experience with these or similar symptoms.
Discuss any medication you have used in the past, its effectiveness (Does it work for you?), as well as any side effects you may have experienced. Please share with your provider all of the information or knowledge that you have in regard to your illness and current state of health.
Never be afraid to “bother” your provider with details, even if you feel they may be unimportant or unrelated. For example, a patient may present a headache as the main concern. This patient may also have a rash on his leg, but he hesitates to share this with his provider because he feels the rash has nothing to do with the headache. It may. The rash may be a secondary effect from an illness and may assist with a diagnosis, or it may be a side effect from the medication that the patient is taking. Be sure that you share all information with your provider.
Finally take notes during the visit, even if you understand what is being said. It’s difficult to keep track of all the information you receive during a medical visit. Taking notes will allow you to refer back to them at a later point, when you have more time to process what was being said or see what you have to do in order to get better.

18. 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?
Page 3 in your workbook also shows some questions you may need to ask your provider at the end of your visit.
If the physician has not already communicated the information, you may ask when you need to return for another visit and how you will be informed of any test results.
Many physicians have different methods of communicating test results; some may communicate via return visit, telephone or letter, or some may assume that “no news is good news.” It would be very frustrating for a patient to expect a phone call relating test results, waiting for days with no contact, only to discover that your provider only contacts the patient with adverse test results.
Before leaving your provider’s office, make sure that you are both “on the same page” and that each understands the expectations of the other.
Also question the provider about side effects or symptoms that may cause concern. Who should you contact with concerns and how (after hrs)? Does the provider have a contact telephone number for you or should you go to the ER/WIC? When do you need to follow up? Is there anything else you need to know?
If you get home and have additional questions, do not hesitate to contact your Provider. Keep asking until you get the answers you need.

19. 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!
On page 4, you’ll see tips on what to do if you are referred to a specialist.
In addition to what we have already discussed, such as bringing a list of medications and a friend or family member to your visit, there are some things you should know when seeing a specialist.
First, know the diagnosis or suspected diagnosis.
Learn about your basic treatment options.
Make sure that any test results or records on your case are sent to the specialist.
Know why the tests are being done. Sometimes, tests are not required and may be optional. If the test is not essential, it may reduce medical costs if you decide not to have it done.
Also, make sure no tests are repeated. You may have seen other providers before the specialist who have already performed a required test. This is why it is so important to send any results to your specialist so you don’t end up paying for the same test twice.

20. 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 for important questions you should ask if facing surgery.
If you are facing surgery, most operations are not emergencies and are considered elective surgery. This means that you have time to learn about your operation to be sure it is the best treatment for you. You also have time to work with your surgeon to make the surgery as safe as possible.
Page 5 in the workbook offers some questions to ask your provider when you are told that you need surgery and questions that weigh the risks and benefits of having a surgery. Thoroughly consider the risks and the benefits. To choose the best anesthetic (regional, general, spinal, or local), speak with the anesthesiologist. During your pre-operative visit, you will have a chance to meet the anesthesiologist and discuss your expectations and risks in order to determine what will be most appropriate to meet your needs.
You may also want to find another surgeon to get a second opinion, to confirm if surgery is the right treatment for you. You might want to ask friends or coworkers for the names of surgeons they have used. Make sure all pertinent medical records are available for the second opinion.

21. Cost Matters 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 doesn’t necessarily cost more.
Sometimes high-quality care is less expensive.
Sometimes low-quality care is the most expensive.

22. 41 miles in 53 minutes = $2,260 difference
Arthroscopic Knee Surgery for Torn Cartilage Examples From The Alliance Market
Janesville and Beloit
Fort Atkinson and Madison
Madison and Madison
The same kinds of price differences exist for many different kinds of procedures.
Here’s some examples …
Yellow = Meriter Hospital 202 S. Park St. ($11,900) vs. Dean Medical Center/St. Mary’s 700 S. Park St. ($8,340)
Blue = Columbus Community Hospital ($7,260) vs. Sauk Prairie Hospital ($9,520)
Purple = Janesville St. Mary’s Hospital ($11,020) vs. Beloit Memorial Hospital ($16,020)
.25 miles = $3,560 difference
41 miles in 53 minutes = $2,260 difference
11 miles in 17 minutes = $5,000 difference
Source: FindADoctor.the-alliance.org accessed 12/14/2017; Source for Distance and Time:

23. Know The costs. Compare the quality. Skip the surprises.
Click on the Find a Doctor button:

24. 3 Ways to Spend Less and Find Quality Care
#1 Save by Staying In-Network
All searches on Find a Doctor show only in-network providers.
#2 Check the Cost
Login to Find a Doctor to access the estimated costs of more than 50 procedures. For additional procedures or locations, contact Customer Service at or
#3 Look for the Symbols
Facility Fees
Hospital Safety Score
Primary care performance rating
Hospital birthing care rating
More Information
Best Price Tier
Find a Doctor is more than just a listing of providers.
[Read through slide as noted on screen.]
If employer will allow, ask attendees to “Write down your name and address” and put it in the box to subscribe to our Better Health Care Consumer Bulletin. You’ll be entered into a drawing for a chance to win a $25 VISA gift card.” There is a note about the BHCC Bulletin in the lower right-hand corner of the “3 Ways to Find a Doctor flyer,” point this out.
[Bring paper, box, gift card. Give entries to Lisa for inclusion on the BHCC list.]

25. 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!

26. Questions?
Call Customer Service at The Alliance Monday through Friday 8:30 a.m. – 4:30 p.m. Or
If the employer will allow ….
Collect names and addresses to subscribe employees to the Better Health Care Consumer Bulletin.