Health care costs have once again risen to the top of the list of problems facing employers. The resulting financial pressures impact market competitiveness and employee relations. To weather this current cycle, employers must have certain fundamental needs met in the management of their employee benefit plans. Simply stated, those management services must be lean, competitively priced, emphasize quality health care services, highly flexible and sufficiently independent to pursue the client’s interests.

Patient Advocates stands for the principle that quality health care is ultimately the least expensive health care.

Our nurse line and case management services are patient oriented and strive to educate the patient as to appropriate health care choices and options. Many health insurance companies operate on a “one size fits all” basis. While this approach offers certain opportunities to achieve internal economies, it usually results in the sacrifice of a client’s ability to manage its plan according to its own unique needs. Patient Advocates provides each client with great flexibility in this area and is completely focused on the needs of its clients. It has no alliances with local health care providers that impede its ability to refer patients.

Patient Advocates has one mission - to manage the health care needs of its clients and their plan participants. Its services are dedicated to that principle.

As noted above, health care costs have once again risen to the top of corporate problem lists. What is different about this cycle is that the “low hanging fruit” of health care cost containment has already been harvested. That is to say that hospital and physician discounts have been utilized to their maximum level of effectiveness and there is no magic solution on the horizon. Risk sharing arrangements have not proved profitable. What then is left? The answer, perhaps, lies in common sense and reality.

Health claim histories have consistently demonstrated that approximately half of all claim dollars are due to medical conditions that could have been prevented through better health habits. That is a staggering statistic that has not yet seemed to have penetrated the consciousness of policy and decision-makers as well as the general public. Common sense tells us it is less expensive to prevent problems than to cure them. Employer health plans have not effectively embraced that universal principle. Simply offering preventive care benefits in an employee health plan, however, is insufficient. Much more is needed by way of patient education, regular follow up and proper alignment of interests and incentives. When one examines claims data, one finds the percentage of claim dollars spent for preventive care generally to be around one per cent. Considering potential savings, preventive care is seriously underutilized. That brings us to the reality issue.

The present health care system has produced a delivery model that can not help but be expensive and ripe for abuse. Essentially, it gives consumers a credit card (in the form of a health benefits card) to use with suppliers (physicians, hospitals). Suppliers, in turn, tell consumers (patients), in an often emotionally charged transaction, what services they need and how often they need them. In a separate transaction, not usually discussed with the consumer, price is determined and then charged on the “credit card”. It does not stretch one’s imagination to understand why the system is expensive, inefficient and unresponsive.

“Managed care” was offered to the public as the market solution. “Managed care”, however, actually offered little or no management at all. For the most part it involved negotiated discounts with health care providers, herding patients via penalties into those arrangements and adding a layer of bureaucratic checkpoints that might deny certain treatments or retroactively deny payment. The result is an expensive and often punitive administrative structure that has alienated both consumers and suppliers.

Patient Advocates believes that the appropriate manner in which to truly manage health care lies in recognizing certain fundamental realities:

• Patients will act in their own perceived interests, especially when it comes to health care choices;
• Quality health care services, like most things, are ultimately the most cost effective purchase;
• Health care quality, cost and performance are enhanced by promoting competition, not by restricting it through reductions in choice of health care providers;
• Neither the health care system nor most employer health plans provide patient oriented, consumer information at the time of purchase;
• There are little, if any, health plan incentives for employees to improve and maintain good health.

Recognition of these principles forms the basis of Patient Advocates’ services. Patient Advocates offers a range of on-site nursing services to educate patients. These services build a foundation of trust between employees and Patient Advocates nurses that facilitates providing vital guidance to patients when health care purchasing decisions need to be made. These services range in intensity and can be tailored to specific client needs.

Patient Advocates also encourages, as part of its commitment to quality health care, utilization of regional and national Centers of Medical Excellence. Most often, these centers offer the more successful outcomes associated with the latest techniques and higher volumes. In addition, these centers, due to higher volume, often provide superior services and results at a fraction of the cost of local services.

A recent example involved a manufacturing employee from northern Maine needing coronary artery bypass surgery. Our nurse met with patient and spouse in their home and offered the option of a leading Boston hospital. The patient was advised that the decision of where to have treatment was entirely up to him and that the Patient Advocates nurse would be available for him and his family throughout the course of treatment. The patient chose to have the procedure in Boston. A leading Boston heart surgeon performed the surgery with excellent results. The patient was thrilled with the result and back to work in a very short time. That, however, is only part of the story. The other part of the story is that the entire cost of this procedure was approximately one-third the cost of having it done in Maine.

Patient Advocates, through its principals, has a long and productive history of working successfully with employers. In all of those mutual endeavors, the result has been a cost effective, patient-oriented service that has benefited patients. In addition Patient Advocates, LLC is an adaptive, flexible and proactive organization. These attributes have never been more in demand and than they are today.

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