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BridgeHealth
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BridgeHealth helps self-funded groups and their plan members save on surgical costs, while proving access to top-quality care.
BridgeHealth helps self-funded groups and their plan members save on surgical costs, while proving access to top-quality care.

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Health Expenditures as an Ever Growing Trend
 
In the United States, costs associated with healthcare are an ever growing trend, and while real wages barely limp along, the amount of financial means necessary to pay for medical bills increases year by year.
 
The U.S. Department of Health and Human Services monitors national health expenditure and related costs every year. The 2013 report revealed, not unexpectedly, an extreme rise in health related costs:
 
●      in the year 2000, national health expenditure totaled $1,378 billion
●      in the year 2013, national health expenditure totaled $2,919.1 billion
 
The figure has more than doubled within a relatively short period of 13 years, causing a severe rise in medical costs for both households and private businesses:
 
●      Private business expenditures went from $346.5 billion in the year 2000 to $610.9 billion in 2013, and employer contribution to private health insurance premiums rose from $255.1 billion in 2000 to $471.1 billion in 2013.
 
●      The development in household expenditures was even more disturbing - from $434 billion in 2000 to $823.8 billion in 2013, and employee contribution to private health insurance premiums and individual policy premiums rose from $133.6 billion in 2000 to $300.2 billion in the year 2013. [1]
 
Various factors contribute to the overall rise in medical expenditure, including inefficient hospital care, wasteful policies and low quality of care of medical providers. Hospital care is expensive and accounts for a large portion of all the costs related to healthcare - expenditures for hospital care accounted for 38% of all personal health care expenditures in 2013. [2] Hospitals have tried various improvement tactics to bring the costs down, e.g. many surgical procedures (knee arthroscopy, hernia repair, large intestine endoscopy, etc.) are no longer performed on an inpatient basis, but rather on an outpatient basis - there are now more than 50 million outpatient surgical procedures in the United States a year. [3] The effort is obvious, but nothing seems to stop out-of-control medical costs, a fact even more alarming as 47.7 million people under age 65 were living in families which had problems paying their medical bills in the year 2014. [4]
 
Both patients and their employers are being severely affected by the continuous rise in healthcare costs, whether it is reducing their personal income or corporate profits. And that’s where entrepreneurial firms like BridgeHealth come to the rescue. Taking a different approach to handling medical expenditure, BridgeHealth professionals understand how difficult it is for self-insured organizations and their plan members to predict and control healthcare related costs. Through BridgeHealth negotiated case rate pricing, patients and their employers are now informed about the ultimate cost of a surgical procedure in advance and are able to prepare for these costs accordingly. Additionally, the surgical procedures are performed within a specialized network of high quality providers - High Performance Network - surgical programs within the 25% top rated hospitals in the country.
 
Self-insured organizations and their plan members can now rely on BridgeHealth’s assistance throughout the entire process of negotiating bundled prices, which will save patients and employers up to 40% in costs on major surgeries, and ultimately minimize adverse effects, post-surgery complications and hospital readmissions.
 
1) Health, United States, 2013; U.S. Department of Health and Human Services, http://www.cdc.gov/nchs/data/hus/hus14.pdf#105
2) Health, United States, 2013; U.S. Department of Health and Human Services, http://www.cdc.gov/nchs/data/hus/hus14.pdf#105
3) U.S. Outpatient Surgery Passes Inpatient, to 53 Million a Year, Tampa Bay Times, http://www.tampabay.com/news/health/us-outpatient-surgery-passes-inpatient-to-53-million-a-year/1124313
4) National Health Interview Survey Early Release Program, Centers for Disease Control and Prevention, http://www.cdc.gov/nchs/data/nhis/earlyrelease/probs_paying_medical_bills_jan_2011_jun_2014.pdf
 

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Disparity in Cost of Surgical Procedures and Its Impact

In the United States, medical care has always been associated with higher costs than in other developed countries - and the reason for it is not a substantially better quality of care. In fact, Americans generally spend considerably more on healthcare than people in other developed countries, and they don’t gain either higher-quality care or superior health. [1]

One of the main issues regarding uncontrollable healthcare costs is the patient’s inability to get a fixed price before a hospital procedure is performed, as well as gather information about hospital charges. At least, that used to be the case before the federal government publicly released the ‘rate card’ prices (the full charge before insurance company discounts) hospitals throughout the US charge for the one hundred most common procedures and services. It did not come as a surprise that for the same procedure, hospitals charged different amounts of money, and for the first time, outrageous price disparities were disclosed. This exposé provided patients with information that could be quite shocking: a simple joint replacement in the New York City area could run anywhere between $15,000 and $155,000, for instance.

