You probably can’t help but notice lately all the reports about the Supreme Court hearings on the Affordable Care Act (healthcare reform). This is a heated topic in the U.S. because the American health care system is almost unique in the extent to which it funnels health spending through employers. While most of the big developed nations use some type of universal single-payer system that socializes health costs across the entire economy, about 60% of U.S. health care spending goes through employers via employer-sponsored medical insurance. So while U.S. employers are heavily impacted by health care expenses, many of those companies’ competitors in the global economy don’t bear those costs.

While I am not commenting either for or against the Affordable Care Act, I wanted to share with you an interesting report about how employers out there feel about it.

The survey, from GfK Custom Research of North America, found that 56% of the 502 privately held companies questioned said they were likely to continue offering their employees health insurance even if the insurance mandate portion of healthcare reform is enacted as planned in 2014. Just 12% said they would be “very” or “somewhat likely” to drop coverage, while about a third said they didn’t know what they’d do.

This is important, because by providing your employees with health insurance, you are privy to much more data about their health (on a macro level, of course, not on an individual level). This provides important information that can guide your investment in employee wellness. After all, if 35% of your employees have diabetes and/or are overweight, you know where you’re going to focus your spending, right?

Also, when you provide the insurance, you also have more control over the quality of that insurance and the care provided. That’s because you can require that health plans and their providers meet certain evidence-based parameters shown to improve health-related outcomes. This, in turn, could keep your costs down by preventing acute exacerbations of chronic conditions like diabetes, asthma, and heart disease that could otherwise be managed.

All is not completely rosy with the employer/healthcare reform dynamic, however. The GfK survey also found that many employers fear that the new law won’t slow cost increases, or might make costs worse. How it will impact U.S. employers will depend partly on the Supreme Court’s Obamacare decision in June. I believe the results could be dramatic for America’s health care system.

Employers’ ability to control costs will depend on two giant decisions. First is the Supreme Court’s ruling on the constitutionality of the individual mandate. If the justices give it a thumbs-down, employers are in a quandary. They like a mandate because it could lower their insurance costs by forcing more people into the risk pool. And in a world where everyone is legally required to maintain insurance, employers may feel less pressure to offer it, and their costs would likely decrease as they encourage more individuals to purchase their own health insurance through the new insurance exchanges. If the mandate is voted down, employers may choose to continue doing what they’ve already been doing—increasing copayments, deductibles, and premiums.

If the mandate is upheld, then everything depends on the second big decision: the voters’ choice in November. A Republican sweep would probably mean Obamacare’s repeal, while a more muddled election result probably wouldn’t.

One part of the law that can help large employers is the medical loss ratio component. This part of the law, which just went into effect, requires that at least 85% of every premium dollar be spent on actual medical or preventive costs, not marketing or administrative costs. Hopefully that will provide some savings. The good news is that if health plans don’t meet the ratios, they are supposed to refund some of the overrun to you, the customer.

So have you figured out your position on healthcare reform yet? Assuming the full force of the Affordable Care Act is implemented, how do you see it affecting your business?

Bob Fabbio
President & CEO
WhiteGlove Health, Inc.

In today’s business climate, most employers are focused on lowering their healthcare costs. Historically, the cost trend for healthcare has continued to rise with no reprieve in sight. This means that employers are searching for ways to lower their costs while not upsetting their most valuable asset – their people. And trying to modify health plans in the midst of ensuring they are in compliance with the new rules established by the healthcare reform laws is a challenge.

The two most common strategies used by employers to lower their healthcare costs are shifting more of the cost to their employees/dependents and minimizing the use of their health plan through wellness initiatives. And while putting programs in place to incentivize employees to be healthier (consequently lowering healthcare costs and increasing productivity) and giving them tools to seek the lowest cost provider are noble things to do, they only have limited utility in truly lowering cost. In the end, these are all just attempts to use an expensive healthcare delivery system less or spot the least expensive provider in the system. But in these approaches, employees and their dependents are still using the same expensive, fee-for-service based healthcare delivery system. The same system that includes the cost for 5 support/administrative personnel for every doctor in America; the same system that requires the patient to endure all kinds of costs, hassles, and inconveniences.

