When people are asked to rate other drivers, most won’t hesitate to say that a large percentage of those they share the road with are bad drivers. But when they are asked to rate themselves, the vast majority will say that they consider themselves to be above average drivers. The same phenomenon seems to apply to many people when it comes to how they view doctors. George McGregor, president of benefit consultants McGregor & Associates, illustrates.
“When I speak to large groups, I usually start by asking how many people think there is a healthcare crisis. Everybody in the audience raises his or her hand. The second question I ask is how many think there is a quality crisis, that there is bad quality being provided in the healthcare delivery system. Everybody raises hands. The third question I ask is, How many of you see a bad quality physician? Nobody’s hands are raised.”
McGregor is not trying to impugn the reputations or abilities of all physicians. He is, however, attempting to point out that individuals have a right and a responsibility to oversee their own medical care. “I use those questions to demonstrate that we are all part of the problem,” he says, “in that we tend to believe our physician is infallible, and simply rely on what he or she says without questioning and without being responsible for our own health care.”
McGregor is the administrator for the Southern California Schools Voluntary Employee Benefits Association (VEBA), a cooperative labor-management trust program for education employees in Southern California. The VEBA includes employees of 30 school districts, one association, and the county office of education, and it covers roughly 82,000 members, including employees and their dependents.
Due in part to geography, McGregor says the medical community in the San Diego area operates something like a cartel. “San Diego has a unique problem in that it is bordered by a foreign country to the south, it has uninhabitable desert to the east, and a military base to the north. It is isolated from a healthcare perspective. There are very few healthcare providers, and those providers believe that you can’t go anywhere else for your health care. Consequently, we’re seeing 30 percent year-over-year increases in actual cost of health care. Obviously, that becomes unaffordable very rapidly.”
As costs skyrocketed, though, VEBA members were not getting healthier, McGregor says. “In fact, we felt that the morbidity of the population was actually increasing, not decreasing. It appeared to us that we were spending more and more money on health care, but getting less and less from it,” he says. The VEBA decided to engage the services of Best Doctors (www.bestdoctors.com), a health benefits service that helps people access top medical specialists to review their medical cases.
Better Quality Means Lower Costs
Long-term healthcare cost control must come through improvements in quality, McGregor believes. “You can always do cost-shifting techniques, but that doesn’t help with the ultimate purpose of controlling costs long term, which comes from controlling quality,” he says.
“We want to get people well, and keep them out of the delivery system. Best Doctors told us to expect that one-in-five of our diagnoses would be incorrect, and that 60 percent of the health care for our chronic users, even in cases where there was a correct diagnosis, would be using old medical treatments. We engaged them to do a study, and what we found was that 18 percent of our diagnoses were wrong. That was a little better than they expected to find.
“But more than 70 percent of the treatments for our members with an accurate diagnosis were old medical treatments—there were better medical treatments out there. What that translates into for the VEBA is they were spending $40 million a year treating diseases that the members don’t have.”
For roughly $3 per member per month, Best Doctors provides members with access to top specialists they might otherwise be unable to reach. While this is an added cost to the plan sponsors, they have had a return-on-investment of nearly 4-to-1. “Not to mention several saved lives,” McGregor reports.
Chart Review Reveals Problems, Saves Life
One of those lives is someone with whom McGregor has worked for nearly 20 years. Fifteen years ago, he says, Barbara was diagnosed with breast cancer and underwent a double mastectomy. At the time, doctors told her she had 6 months to live. McGregor says they she became a test case to see how Best Doctors could improve quality. “They found out that she had bone cancer that had gone untreated over that time frame,” he says, “and that there was evidence of that in her medical records, which was ignored by the medical delivery system.
“The review found that the treatment her doctors had recommended for the resurgence of her cancer was ineffective for the kind of cancer she actually had. Best Doctors got her daughters genetically tested and found that one of them had the gene predisposing her to the disease, so they can work proactively to keep her from getting it.
“Barbara took the report from Best Doctors in to her own oncologist, who said, ‘I don’t need anybody telling me how to practice medicine.’ Then he looked at the name of the person who signed the report and saw that it happened to be one of the foremost cancer experts who had recently been published in the authoritative literature. He took the report and stapled it on the outside of her chart to review.”
Members who are diagnosed with a serious illness have the option of utilizing Best Doctors when it is offered by their health plan. When they do use it, Best Doctors performs an extensive review of their medical records, as was done for Barbara, and provides a recommended treatment plan.
In cases where the physician is unwilling to participate, Best Doctors locates a quality physician who specializes in the diagnosed condition and who is within the insurance network.
“The insurance company benefits because people are getting properly diagnosed and treated, and it’s all done within the network through contracted providers,” McGregor says.
Although at this writing Best Doctors is available only to groups of 5,000 or more, McGregor is working with the company to offer it to consortiums of small employers.
McGregor says that, as a result of the last decade or so of cost-sharing and rapidly increasing healthcare costs, employees tend to be skeptical about suggestions from their employer. “People may think that the program is something being suggested by their employer simply to reduce costs,” he says.
“Companies need to find employee champions to help implement the program. When I was out telling people about this, I couldn’t get anybody to pay attention.
“So at our annual advisory meeting, I had Barbara come and speak to the 100 business people who deal with benefits in multiple employer trusts. She told her story personally, and I literally got backed into a corner with 40 people demanding information on the program.
“Hearing somebody, in their own words, talk about a misdiagnosis and how the delivery system failed her, humanizes it.” If you’d like to hear Barbara’s story in her own words, you can see her video at www.vebaonline.com.