The difference in pricing could be partially explained by variable labor rates, real estate prices, quality of physicians and staff, success rate, etc., but if a procedure costs 10 times more in the same city, let alone the same street, there’s simply no economic explanation other than trying to boost profits, or make up for losses generated somewhere else. [2]

The large amount of data about hospital pricing was first released by the Centers for Medicare & Medicaid Services in the year 2013, and the hope was that now that the public was better informed about the pricing of individual hospital providers, it would be easier for them to shop around, and thus naturally force the most expensive providers to go down with their prices. [3] Sadly, that never happened. Amidst health economics, the outrageous MS Excel data sheet was still highly problematic to navigate through. It would require for a patient to understand hospital procedures in detail, be very well-versed in Diagnostic Related Group codes, as well as copious additional charges - otherwise, he or she are still in the dark about the appropriate cost of a hospital procedure and thus unable to tell whether the hospital is charging them fairly or executing daylight robbery. [4] Furthermore, many insurance plans include only a limited amount of providers that patients can choose from, so even if they wanted to shop around, they don’t always have the luxury of making a choice based on prices.

As self-funded health plans began to develop, it became extremely important to know how much hospital providers charged for their services and what the actual costs were. Regrettably, the hospital charges and costs now being publicly accessible are little of help to most organizations and employers under self-funded health plans and they face the same problem any other lay person would - it is beyond bounds of possibility to gather detailed information and more importantly, negotiate a fixed price for a surgical procedure with a hospital provider. That’s where entrepreneurial firms like BridgeHealth come to the rescue.

BridgeHealth professionals have been helping organizations and their plan members negotiate and pre-determine bundled prices for various surgical procedures since 2007. BridgeHealth not only gives its clients more knowledge and decision power to control healthcare costs, but also guarantees better quality services by working with medical providers and hospitals in the top 25 percent nationally.
 
Together with pre-negotiated bundled prices, the superior quality of medical care will considerably reduce possible medical complications, eliminate extra costs - savings range anywhere between 15-40% per procedure, and give the plan member full control to manage healthcare costs.
 
1) Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences, The Huffington Post, http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html

2) The Great American Hospital Pricing Scam Exposed - We Now Know Why Healthcare Costs Are So Artificially High, Forbes, http://www.forbes.com/sites/rickungar/2013/05/08/the-great-american-hospital-pricing-scam-exposed-we-now-know-why-healthcare-costs-are-so-artificially-high/

3) Medicare Provider Utilization and Payment Data, Centers for Medicare & Medicaid Services, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/index.html

4) Disparity in Medical Billing, The Washington Post, http://www.washingtonpost.com/wp-srv/special/national/actual-cost-of-medical-care/

The inefficiency of healthcare system in the United States is overwhelming and healthcare-related costs have become paralyzing for both patients and their employers. Hospitals’ ceaseless endeavor to maximize profits by specializing in every single medical area, condition and treatment, and trying to satisfy all patients has unfortunate outcomes:

·       Hospitals have turned into oversized dinosaurs that are inflexible, ineffective and oftentimes incompetent to provide high quality, coordinated care.

·       The current healthcare system is so complicated that the patients are incapable of making reasonable, informed decisions about healthcare spending.

According to Consumer Reports Health, 80% of all medical bills contain errors, yet healthcare consumers are always kept in the dark about actual medical costs, which prevents them from simple price shopping for a medical provider.

For as utopian as it might sound, superior care for lower costs is now easily accessible with BridgeHealth. BridgeHealth’s High Performance Network of medical providers offers pre-negotiated bundled prices, providing less costly surgeries and high quality care within top-rated surgical programs. With BridgeHealth you can reduce risk in quality while being fully informed about the ultimate medical bill.

