An MRI or X-ray reflecting no musculoskeletal damage may lead to an unnecessary painkiller prescription. A surgery where an incorrect body part is operated on falls under the heading of malpractice; but what is the classification for an unnecessary surgical procedure or prescription? How many unnecessary surgeries could be avoided with a treatment plan that is focused on return-to-work protocols or physical rehabilitation. Prescription (RX) utilization and MRI/X-ray scan costs are reduced when noninvasive alternative therapies are included by a plan sponsor as the recommended initial approach.
Twenty percent of the U.S. Gross Domestic Product is devoted to healthcare. Ninety percent of MRI’s and X-rays may be unnecessary as they will only indicate a bone, ligament or tendon issue and are unable to detect soft-tissue muscle problems. Prescriptions for opioid pain relievers are fairly common following an MRI or X-ray. Frequently, a patient experiencing soft-tissue pain is better served with a lower cost and non-addictive pain solution such as ice and Ibuprofen.
There are an increasing variety of innovative solutions for reducing medical and pharmacy costs. The most impactful savings approach is to focus on reducing the cost of frequent, predictable claims, an example is scheduled procedures. This highly variable “frequent claim layer” could easily range up 80% or 90% of the health insurance dollar for mid-sized employers. Increased data transparency provided by self-funding allows for more accurate identification and measurement of claim frequency trends. The employer can then implement more targeted cost control initiatives.
Participation in a medical stop-loss group captive can smooth renewals and lower an employer’s medical benefit spend by spreading risk and applying the principals or risk pooling to enhance long-term rate stability. Surplus returned in the form of dividends serves to further reduce an employer’s cost of benefit delivery to employees.
Donald McCully runs Medical Captive Underwriters LLC, (www.medicalcaptive.com). A program management company focused on alternative risk transfer solutions to lower employer’s costs in both accident and health & property and casualty insurance. Primary focus today is employee benefit advisors assisting them to lower medical spend and medical trend for employers enrolled in ClearCaptive. ClearCaptive is a 50 state open, stop-loss captive solution for middle market employers above 50 employees enrolled on the Plan.