Workday, SAP and Oracle have the power to lower the cost of individual healthcare

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When premiums for individual health insurance reach the level of a mortgage, something’s got to give. Yet, that’s happening now, with premiums expected to grow higher in 2018. And the middle class are being hit the hardest.

Ricardo Alonso-Zaldivar reports on the plight of “early retirees, skilled tradespeople, musicians, self-employed professionals, business owners, and people such as Sharon Thornton, whose small employer doesn’t provide health insurance.”[1] Alonso-Zaldivar quotes Thornton, a hairdresser from Newark, Delaware, whose policy carries a deductible of $6,000: “We’re caught in the middle-class loophole of no help,” said Thornton, who is currently paying about $740 a month in premiums, and expects her monthly bill next year to be around $1,000, a 35 percent increase. ‘It’s like buying two new iPads a month and throwing them in the trash. To me, $1,000 a month is my beach house that I wanted to have.’”[2]

At the same time, we hear reports of big data lowering healthcare costs. “Big data,” according to Mathias Goyen, chief medical officer, Europe, for GE Healthcare, “is supposed to make medicine more affordable and better. Data transparency and analysis are the drivers towards value-based medicine where the basis of payment is not the resulting medical expense, but the success of treatment for the individual patient.”[3]

We applaud big data and look forward to the time when it truly does impact the bottom line for people. But we aren’t seeing costs go down at this point. In addition to individuals bearing the brunt of rising costs, small to medium-sized businesses across the country are struggling. Healthcare consultants and employer groups project that the average national cost of insurance premiums per employee will rise to $12,850 in 2018. Take someone like Richard Pietranek in Chicago, who “runs Servpro, a property restoration company in Glendale Heights with about 20 full-time employees. He’s been socked by rate hikes of 9 to 46 percent since 2014, causing him to significantly reduce how much Servpro, contributes to workers’ premiums.”[4]

So what’s the answer? In an article for Forbes, Michael Evans and Kevin Fleming report that “Patient payments now account for 35% of provider revenue, the third largest source of provider income behind only Medicare and Medicaid. By comparison, in 2000 patients paid just 5% of healthcare provider revenue. This trend is expected to continue, with patients bearing a growing portion of the financial responsibility for their care.”[5]

In the Forbes article, Evans and Fleming provide 10 suggestions to lower healthcare costs. And their No. 1 suggestion is pricing transparency: “The lack of pricing transparency in healthcare makes intelligent decision making impossible. It disempowers consumers and allows for wide pricing disparities among payers. Most consumers are comfortable with the notion that you get what you pay for and are happy to spend more when they see greater value. Healthcare can no longer be exempt.”[6]

What other industry can exist by supplying only estimates? Leading health research consultants, Price Waterhouse Coopers, says: “Health systems command billions of dollars in revenue and yet few can do what other billion-dollar companies consider table stakes – identify the cost of the services they provide. Now insurers, consumers and other major healthcare buyers are demanding better value for their spending, and healthcare providers are scrambling to calculate these costs.”[7]

Simplifying the purchase process for patients can be extremely complicated in healthcare, which is why this industry has been slow to adopt retail-like approaches. HealthQRS has developed algorithms that do all the work, keeping the process simple for healthcare providers and payers to publish true pricing. Our E-Commerce Medical Marketplace and Point-of-Service solutions use the actual payer contracts by provider plus insurance verification information plus charity plus other business rules to calculate the true out-of-pocket per patient per procedure. We also provide navigation capabilities to guide the employee or consumer to the lowest cost service or procedure based on quality.

Partnering with HealthQRS, companies such as Workday, SAP, Salesforce and Oracle could provide the pricing transparency so desperately needed in today’s healthcare economy. If Workday implemented a marketplace for each one of its corporate accounts, it could drive healthcare costs down in each of those corporate markets. Providers, reluctant to embrace a consumerism model, would have to fall in line.

Pricing transparency solutions that just give estimates aren’t creating a marketplace. We need a quantum leap toward providing the same type of shopping experience in healthcare that employees/consumers expect for just about everything else they purchase such as with Amazon. For companies such as Workday, SAP, Salesforce and Oracle, this a huge opportunity to play in the largest market in the world and a chance to take advantage of dramatically increased growth and revenues. If they partner with HealthQRS, they would have a solution to solve the biggest problem in healthcare.

We invite you to learn more. Why not  contact us right now for more information or click here to schedule a demo? Or click here for a quick, 6-minute video about our e-commerce strategy.

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[1] Ricardo Alonso-Zaldivar, “Millions who buy health insurance brace for sharp increases,” Associated Press, The Brunswick News, Sept. 4, 2017, http://thebrunswicknews.com/ap/business/millions-who-buy-health-insurance-brace-for-sharp-increases/article_b9ee5a7f-8d0f-5ac9-b5b3-bf0af3c940c8.html

[2] Ibid.

[3] Mathias Goyen, “’Big Data and Analytics’ in Healthcare,” LinkedIn, Sept. 6, 2017, https://www.linkedin.com/pulse/big-data-analytics-healthcare-mathias-goyen-prof-dr-med-

[4] Kristen Schorsch, “How much more will health care cost your company in 2018?” Crain’s Chicago Business, Aug. 12, 2017, http://www.chicagobusiness.com/article/20170812/ISSUE01/170819946/how-much-more-will-health-care-cost-your-company-in-2018

[5] Michael Evans and Kevin Fleming, “What We Can All Do About Rising Healthcare Costs,” Forbes, June 28, 2017, https://www.forbes.com/sites/allbusiness/2017/06/28/what-we-can-all-do-about-rising-healthcare-costs/#63735982f375

[6] Evans and Fleming, Rising Healthcare Costs, Forbes, https://www.forbes.com/sites/allbusiness/2017/06/28/what-we-can-all-do-about-rising-healthcare-costs/#63735982f375

[7] Price Waterhouse Coopers Health Research Institute, “Top health industry issues of 2016: Thriving in the New Health Economy,” Annual Report, Dec. 2015, p. 11, https://www.pwc.com/us/en/health-industries/top-health-industry-issues/assets/2016-us-hri-top-issues.pdf

 

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