The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals which are lower costs, better benefits and higher wages.
By Bill Rusteberg
Recently I have noticed a growing trend among brokers, consultants and third party administrators pushing alternate payment methods for medical care givers. All share two things in common – (1) They understand PPO’s are cost drivers providing the guarantee of overpaying for healthcare and (2) Their wavering cult mentality essentially remains strong.
Most are late entrants in the Reference Based Pricing arena primarily because these cult members have found difficulty in escaping from 40 years of managed care indoctrination.
“Let’s implement Reference Based Pricing slowly, over a three year period so we don’t disrupt employees” is their theme. “We can start by getting our children (employees) used to narrow networks, or we can limit Reference Based Pricing to four or five surgical procedures. But we must keep a PPO network option in place!”
These intermediaries are “Me Too” operatives. “Mr. Plan Sponsor, if you don’t like it neither do I!” or “If you like it, so do I!”
The problem is there is no such thing as being half pregnant. It is my opinion and philosophy that a half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals which are lower costs, better benefits and higher wages.
Below is an open letter to my fellow, newly minted health care revolutionaries:
I guess the question comes down to philosophy vs practicality (recognition of other people’s perceptions).
Your strategy is much more practical and will produce far greater results than mine. Let’s outline yours first which is based on assuaging a plan sponsor’s risk tolerance levels commonly perceived to be on the low end in regards to employer – employee relationships. Pissing off employees creates mind numbing fear among HR in particular and upper management in general. Thus, stepping away from the status quo (wherein there is very little noise) is a really hard thing to do. And, as long as money is not too much of a problem, kicking the can down the road makes perfect sense.
But, as we all recognize, money is always an issue, whether you have enough or not. That is evident in the continuing search for plan savings. The search is well road-mapped, with little or no deviation. The compass always points in the same direction – cost shifting, changing carriers, wellness programs (that don’t work), and the like. But all these have been documented failures.
So what’s next?
The answer is: moving away from egregious managed care contracts no one can see but through which most health care costs are based. This amounts to blindly gifting co-mingled funds through third party intermediaries to be distributed to parties known and unknown. That is the reality slowly creeping through board rooms across the country.
Slow creep in the board room extends the faint realization of the difficulty of politics of change. Uneasy anticipation of perceived coming angst associated with addressing difficult issues one would rather forget about, becomes a part of the root problem, compounding it. Overcoming 40 years of indoctrination is similar to leaving a cult. The cult’s historic control of the board room is now increasingly under siege by the growing phenomenon of SLOW CREEP.
SLOW CREEP is the term I would assign to your strategy of tip-toeing-through-the-tulips.
My philosophy mirrors yours in fundamental ways other than approach. I don’t discount yours of course as it makes sense for most. However, the execution is far different between us.
My philosophy is based on individual responsibility, prudent economic practices without much concern for “social” issues. I have found that “jumping off the cliff” produces the desired results quickly and efficiently. No network at all with the promise to plan participants that “The plan will pay what it says it will pay, nothing more and nothing less.” I have found that if this approach is carefully laid out in advance, with the full backing and support of management, there is little or no noise. And plan savings are immediate and significant.
Once this becomes apparent, plan members and management join together to keep the plan “rolling” with the first-in-a-lifetime opportunity to raise wages while improving benefits at the same time.
Employees are not stupid people.
Your strategy makes sense because there are a whole lot of “Me Too’s” out there. A “Me Too will be better received in the brokerage / business community than a “Why Not!”
I can see an initial prospect meeting that would go something like this: “First Mr. Prospect, I need to determine if you are a half pregnant flower lover with a passion for tulips or a cliff diver looking for adventure.”
My clients are cliff dwellers.