Cracking Health Costs: How to Cut Your Companys Health Costs and Provide Employees Better Care

A simple solution exists for reducing your company′s healthcare costs: spend less money. Until now, we′ve been taught the reverse: spend more money today for the promise of an ROI later, one that is usually made up. Hence your costs keep rising due to massive overspending on diagnosis, testing, medication, procedures, and even prevention that in some cases actually harms your employees. Cracking Health Costs explains what you, as the executive responsible for your company′s healthcare spending, can do to slow this epidemic of healthcare–gone–wild, by spending less freely but more wisely on vendors, consultants, and providers.

You′ll learn:

How businesses can help employees avoid specialists and hospitals driving volume for profit How benefits consultants and brokers inflate your healthcare spending How wellness actually increases your costs . . . and can even harm your employees Why PBMs are so profitable at your expense Why strategies emphasizing coordinated care and employee well–being succeed where wellness fails And much more

Cracking Health Costs offers unique solutions that your businesses can implement immediately, mostly at no cost. Start fighting back against healthcare costs, and start improving your employees′ health today.

Foreword David A. Rearick ix

Introduction xiii

PART I MOSTLY BAD NEWS 1

Chapter 1 Myths and Facts about Your Health Benefit 3

Chapter 2 Does Your Broker or Consultant Have Your Back? 25

Chapter 3 It′s Time for the Wellness Industry to Admit to Doping 39

Chapter 4 This Is Your Health Benefit on Drugs 57

Chapter 5 Your Employees′ Health Is Too Important to Be Left to the Doctors 69

Chapter 6 Are New Delivery Models Déjà Vu All Over Again, Again? 89

PART II MOSTLY GOOD NEWS 109

Chapter 7 The Company–Sponsored Centers of Excellence Model 111

Chapter 8 Hospital Safety: How to Get Your Employees Back to Work in One Piece 131

Chapter 9 Real Care Coordination: The Only Other Way to Save Money 145

Chapter 10 Goofus Retains a Wellness Vendor, Gallant Implements Well–Being 161

PART III WHAT SHOULD YOU DO NEXT? 175

Chapter 11 Health Insurance Exchanges: Should You Stay or Should You Go? 177

Notes 189

Bibliography 193

Acknowledgments 195

About the Authors 197

TOM EMERICK is a leading expert in health benefits design, global healthcare challenges, healthcare economics, evidence–based medicine, and process improvement. Currently, he is the President of Emerick Consulting LLC. Tom spent fifteen years at Walmart, designing and managing benefits for over 1.6 million employees. He has held positions with Burger King Corporation, British Petroleum, and American Fidelity Assurance Company.

AL LEWIS, President of the Disease Management Purchasing Consortium, is widely credited with inventing disease management. Lewis is also the author of the award–winning Why Nobody Believes the Numbers (Wiley). He provides procurement and outcomes consulting to health plans and human resources/benefits departments, and administers the industry certification program in Critical Outcomes Report Analysis. He holds undergraduate and graduate degrees from Harvard, where he also taught economics.