Within the standard PPO networks, patients have to deal with various levels of quality of healthcare because these networks are ‘all inclusive’. For a patient, obtaining detailed information about a hospital’s practices and quality is problematic, to say the least, as the majority of hospital administrators are simply unwilling to release quality data and provide transparent system of medical costs and prices. In consequence, the decision power of patients as healthcare consumers is limited and most of them eventually choose their medical provider based on convenient location, not realizing that better quality for lower costs is available.

BridgeHealth’s professionals assist patients and their employers with making informed decisions about surgeries and specialized procedures, presenting top-quality medical providers and substantial savings.

Every medical provider incorporated in BridgeHealth’s High Performance Network is rated in the top 25 percent nationally in the Comparion CareChex Hospital Quality Rating tool, which uses multiple quality factors, e.g. infection and complication rates, mortality rates, re-admittance rates and patient satisfaction surveys. Choosing a medical provider within BridgeHealth’s Program bears major benefits:

·       Undesirable side-effects, such as post-surgical complications and prolonged recovery due to a poor quality treatment, are eliminated as the price of each individual surgery is negotiated and determined in advance and it is thus in the hospital’s best interest to offer the best quality care, otherwise any complication-related costs and readmissions would be covered by the hospital itself.

·       Instead of receiving exorbitant medical bills, the patient can expect enormous savings on major surgical procedures – anywhere between 15-40% compared to discounted costs through the current PPO network.

BridgeHealth offers patients and their employers plentiful information about each provider’s quality of care as well as the total costs of a surgical procedure. As a result, patients are in better position to make an informed decision when choosing the right provider and thus receive high quality care, with minimum surgery-related complications and for lower costs.

Businesses in the United States as well as their employees are becoming increasingly burdened by out-of-control healthcare costs that inflate their monthly premiums and deductibles. Between the years 2005 and 2013, in fact, premiums for employer-sponsored health insurance coverage soared:

·       For employee-only, premiums rose by 42.4 percent
·       For family coverage, premiums rose by 57 percent

It is difficult for business owners to control healthcare expenses through regular insurance plans and premiums, which results in additional costs. As a result, many employers are now searching for ways to decrease health care costs with their current insurance carriers, or opting for self-funded health plans – in 2014, 55 percent of employees in firms with 200 to 999 workers were self-funded.

Various reasons lie beneath the inability for businesses and their employees to manage healthcare costs, but the failure to predict the final costs of medical procedures and treatments is predominates. With various factors and third-party entities merging into the process – laboratory tests, payments for hospital staff, surgeon, anesthesia fees, etc., the system of hospital logistics has become so complicated that the ultimate price is never carved in stone. As this model increases the hospital profits – the more they do, the more they get paid – it is also becoming extremely inefficient for patients, whether it is about running avoidable lab tests or making the patient pay for possible failings of the hospital in case of complications. Sadly, this presents a vulnerable position for the ones who share the healthcare costs - patients and their employers, as they are not able to forecast the exact final costs and make arrangements accordingly.

There is a solution to managing out-of-control medical costs – a bundled payment system with pre-negotiated prices for all hospital and doctor costs for individual procedures, mainly surgeries. Knowing the definite price for a specific surgery will help patients and their employers prepare for these costs properly and give them the advantage to plan ahead instead of blindly walking into the darkness and helplessly expecting the final bill that might ruin their savings. Another major benefit of pre-negotiated procedure costs is the full responsibility of the hospital and the doctors in case of procedure complications – what would formerly require extra money out of the patient’s pocket is now the hospital’s liability.

BridgeHealth is now able to assist sponsors to negotiate fixed prices for surgeries and other medical treatments. Since BridgeHealth only works with medical providers and hospitals in the top 25 percent nationally, best quality medical care is assured. Together with pre-negotiated bundled prices, the high quality of care will significantly reduce possible medical complications, eliminate extra costs and give the plan member full control to manage healthcare costs.

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Experts are still debating, but one thing is for sure—we need to figure out what caused the 2013 slowdown in health spending if we're to determine how to control our health dollars moving forward: http://ow.ly/GjhtU

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With rising out-of-pocket costs and inaccessible price information, Americans see basic medical care as a hardship: http://ow.ly/GbNsu

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There's no doubt that informed patients make better decisions about their health and treatment options—but who is there to supply that information? ow.ly/G80NJ

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Medical tests are a big source of revenue for physicians as the cost of tests go up and prices for equipment go down: http://ow.ly/FZwsg
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