Benefits Column Employees Access to 5-Star Care

Offering workers and their families the ability to go to medical centers of excellence for complicated health situations can reap huge rewards for both the employee and the employer.

Wednesday, May 3, 2017
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A friend of mine was injured a few months ago when a driver rear-ended her car. The air bag deployed and saved her from life-threatening injuries, but it also shattered her kneecap.

She sustained a type of patellar fracture that required a surgeon to reassemble the pieces of the bone and wire them into place. She then needed to wear a knee immobilizer as part of her recovery plan and to participate in physical therapy. While the recovery typically takes about three months, the hope was she could recover in less time, since she had age on her side and was in great physical shape prior to the accident.

At least, that's how the story should have gone.

Unfortunately, when the ambulance arrived at the accident scene, the emergency medical service workers took her to one of the two worst-rated hospitals in her state according to the Leapfrog Group's Hospital Safety Grade -- despite her request to go to a better hospital. Her experience was not much different than the one I had after being hit by a car.

Her treatment unraveled from there. Her orthopedic surgeon was kind, but had limited experience in the type of surgery she needed. Given that fact, she asked to be transferred to a more experienced surgeon who worked at a highly rated hospital nearby. I'll spare you the story, but her request was not approved.

My friend was an in-patient for three weeks, which is a rare statistic these days. When she became stable, she was transferred to a nursing home for rehabilitation instead of the state's well-regarded rehabilitation hospital. Two months later, she's finally home and still in her knee immobilizer. Fortunately, she's making progress and -- given her determination -- should make a significantly delayed but reasonable recovery. She is still unable to work because her employer is not able to make the accommodations she needs to return to her job while using her walker.

As we continue our discussion on how to offer benefits that attract and retain employees, my friend's story reminded me of the obvious importance of access to quality medical care. Despite the unease most Americans feel toward the discussions about and proposed alterations to the American Health Care Act, there is something employers can consider while these debates continue: offering employees and their families the ability to go to medical centers of excellence for complicated health situations.

Definitions of a center of excellence vary, but these medical hubs generally consist of teams of highly skilled experts and are often involved in research and innovation to advance their field. When Tom Emerick held the position as Walmart's vice president of global benefit design and continuous improvement, he led the retailer's creation of its own centers of excellence for employees and dependents by partnering with six nationally well-known healthcare organizations, including the Mayo Clinic and the Cleveland Clinic.

Emerick believes an increasing number of employers are following the lead of companies such as Walmart, Lowe's, Pepsi, General Electric and Kohl's in establishing centers of excellence. He indicates that "forward-looking companies are now sending some of their sickest employees and covered family members to outstanding medical centers to ensure they receive the best care."

Workers additionally benefit, he adds, by voluntarily using a center of excellence because their employers often waive health insurance deductibles, co-pays and co-insurance, and also pay for travel expenses for the employee and a companion. 

The Pacific Business Group on Health helps its members set up these programs through its Employers Centers of Excellence Network. Not only do employees and their dependents receive great care, but PBGH is also able to negotiate bundled pricing for procedures and rehabilitation at rates that are 20 percent to 30 percent below what the companies used to pay.

Lowe's is part of the PBGH network and reports that employees not only receive better care, but they sometimes avoid unnecessary surgery. The company finds almost 30 percent of proposed joint-replacement surgeries are avoided because the employees never went through more conservative approaches such as physical therapy.

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Access to centers of excellence was once limited to large employers, but a growing number of small employers (who opt to self-insure their health coverage) are offering these benefits as well.

Janet McNichol, human resource director at the 300-employee American Speech-Language-Hearing Association, moved her organization to self-insurance less than two years ago. McNichols was able to immediately access a transplant centers of excellence program through her utilization review program. She is now interested in building centers of excellence to help her employees avoid unnecessary back surgeries.

The prospect of money saved did not motivate McNichol to explore offering centers of excellence. Rather, she was motivated by quality of care. "Seeking care at a D-rated hospital versus a center of excellence is a night-and-day experience for employees and their families," she says.

McNichol believes that it's important for HR leaders to both mine their company's healthcare data and listen to inquiries about health insurance coverage by prospective employees during interviews. She is personally seeing new trends in inquiries regarding infertility and transgender surgery benefits.

Small employers that do not want to build their own centers of excellence programs and are not large enough to join the PBGH can tap into companies such as EdisonHealth, which was co-founded by Emerick. The company provides standardized contracts with centers of excellence, so smaller companies can gain access to the same deals large companies negotiate.

Emerick believes providing employees with a centers of excellence program is one of the best recruiting and retention tools available, because these programs help employees and their families when they are going through one of the most vulnerable points in their lives.

Carol Harnett is a widely respected consultant, speaker, writer and trendspotter in the fields of employee benefits, health and productivity management, health and performance innovation, and value-based health. Follow her on Twitter via @carolharnett and on her video blog, The Work.Love.Play.Daily.


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