Simple ROI Strategies to Assist in Health Care Savings

​Return on investment (ROI) has become a popular concept for companies, charitable organizations, households and even government agencies (humor emphasized). In simple terms, it’s a measure of the benefits delivered above the costs expended for a product or service.
There are many circumstances when it’s easy to measure ROI, such as when you invest in a security or put money in the bank. However, it’s not always so cut and dry.
Take health care costs, for instance. You’ve heard me talk about limited transparency in the health care space. It’s difficult for the average consumer to investigate the actual out of pocket (OOP) costs associated with the most basic medical procedures. An MRI image can vary in cost by thousands of dollars, depending on where the MRI is administered. The same goes for an operation. In fact, many people don’t know that surgeons are often accredited to perform procedures in multiple hospitals. The actual procedure cost is a constant, while the facility charges and other necessary services can vary significantly. By making the correct facility choice, you could save thousands.
Take note of the following real-life example:
A patient calls to pre-certify a total knee arthroplasty surgery. Without any professional assistance, the patient wouldn’t know the following facts (actual facility names have been altered): 1
Facility                                Total Cost
**** Memorial Hospital         $28,400
**** Methodist Hospital        $70,108.12
**** University Hospital        $23,300
While all three hospitals have acceptable quality ratings and are geographically compatible, the least expensive option has the highest quality rating (believe it or not). By choosing the least expensive option, the patient saved 67 percent over what he/she could have paid.
Unfortunately, without assistance from a professional who can research the relative costs, it’s difficult for the average consumer to reach an educated decision. That will change, as transparency in the medical cost arena is evolving. Someday – probably sooner than we think – we’ll be able to shop for health care like we do for any other goods.
In the interim, here are some simple things you can do to positively influence your ROI:

• Ask for a generic equivalent for prescribed pharmaceuticals. Generic drugs can save you significantly, especially for maintenance drugs that are utilized on a routine basis.
  
• Use telemedicine when available. An average trip to the emergency room (ER) costs about $1700. 2 A call to a telemedicine provider averages $50 and the average session time is approximately 10-15 minutes. 3 Many plans offer telemedicine services at no cost to the member.
  
• When a visit is necessary for urgent care purposes, use an Urgent Care (UC) facility as opposed to an emergency room. Co-pays and out of pocket expenses are typically much lower when you use an urgent care facility. Of course, if you are in a true life-threatening emergency, head straight to the ER.
  
• Use the mail order option for your maintenance prescription drugs. Most often, you’ll receive a three-month supply for less than what you’d pay for the same drugs over the counter. Also, be sure that you use an in-network pharmacy for maximum discounts.
  
• Make sure your provider and other services are in your health plan’s network. Be sure to specify your specific plan name and company, as the major insurance carriers have many different network options available.
  

Those are a few strategies to get you on the right track in preserving ROI. Remember, just because you have limited out of pocket exposure for various visits and procedures, doesn’t mean the costs stop accumulating for your plan. By taking an ounce of effort, you can play a major role in increasing ROI not only for yourself, but also for your company and the premiums that you both pay upon your plan’s renewal, as well as the entire health care community!

1  Actual data received in 2016 from Paradigm Health
2  US Dept. of Health and Human Services
3  Expenses vary by plan.