Here’s an old joke: What do you call the person who graduated last in their class at medical school? Doctor.
Not all providers are created equal. Some have more experience with certain populations. Others have specialized training. Others clearly score last in their quality of care. However, with traditional insurance, none of these factors are as important as whether or not they are “in-network.”
“In-network” means a doctor or provider has agreed to terms with the insurance company. It doesn’t mean that they are the best quality provider or even the lowest cost. They’re just “in-network.”
Believe it or not, when it comes to healthcare, cost and quality have an inverse relationship — the higher the cost, the lower the quality of care and vice versa. How can this be?
Think of it this way: If you need surgery and go to the local “in-network” doctor, they may need specialized equipment for the procedure. That cost is now yours. In addition, because they are not a trained specialist, the chance of relapse and repeat visits increases dramatically. All along, your costs keep mounting. Poor care = high cost.
However, if you go to a world-class doctor who performs the procedure several times a week, the equipment is there, follow-ups and readmissions are non-existent, and you’re back on your feet in no time. Excellent care = low cost.
Healthcare providers encompass a wide swath of professionals, many of whom reside outside the traditional hospital/insurance structure we’re accustomed to. Top-tier doctors in every field run specialized clinics that can save significant money upfront because they don’t have the massive administrative staff of a hospital. And in the long term, costs are kept down because once the procedure is done, readmissions are much less frequent.
By guiding employees and their families to the right providers, you can help lower their costs and improve the quality of your clients care by avoiding the infamous “Doctor” in that old joke.