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Better prepared patients, higher-value health care

A well-informed patient can advocate on their own behalf

Jim Mueller - Mueller QAAS
Jim is the founder, President, and CEO of Mueller QAAS, LLC, an independent healthcare consulting firm located in Waukesha, Wisconsin. Jim provides leadership and strategic direction to Mueller QAAS, and also provides his clients with objective market insight on their employee benefit decisions.

Summer is finally here, though the Wisconsin weather can still be a bit unpredictable. Before enjoying the great outdoors, it is best to follow the cardinal rule of camping and be prepared. Like the weather, our health care system is also complex and unpredictable. This makes it hard for patients to be prepared to make the best decisions for themselves and their families. Thankfully, improved tools and patient resources are now available that make it easier to prepare for treatment and can lead to lower cost, higher quality health care.

There are three main players within our health care system, each with their own interests. At the top, hospital administrators are mainly concerned with keeping their facilities operating smoothly and efficiently. Physicians’ chief concern is their patients’ safety and well-being. As the largest and most important group, patients want high-quality health care services for the lowest possible price. In this environment, health care executives are focused on the bottom line and may push providers to create more revenue in less time. This could consequently mean less time for the patient than the provider would like. As a result, patients may feel under-satisfied and frustrated with their overworked physician.

Despite these challenges, patients rightfully rely on their physician for medical knowledge and guidance. However, it is important that they can advocate on their own behalf as well. A well-informed patient asks more relevant medical questions. They can also skip pricing or insurance questions that their provider may not be able to answer. Being prepared, therefore, leads to higher patient satisfaction, less frustration for the provider, and more productive visits for both parties. The time has come for patients to effectively advocate for themselves within our confusing medical bureaucracy.

Cost estimator tools are one valuable resource. For example, Fair Health Consumer’s cost-estimator tool price compares low- and high-risk procedures and associated care according to insurance coverage and location. The tool is sophisticated and specific, yet very easy to use. In addition, many insurance providers now offer their own cost-estimator tools. Anthem, for instance, recently made huge improvements to their comprehensive estimator and search tools. Other carriers are making similar tools equally accessible to members in response to demand. In short, cost-comparing in an era of extreme price variation for common procedures could mean not receiving that surprise bill in the mail.

Beyond cost, care quality is most important when you or a loved one is faced with a more serious diagnosis or emergency. The National Quality Assurance Association (NCQA), for example, is a great quality resource. With scores of health care datasets at its fingertips, the NCQA creates quality-focused provider “report cards.” The report cards help patients choose a high-quality provider in any location. The association also produces articles and resources on procedures, health care transparency, and current health care news to help patients better navigate the system.

While the importance of cost and quality depend on the situation, value – highest quality for lowest cost – is what most search for in a provider above all. MyHealth Wisconsin contains a database that connects patients with quality facilities that have high-value providers in any chosen area. This resource uses a thorough facility-rating system and even provides specific quality measures patients should expect out of any health care facility they visit.

For our part, mueller-QAAS seeks to advocate for clients searching for value-driven, cost effective health care plans. We also encourage our employer clients to educate their employees on accessing resources that can better inform their health care decisions. Taking advantage of every resource available and empowerment towards self-advocacy is a necessary step down the path towards better – and more valuable – health care.

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