Looking Out For You: How to be a Better Health Care Consumer

What is The Alliance?

> Employer-owned, not-for-profit health care purchasing cooperative.

> Freedom to choose from 63 hospitals and 10,365 professional service providers.

> Creates resources to help you and your family become more informed about health care choices.

Today’s Goals Discussion

> Increase your awareness of the safety and quality of our health care system and its impact on you.

> Provide tools to help you become a wise health care consumer.

> Help you maximize the effectiveness of each health care encounter.

> Health Care Quality and Cost.

> What You Can Do Today.

> How to Make the Most of Each Health Care Visit.

What is Health Care Quality?

> Doing the right thing> Doing it at the right time> Doing it the right way

Quality Problems

> Underuse Care that would benefit patients isn’t given.

> Overuse Care that is unnecessary or where the risks

outweigh the benefits.

> Misuse Complications caused by patients who do not

follow doctors’ orders & doctors who misdiagnose their patients.

In doctors’ offices and clinics, adults receive only 55% of recommended care (preventative, acute and chronic)!

Cost In Perspective

> Self Funding The employer assumes the financial risk of

providing health care benefits to employees.

The employer pays for employee medical claims out-of-pocket as they occur.

Share in Your Medical Decisions

> Let your provider know that you want to be an active partner in your health care.

> Do your own research: www.the-alliance.org www.webmd.com www.crbestbuydrugs.com

> Ask why?> State your preferences.> Compare your expectations with those of your

provider.> Accept responsibility.

Did you know?

8 out of 10 Internet users have searched online for information on at least one major health topic.

That translates into about 95 Million American adults who use the Internet to obtain health information.

* 2011 Pew Internet Project and California HealthCare Foundation

Ask Questions

> 3 Good Questions to Ask: What is my main problem? What do I need to do? Why is it important for me to do this?

Bring a Friend or Family Member

> A personal representative, or health advocate, can: Get information and ask questions when

you can’t. Remind you about instructions and help

you make decisions. Find out who to go to if you are not getting

the care you need.

Remember…

> Let your doctor, nurse, or pharmacist know if you still don’t understand something.

> You don’t need to feel rushed or embarrassed if you don’t understand something.

> You can ask your doctor, nurse, or pharmacist a question as many times as you need to.

> Be honest with your doctor, don’t tell them what you think they want to hear.

Asking questions helps you understand how to stay well or get better!

Did you know?

> A survey of 1,100 patients revealed… 68% of patients said that they would not inform

their physician that they had failed to comply with a prescribed drug therapy.

83% said that they would never communicate with their physician that they did not plan on buying a prescribed drug.

1/3 of all hospital admissions are due to poor medical adherence. This equates to $300 Billion annually.

*The Adherence Estimator, McHorney CA. Curr Med Res Opin, in PubMed

Keep and Bring a List of All the Medicines You Take

> Give your doctor and pharmacist a list of all the medicines you take, including non-prescription medicines. This includes vitamins and herbal

supplements.> Tell them about any allergies you may

have.Medication errors are the most common type of medical error!

Did you know?

The average doctor to patient interaction during an office visit is less than 10 minutes.

Often clinics will schedule office visits as short as 8 minutes in a physician’s calendar to maximize the number of patients they will see in a day.

Making the Most of Each Visit-Before the Visit-

Before you go, bring along all of thefollowing information:> Current insurance card> Social Security number> Emergency contact information> Employer information> A referral or order, if required> Any previous x-rays, if requested> An interpreter, if needed

Making the Most of Each Visit-During the Visit-

> State your main concern first.> Describe your symptoms.> Describe past experiences with the

same concern.> Ask questions about things you don’t

understand.> Take notes, even if you understand

what is being said.

Making the Most of Each Visit-At the End of the Visit-

> Am I to return for another visit?> Am I to phone in for test results or login

online?> What side effects or concerns should I

look for?> When do I need to follow up?> Anything else I need to know?

When You See a Specialist

> Know the diagnosis or suspected diagnosis.> Learn about basic treatment options.> Make sure the specialist has all test results

and records on your case.> Make sure you know why the tests are being

done. Ask: Are these tests necessary? Don’t repeat tests!

If You Are Facing Surgery…

> Most surgeries are not emergencies.> This means that you have time to make

sure that this surgery is the best treatment for you.

> Refer to the toolkit to see important questions you should ask if facing surgery.

QUALITY and COST vary in ways that affect your life and your wallet.

Putting Quality in PerspectiveNumber of Americans who die each year from:

> Accidents and Diseases: Breast cancer:

About 39,500 Motor vehicle

accidents: About 43,000

> Quality and Safety: Medical errors: About

98,000 Infections acquired

while in the hospital: About 90,000

> 25 – 75% of these infections could be prevented

Cost Matters Too

Cost varies: You could pay more for the exact same

type of care depending on which hospital you choose.

What you pay is not related to the quality of your care. High-quality care don’t always cost

more.

QualityCounts Inpatient Hospital Report

> Overall Care for Adults

> Birthing Care> Major Surgery

Hip and Knee Surgery Back and Neck Surgery

> Overall Heart Care Heart Surgery Non-Surgical Heart Care Balloon Angioplasty Bypass Surgery Heart Attack Care Aortic Valve Replacement

QualityCounts™ Outpatient Procedures and Tests Report> Surgeries:

Removal of Adenoids Adenoidectomy & Tonsillectomy Arthroscopic Knee Surgery Cataract Surgery Laparoscopic Gallbladder Surgery Laparoscopic Hernia Surgery Ear Tube Insertion

> Tests: Bone Density Study Cardiac Perfusion Scan Colonoscopy Upper Gastrointestinal (GI) Endoscopy

> CT and MRIs Abdominal & Pelvic CT with

and without contrast Brain MRI with and without

contrast Head or Brain CT Lower Spine MRI MRI Joint of Lower Extremity

without Contrast MRI Neck Spine without

Contrast Thorax CT with Contrast

Brain MRI (Dane County Example)

 Specialty MRI Center

(Dane Co.)   Dane Co. Hospital

Total Average Cost $2,304 $3,884

   

EE Deductible ($1000) $1,000 $1,000

EE Coinsurance (10% to $250) $130 $250

Total Employee Cost $1,130 $1,250

Cost Difference to EE $120

Total Employer Cost $1,004 $2,634

Cost Difference to ER $1,630

Laparoscopic Hernia Surgery(Dane County Example)

 Outpatient Surgery Center (Dane Co.)   Dane Co. Hospital

Total Average Cost $5,351 $8,812

   

EE Deductible ($1,000) $1,000 $1,000

EE Coinsurance (10% to $250) $250 $250

Total Employee Cost $1,250 $1,250

Cost Difference to EE $0

Total Employer Cost $4,101 $7,562

Cost Difference to ER $3,461

To access: www.the-alliance.org

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The single most important way you can help get safe, quality care while reducing your costs is to be an active participant in your health care!

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