Self-funded group captive health insurance plans offer mid-market employers the opportunity to make the right choices when an employee needs a liver transplant surgery.
By: Nate Szabo, Cost Containment Consultant
While a liver transplant surgery is the second most common transplant surgery after the kidney, it is not a common health care condition faced by a majority of Americans. According to the United Network for Organ Sharing, less than 1% of the U.S. population has had an organ transplant. These surgeries are only necessary after every other treatment option has been exhausted and/or completely ruled out. Needless to say, it can be overwhelming to navigate through the process of selecting the right path of care to get the best possible outcome.
Centers of Excellence
Not every hospital offers the same level of care when it comes to major medical procedures such as an organ transplant. Fortunately, there are medical resources located within hospital systems referred to as Centers of Excellence. They can assist both the patient and their employer in guiding them through the transplant process – before, during and after surgery.
Centers of Excellence are specialized programs found within healthcare institutions that provide an exceptionally high level of expertise and resources focused on a particular area of medical care. Delivered through a comprehensive, integrated approach, these centers afford many advantages for healthcare providers and the populations they serve by offering high-quality care at a lower cost.
Patients benefit from utilizing a Center of Excellence by acting as a consumer of their own health care. Employers should assist their employees by offering tools to locate high-quality doctors, hospitals and health systems to reduce the overall cost of healthcare. This will not only save the patient money if a major surgery is critical, but it will also provide savings for the employer group as well.
Cost Containment Success
It is typical of health insurance companies to require a pre-certification for a liver transplant surgery to ensure the requested service meets established guidelines. Recently, the Roundstone Cost Savings Investigators (CSI team)—made up of nurses and cost containment experts—was made aware of a liver transplant surgery with an expected cost of $600,000. This cost was determined by the average national rate for liver transplants.
The CSI team took action by reaching out to several Centers of Excellence to determine how nearby hospitals close to the patient ranked in performing liver transplants. Then, the team dug deep to uncover the medical costs associated with a liver transplant surgery. The CSI team presented the patient and their employer with three hospital options—all under half the price of the original expected price.
The three presented Center of Excellence facilities all ranked within the top ten regionally in terms of hospital systems performing liver transplant surgeries. The hospital selected was local to the patient and had an expected cost of $265,000 for the surgery. Overall, the employer realized a cost-savings of at least $300,000 along with the reassurance that the patient was receiving the best quality of care.
Unlike other industries, high cost does not always determine high-quality in health care. In fact, the best-ranking hospital systems usually have the lowest costs. It is important for employers to educate their employees in order to save them money and ensure they get the best possible care. To learn how you can actively engage your employees in their health care choices, contact Roundstone today.
About the Author:
Nate Szabo is a graduate of John Carroll University and brings experience from the medical device and healthcare industries—providing innovative solutions to Roundstone’s employer clients.