Employee Benefits... General Better Outcomes a...
Better Outcomes and Employee Satisfaction Through Episodes of Care!
By Lars Schultz, Hausmann-Johnson Insurance
Employers often find it a challenge to create ways for employees to bring their best selves to work every day.  Research has shown us that wellness is not just the physical health of the employee, but much more than that.  Financial health, personal health, emotional health etcÖ  I have heard from many HR professionals that issues involving healthcare can be one of the top reasons for employee dissatisfaction/stress and I wanted to introduce you to a new way of thinking called Episodes of Care.

The episodes are derived from big data and the data is drilled down to each episode of care.  Now this data is different from the typical carrier data you are used to seeing.  The idea of episodes of care isnít brand new but Iíve found that it is rarely talked about.  Let me first explain to you what episodes of care is, then we will break down the different parts of it to show you how this great tool is used.  Not only to drastically improve employee and dependent satisfaction but in bending healthcare trend.  We will focus on the employee satisfaction in this blog.

Episodes of care is to follow a single patient through from the start of an episode or condition all the way through completion or return to health.  We are asking ourselves these questions:  What happened?  What happened to others?  Why did it happen?  Should it have happened?  Did the right thing happen?  We are also looking at things like:  appropriateness of care, the timing and sequence of care to get to the best possible outcome for the patient.

Timing and Appropriateness of Care is the physician using the correct diagnostics at the right time to reach a diagnosis.  Is the treatment appropriate for the diagnosis?

Sequence of Care is the game plan of what the physician will do when a patient explains their symptoms.  Our example below shows pneumonia like symptoms.  What is the physician going to order as far as diagnostics like an x-ray or what medication and in what order.

Picture from Gerald W. Frye Presentation: The Limitations of Transactional Data

As you can see in the example above with Physician A the office visit copay is $20 more than physician B, Physician A followed the same treatment pattern as Physician B except Physician A has a team of nurses that make follow up calls to the patient to see how they are doing and making sure they are taking the prescribed medication, while Physician B did not.  We can plainly see that the condition got more complicated in the Physician B example and the patient required a hospital stay.  If the member looked at a transparency tool for the cheapest doctor visit they would have gone to Physician B.

I also want to point out the time to return to health.  Two weeks for Patient A and three weeks for patient B.  Not only did the episode of care cost more for patient B, but the return to health took a week longer.  Patient A is feeling great about their outcome and return to work while patient B endured a longer road to recovery and a more expensive episode which could lead to financial and emotional stress for the employee.

The great thing about episodes of care is we can answer these questions and for all sorts of diagnoses.  The employer can give your employees the outcomes they deserve while saving the employee and the employer from spending unnecessary dollars on healthcare. 
Your employees will thank you by bringing their best, most productive self to work every day!
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