So, what history has shown is that in spite of all the efforts that benefits consultants and employers go through to lower their healthcare spending and break the trend, it isn’t working. Kaiser reports that over the last five years, both employers and employees have endured double digit increases.

The reason is simple. Employers and benefits consultants cannot change the inherent cost and inefficiencies found in the healthcare delivery system made available to them by their insurance companies.

It is time to Think Differently About Healthcare. If employers combine proven wellness initiatives with access to a lower-cost, higher-quality healthcare delivery system, they now have a winning combination. That’s what we’re already doing with hundreds of employers at WhiteGlove Health. Employers that are working with WhiteGlove give their employees and dependents access to acute care, chronic care, and wellness 365 days a year. The experience is extraordinary, the clinical outcomes are better, and it’s a fraction of the cost. High-quality healthcare that comes to people, not the other way around.

Bob Fabbio
CEO – WhiteGlove Health

In the midst of a very busy schedule 2 weeks ago running from meeting to meeting in 100 degree heat with suits on during our IPO roadshow, I started experiencing vertigo (a few times a day on Tuesday to 20 times on Thursday). I have never had this before. Everything was spinning while walking, eating, presenting, and even sleeping. On Thursday night, I decided that I should drive from NYC to Boston instead of flying. I was worried about how I was feeling. Thursday night, on the car ride to Boston, I decided I should schedule a WhiteGlove visit in my hotel room for 8am Friday morning before we started another pretty busy roadshow day; which I did. Unfortunately, an hour outside of Boston, a dizzy spell started and lasted for more than 30 minutes where it feel like I was completely drunk with bed spins riding on a crazy amusement park ride and it would not stop. Everything was amplified. It caused us to pull over on the highway where I could not stop violently throwing up (or stop the bed spins) for nearly 30 minutes. It was awful. So, I made a decision in that moment to forego my WhiteGlove visit the next morning and go directly to the Massachusetts General Hospital ER that night. We got there about 11pm Thursday night and I did not leave until 5am on Friday morning. While in the ER for 6 hours, they administered all the most expensive medical services they could … EKG, lab work, and a 45 minute high resolution MRI of my brain. Talk about running the meter! This, coupled with multiple instances where they confirmed the wrong name or address throughout the 6 hours, they provided care to me in a hallway (no privacy), and they only spent about 10 minutes of time with me providing care is so ILLUSTRATIVE of the problems we have in America with healthcare. Massachusetts General Hospital is supposed to be one of the best in the country. HERE IS WHAT’S MOST AMAZING – Thursday night’s ER experience probably cost me $10,000 and after 6 hours they could ONLY tell me that my vertigo symptoms was likely caused by an inner ear problem – YET, THEY NEVER ONCE LOOKED INTO MY EARS OR NOSE!

On Saturday morning, now home, I was still congested and not feeling quite right. I called WhiteGlove again, this time to come to my house. A nurse practitioner showed up within 90 minutes from my call for an 11am appointment. After a 20-25 minutes with the NP, he diagnosed without a doubt that this week’s issues were due to an inner ear problem where my tubes are not draining properly and thus throwing off my equilibrium. How did he do that? He asked different questions and simply looked in my nose and ears and saw symptoms that would suggest that I was very incredibly swollen and congested. The nurse practitioner gave me a cortisone shot and some other prescription meds and it cost me a TOTAL of $35!

So, $10,000 and 6 hours in the ER … vs. $35 and 25 minutes with WhiteGlove at home. And by the way, the nurse practitioner was *absolutely* terrific! If I had not had had such an awful experience in the car on the way to Boston, I would have been seen by WhiteGlove on Friday morning and I could of saved myself and the company $9,965 and lots of lost sleep before a busy day on Friday.

One day later — Sunday, I am feeling 1000% better than I was when I left on Tuesday! So, thank you to the WhiteGlove team for doing what it does. This personal story is a great example of the kind of impact we are able to have on society and healthcare. And just more real world validation.

Bob Fabbio
CEO
WhiteGlove Health