WHAT IS DRIVING CARE?
The healthcare system is often shaped by various hidden incentives that can impact the quality and type of care patients receive. The system itself often creates friction between financial incentives and patient care goals. An expert healthcare advisor can help you navigate these hidden incentives of the healthcare system by acting as the conduit between the doctor, family, patient, insurance company and the healthcare system. We share critical information, ask relevant questions and understand the hidden incentives in health care. Plus, advisors know how health insurance works. Here are a few areas where these incentives might be at work:
1. Doctor billing and hospital discharges
There is a balancing act that physicians and hospitals often face related to billing and discharges. The need to align services with specific billing codes can sometimes influence the type and extent of care provided. And though the incentives are well-meaning, they still can drive care in unintended directions. For example, they might be incentivized to perform more procedures or to discharge patients more quickly to free up beds, potentially affecting patient outcomes.
2. Health insurance brokers
These professionals play a significant role in helping individuals and businesses select insurance plans. However, brokers may have incentives to promote certain plans over others, which may not always align with the patient's best interests.
3. Approving and denying treatment
Insurance companies wield considerable power in approving or denying treatments. Their decisions can be influenced by cost considerations, potentially delaying or denying necessary care for patients.
4. Insurance reimbursement
The way insurance companies reimburse healthcare providers can also drive care decisions. Providers may be more likely to offer reimbursed treatments at higher rates, even if less expensive alternatives might be just as effective.
5. Meeting patient quotas
Some healthcare providers operate under pressure to meet patient quotas, which can lead to rushed appointments and reduced quality of care. This quota system can sometimes prioritize quantity over quality.
How an advisor can help
Deciphering billing practices: Helping you understand what you are being billed for and why.
Managing hospital discharges: Ensuring you receive appropriate follow-up care.
Choosing the right insurance plan: Offering unbiased advice on selecting the best insurance coverage for your needs.
Appealing denied treatments: Assisting with the process of appealing insurance denials to secure necessary treatments.
Maximizing insurance reimbursements: Helping you navigate the reimbursement landscape to optimize your healthcare benefits.
Given these complexities, navigating the healthcare system can be daunting for patients. Relying too heavily on U.S. News and World Report scores may sometimes lead to misalignment with your personal healthcare needs. This is where an expert healthcare advisor can make a significant difference. They have the knowledge and experience to help you understand your options, make informed decisions, and ensure that your care is not compromised by hidden incentives. An advisor adds value by understanding their clients' preferences and maintaining close, personalized communication.