There are a lot of things in life we don’t like to waste: time, energy, money, youth, dessert…these are all precious and deserve to be used wisely.
In this week’s blog, we’re looking at healthcare waste. This refers to any resources or activities that don’t directly improve patient health or well-being. There are many components to healthcare waste, and not looking to reduce it leads to inflated benefit premium costs on your plan.
Prescription waste comes in many forms:
Doctors prescribing larger-than-required doses
Employees filling brand-name prescriptions, instead of generic equivalents
Employees filling prescriptions, but not completing treatment
Medication going unused as employees and their medical professionals try to find the right medication for them
Employees not taking advantage of programs and cost-saving initiatives when filling prescriptions
Insurance companies have created many tools to try and reduce prescription waste:
For certain medications (particularly narcotics), a smaller supply (ie: 3 days) will be initially filled to cover the time period when the drug’s need is expected. This minimizes becoming addicted to the medication; unused medication being used by others (ie: teenagers); and the possible sale of narcotics on the streets.
If your benefits plan can include pharmacogenetics – include it and encourage its use. Finding the right medication sooner is not only a game-changer for the patient, but reduces a significant amount of medication trial & error waste.
Certain classes of medication (particularly biologics & biosimilars) will be filled by specialty pharmacies in order for reimbursement coverage to be maximized. This results in not only lower costs for the plan but better adherence as there’s a team of specialists working with the employee on treatment.
Many plans have been designed to nudge employees towards pharmacies with lower costs, such as Costco – especially for maintenance medications. This is generally done via higher reimbursement levels or lower per-prescription deductibles.
A significant number of group insurers offer tools for employees to check pricing on brand-name vs generic medications; where to find lower-cost pharmacy dispensing fees; etc.
Extended Health & Dental
Have you noticed all of the signage & communication that magically shows up in late Fall, “reminding” you to use up your benefits before the New Year? It’s a common trend for items such as massage therapy and vision benefits. How about the dentist who notices you have a new insurer – and “now’s a great time to have all of those x-rays redone and fillings looked at!”. Employers can curb much of this excess spending with communication strategies that highlight excessive claims and the part it plays in benefit costs – particularly when employees are paying part of the premiums.
Fraud within a benefits plan is fraud, plain and simple. It’s commonly committed by:
Employees, claiming for benefits they didn’t receive
Providers, who submit claims in your name that they didn’t treat you for
Crime syndicates – and benefits fraud is one of the fastest-growing areas of gang crime
Both employees and employers can help to battle benefits fraud and reduce this waste in the plan. Some things you can do:
Don’t sign blank claim forms with a practitioner
Regularly review your claims history in your insurer portal, and question claims that you don’t recall receiving treatment for
A quick Google search brings up stories of coordinated fraud within employee groups. If you know this is happening within your workplace, it can be reported anonymously here.
Stealing from the benefits plan is stealing from the employer – and is equally as criminal an offence as pilfering from the cash register. Employers should be encouraged to specifically note benefits fraud consequences in their employee handbooks and include it in refresher materials.
To reduce healthcare waste and keep costs low, minimize prescription waste by using smaller initial supplies and specialty pharmacies, and combat benefits fraud by reviewing claims and implementing consequences for fraudulent activity. This will improve your employees’ health while keeping your benefits plans as efficient as possible.