Understanding Group Health Plan Management

Healthcare Price - Quality Disconnect. Do Higher Prices Mean Higher Quality? No! Here's Why. Price and Quality are NOT Correlated in Healthcare. Here Are 3 Examples That Explain Why: 1) Let's Say the Facility Allowed Amount for a Surgery at a Hospital (e.g. arthroscopic knee surgery or hernia repair) is $16,000. That Same Surgery with the Same Surgeon Would Have a Facility Allowed Amount of Only $4,000 at an Ambulatory Surgery Center. Price Not Related to Quality. 2) Let's Say a Hospital Outpatient Surgery (e.g. gallbladder removal) Has a Facility Allowed Amount of $28,000. That Same Surgery at the Same Hospital with the Same Surgeon Would Have a Facility Allowed Amount of Only $2,500 if the Patient Says Overnight and the Surgery is Considered Inpatient. Price Not Related to Quality. 3) A Study by Dr. Atul Gawande Found that Hospitals Make More Money Off of Surgery for Commercially Insured Patients AND Have a Higher Profit Margin If There are Complications. The Price Goes Up as the Quality Goes Down. Note: Atul Gawande is no longer the head of Haven... the Amazon, Berkshire Hathaway, JP Morgan Chase Joint Venture... and Haven has been wound down and no longer exists. Sources at AHealthcareZ YouTube Channel. #Healthcare #HealthcareQuality

The same holds true with medications. More expensive doesn't mean they work more effectively or have better outcomes. The pharma and life sciences market access conversation needs to shift to paying for outcomes with specialty therapies. It defies common sense to pay the same amount for something that works for one person and does nothing positive for another person. Our current system promotes in medication the exact opposite of what lemon laws in automotive sales has achieved in terms of consumer protection.

A higher price does not necessarily mean higher quality in the current healthcare system. Patients are often unaware of the drivers of costs. Cost does not reflect the quality of care or the experience level of the provider; it is determined by the location, the insurer, and the contracted rate.

Such an important topic by Dr. Bricker today. The price of care can vary significantly, yet it has zero correlation to quality or outcomes. On the heels of so many reports of continued healthcare cost increases YoY, (for employers and employees) that plan sponsors must navigate, this highlights the continuous need for transparency and education of how the healthcare system actually works for the people who use it every day.

Modifier 78 — Unplanned return to the operating/procedure room by the same physician (or other qualified health care professional) following initial procedure for a related procedure during the postoperative period. 🔎 Key points: It’s used when a patient needs to go back to the operating room/procedure room during the global period of the original surgery. The return must be unplanned and for a related reason (such as a complication). The procedure is performed by the same provider. 🩺 Example: A patient has gallbladder surgery, then 10 days later develops postoperative bleeding that requires a return trip to the OR to control the bleed → use modifier 78 on the second procedure.

A new GP telephone contact hub is transforming how patients connect with their local practices - making it faster and easier to get the help they need over the phone.☎️ Based at South Petherton Medical Centre, the hub now handles all phone calls to four Symphony Healthcare Services GP practices in South Somerset: - Buttercross Health Centre & Ilchester Surgery - Crewkerne Health Centre: Middle Path & West One - Hamdon Medical Centre, and Martock Surgery - South Petherton Medical Centre. Before the hub opened, patients often had to wait around 20 minutes to speak to someone, but now that wait time has been cut by more than half down to just 9 minutes - a significant improvement that’s helping people get support when they need it most. More patients are noticing the difference too as satisfaction has risen from 91% to 95%. This isn't just about speed, its about providing better care. This hub is more than a phone line. It’s about making sure every patient feels heard, supported, and cared for💙

The medical system spends billions on back surgeries every year… But do MDs really know the truth? 📉 30% of surgery patients get better ⚖️ 30% stay the same 📈 30% actually get worse That’s not good enough — for you or your patients. And those PCPs in your community? They hate seeing failed surgery patients come back to their office. ✅ It’s time to step in before surgery happens ✅ Use B2C communication to reach patients directly ✅ But don’t forget B2B — build referral networks with MDs who want better options Your practice — and your community — deserve better outcomes. #mdreferrals #chiropracticalternativestosurgery #theevidencebasedchiropractor #chiropractorbusiness #failedbacksurgery https://lnkd.in/eg_pxJpQ

Access to and Quality of Elective Care: Hernia Surgery • 🌍 83 countries, 640 hospitals, 18,058 patients studied • 🚨 Emergency surgery rates: high to low-income rise from 6.8% to 14.2% • 📉 Mesh use drops from 97.6% in high-income to 61.0% in low-income countries • ⏱ Median waiting time: 8 months worldwide • 🏥 Day-case surgery rates were low across all income groups • 🔍 Action: boost mesh availability and streamline referrals in low-income areas #ElectiveCare #HerniaResearch #GlobalHealth #NIHR #Pub2Post tnyp.me/GuGwxqrx

How do Ambulatory Surgery Centers (ASCs) manage to do more cases per day - without compromising workflow or quality of care? 📍It starts with simplifying the process. With our single-use, sterile, and pre-configured systems, surgical teams no longer have to worry about: 🔹 Missing instruments 🔹 Sterilization delays 🔹 Time-consuming setup The result? ✅ Shorter turnover times ✅ More predictable procedures ✅ A workflow built for high-volume, high-efficiency environments Because enabling ASCs to do more — and do it better — means giving them tools that work as hard as they do. 🎥 Watch the video where Matthew Palmer - founder of OrthoFundamentals, LLC - talks about how we’re reshaping outpatient spinal surgery. #OrthoFundamentals #DemetraSpine #SpineSurgery #ASC #WorkflowOptimization #SurgicalEfficiency #SurgeryInABox

OIG's latest audit found that postoperative visits are underreported and global surgery payments often assume more visits than provided, resulting in estimated overpayments of $7.8M by Medicare and $4.8M by beneficiaries. Read on as we explore these findings are their implications for stakeholders: https://lnkd.in/esyT-S33