What Does Effective Healthcare Steerage Look Like?
The price of healthcare procedures can vary by thousands—if not tens of thousands—of dollars among different providers and facilities. Even with new hospital price transparency rules, navigating this system is difficult for patients, many of whom have delayed or canceled procedures due to cost. This is especially true for low-income patients or those in poor health, and can lead to worse health outcomes in the long run.
Quality also varies between providers, and high cost is not necessarily indicative of high quality. In fact, high quality providers are often less expensive than lower quality providers.
What is Healthcare Steerage?
To support patients as they navigate this baffling system, payers might employ a method called steerage, also known as healthcare navigation or guidance. Steerage occurs when a health plan directs a member to a better, more affordable provider who is in their network. This process also might include incentives for members who go to the recommended provider, such as reduced or waived out-of-pocket costs.
In turn, both the patient and employer save money, and the patient gets a better healthcare experience.
What Does Effective Steerage Look Like?
An employee of a national lawn and tree service company who works with Flume needed gallbladder surgery. The employee faced a $35,000 charge from an out-of-network provider for facility charges alone—not including the cost of the procedure itself.
Additional charges would incur for the physician and anesthesiologist. Flume was able to negotiate the facility cost to $24,000, but the member would still be responsible for their deductible and co-insurance.
Flume coordinated with the employee to ensure they were willing to switch to a less expensive provider. In addition, Flume identified that the procedure was safe to proceed outside a hospital facility.
Flume identified a lower-cost, higher-quality physician less than an hour’s drive away, and coordinated with the patient and provider to schedule an appointment. After updating the authorization to reflect the new provider, Flume’s claims department paid the bill accordingly and without any patient responsibility.
The new provider charged a $6,500 bundled fee, a total savings of more than $28,000. The employee was not charged any out of pocket fees.
In addition, the lower-cost provider had a higher performance rating according to Healthcare Bluebook: a Quantros score of 92.4/100 versus the higher-cost provider’s score of 63.9/100.
By steering this employee elsewhere, Flume helped them to receive a high-quality procedure at zero cost to them.