According to Dave Chase, Co-Founder at Health Rosetta, “every dysfunction in health care is codified in health care plans.” His company investigates every corner of employer and union health care plans—which cover 64% of Americans—to make them more efficient and serve their employees better.
In this video, Chase explains some of the ways that payers, PGMs, third-party administrators (TPAs) and other institutions pad costs. He also describes the collaborations among people throughout health care to created a set of standards for contract language and for measuring the performance of a health care plan.
This open source effort is concentrated in a non-profit that Health Rosetta started, the Nautilus Health Institute. A conference, RosettaFest, they’re holding this month in Denver (with virtual access as well) will bring together about 1000 people divided among technology companies, employers and unions, benefits advistors, and providers. One of their announcements at the conference will be a “PBM field guide.”
He reports that adopting the Health Rosetta process has saved employers and unions 540 million dollars in Florida. They developed their initial standards by working directly with 40 employers, then spread it by training 250 benefit plan advisors, who collectively serve about 10,000 employers to cover 5 million to 15 million people.
Chase repeatedly refers to transparency as key to reducing costs. Chase claims that the health care industry has captured legislatures and regulators, and that an open source effort is the only way to break that control.
Health Rosetta now offers an objective rating system for health care plans. It asks about 40 questions and rates plans along 8 scores, then offers suggestions for how to improve the plan. He says that most plans achieve a rating of only 5-17 out of 100. The best indicator of whether a plan performs well is whether it offers the employer complete access to its claims data, which actuallly is required by law.
He also cites recent court cases showing how various players pad expenses, often inflating costs or throwing in arbitrary charges and then offering “discounts” or “savings.”
The video offers many more details about legal, financial, and technical aspects of health plans and Health Rosetta’s efforts to address poorly designed plans.
Learn more about Health Rosetta: https://healthrosetta.org/
Listen and subscribe to the Healthcare IT Today Interviews Podcast to hear all the latest insights from experts in healthcare IT.
And for an exclusive look at our top stories, subscribe to our newsletter and YouTube.
Tell us what you think. Contact us here or on Twitter at @hcitoday. And if you’re interested in advertising with us, check out our various advertising packages and request our Media Kit.
No comments:
Post a Comment