Can Higher Quality Medical Care Save You Money?

January 31, 2024

How an optimized provider network can save your organization money

When it comes to healthcare costs, doctor quality matters.  

If your employees see low quality providers, your organization could end up paying for unnecessary services of care or seeing higher complication rates and productivity losses.  

Worker productivity is a good example. Over $225 billion is lost every year when employees are out on medical leave. Low-quality care, in other words, not only means more upfront expense, but also can mean higher complication rates and longer recovery time away from work. This is the unspoken affordability crisis facing employers and employees.  

When you realize that unnecessary medical care accounts for nearly $210 billion of the estimated $750 billion excess healthcare spend each year, one important place to look is the quality of doctors that your employees see.  

Take cardiology for example, which is a top expense for most employers. For an employee with heart issues in Berkeley, CA, the likelihood of having an inappropriate surgery varies depending on one factor – which cardiologist they see. 

With a lower-evaluated doctor in the market, you are 6% more likely to have a PCI/heart catheterization. Heart surgery is a major event for anyone, and only should only be undertaken when it is medically necessary. Such a drastic procedure can have a long-term impact on a worker’s productivity in addition to the overall claims cost for your organization.

This doesn’t just impact those with heart issues - we see the same challenge in other specialties. For example, we’ve known for 20+ years that arthroscopy, the most commonly performed orthopedics procedure, offers no benefits for a degenerative joint disease like arthritis. And yet, it is routinely performed anyway.  

Your likelihood of having this unnecessary surgery can vary by 14% across orthopedic surgeons in the market.

All this leads to a simple idea: Avoiding low-quality providers and unnecessary care can yield significant savings for organizations.

Consider the alternative: High-performing providers are more likely to prescribe and recommend care that is evidenced-based, and as a result, make sure that employees get their health needs met the first time. By ultimately avoiding unnecessary treatments and costs, employers and employees see the long-term health and financial benefits by preventing more extensive and expense care down the road.

According to a new study from the Business Group on Health, many of the country's largest employers are considering proactive measures to help connect employees to higher value and quality care.  

Elevating the level of care in your community can result in not only lower upfront costs, but also long-term positive impact like lower complication rates, fewer disabilities, and less unnecessary time off for your employees.  

But this is not an easy problem to solve. Until recently, there has not been a standard way to measure the performance of physicians in the U.S.  

As a result, consumers have had to rely on word of mouth or online reviews and are often left with little objective, trustworthy information to make the best healthcare decisions for themselves.

To learn about our methodology for measuring doctor performance, download our technical whitepaper here.  

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SOURCES:

1. Cantillon D.J., Exner D.V., Badie N.et al. : "Complications and health care costs associated with transvenous cardiac pacemakers in a nationwide assessment". J Am Coll Cardiol EP 2017; 3: 1296.

2. Perino, Alexander C. MD, et al. "Patient and Facility Variation in Costs of Catheter Ablation for Atrial Fibrillation." Journal of Cardiovascular Electrophysiology, vol. 29, no. 8, 2018, doi:10.1111/jce.13655.

3. Kwok CS, Amin AP, Shah B, Kinnaird T, Alkutshan R, Balghith M, Ratib K, Nolan J, Bagur R, Mamas MA. Cost of coronary syndrome treated with percutaneous coronary intervention and 30-day unplanned readmission in the United States. Catheter Cardiovasc Interv. 2021 Jan 1;97(1):80-93. doi: 10.1002/ccd.28660. Epub 2019 Dec 26. PMID: 31876371.