Employers and Coalitions

The Employer Challenge

CEOs say that improving business efficiency and profitability are the top business priorities. So, what can be done about the cost of healthcare? Is it truly uncontrollable? Employers and Coalitions

Modern healthcare is the only market in which a product or service is provided for a consumer (the patient) by a second party (the physician) through a third party (the hospital, clinic, or laboratory) paid for by a fourth party–who also negotiates the pricing (insurer or TPA) –on behalf of a fifth party (the employer). It is truly a complex situation.

There are answers–just not simple ones. The challenge is to provide greater coverage without just shifting the burden to employees through higher premiums. Many companies have gravitated toward consumer-oriented solutions, such as Wellness, Disease Management, and most recently consumerism in the form of consumer-directed healthcare programs. These programs are not turning out to be the silver bullets that many had hoped.

Is it possible to improve quality and responsiveness to customers, while simultaneously lowering total costs in the system? We believe it is. In fact, the problems in healthcare are similar to other industries and can be treated in a similar manner. The key is understanding that large problems are not solved by functional experts working in isolated silos, nor are they solved by quick-hit technology solutions. Major business problems almost always require:

  • Structured approach to identifying the root causes of the problem
  • Broad, cross-functional approach to defining and deploying the solutions
  • Significant change in the way we view the world
  • Dramatic, and usually uncomfortable, changes in behavior

Healthcare is viewed by most as an external factor, something that is largely beyond our ability to control in any meaningful way. The better approach is to view healthcare as an internal factor that is a manageable part of an enterprise.

Historically, employers have looked to the provider community to become more efficient as a solution to reduce their cost. Now, employers are recognizing that they need to get more control over their healthcare spending (both in creating healthier patients and how they design their health plans). Large employers have relied on third party administrators to manage their healthcare checking accounts, but are now finding that these plans are not managed with their best interest in mind. Thomas Group has identified multiple avenues to impact healthcare costs for employers:

  • Helping Employers Better Manage the TPA Process
  • Value-based purchasing (identifying drivers to change behavior)
  • Predictive modeling
  • Managing variability of provider charges
  • Bringing a Culture of Health, Like Safety
  • Absenteeism
  • Presenteeism
  • Consumer-driven Healthcare
  • Wellness programs
  • Process Value Management
  • Facilitation
  • Knowledge Leadership
  • Culture/Change Management
  • New Product/Service Innovation
  • Sales and Marketing
  • Supply Chain
  • Operations
  • Finance and Administration

Case Summaries

Thomas Group’s integrated services deliver powerful business solutions that solve real business challenges. Browse our recent client engagements below, and you’ll find the work of thorough, knowledgeable, and collaborative professionals determined to create value and solve your business challenges.

Healthcare Coalitions
Community Coalition
National Employer Health Coalition
National Health Care Think Tank

How Thomas Group Can Help You

Thomas Group helps employers align business processes, people, and technologies to aid cycle time reduction, administer products and services more efficiently, and engage employees to take greater roles in their healthcare decisions, through better information and information exchange.