Benefits of VEBA Empower employers to improve the quality of care for their employees

• By Evan Falchuk
• 01/01/08

Three years ago, the Rand Corporation’s The First National Report Card on Quality of Health Care in America reported that patients in the United States have a 50 percent chance of getting the right care. The media jumped on the story, calling it “coin-toss medicine,” and it helped spark a national quality improvement movement.    

What is quality in healthcare? Quality continues to be a hot topic in healthcare. As of late, the industry has not looked at the issue of getting the right diagnosis and treatment as the fundamental quality metric. A recent report by the consulting firm Hewitt, entitled The Road Ahead: Emerging Health Trends 2007, shows that this may soon change. Employers are beginning to target the root of the issue and are looking for solutions that influence the interactions between providers and their patients.

This focus on quality at the point of care is long overdue, creating an opportunity for health plans and employers to adopt new ways to help patients partner with their doctors. In particular there is a need to create the tools that patients can use to make sure they are asking their doctors the right questions, especially those patients diagnosed with serious and/or chronic medical conditions and illnesses (like cancer).

In these types of situations, healthcare quality can be vastly improved — without question — by the availability of services that give patients the right information to work with their doctors. Even some of the most rudimentary information can be helpful, but when it comes to serious illness, the need for focused, detailed information is even more important. The stakes are high and the impact of error is great.

Getting to Quality - VEBA

One example of healthcare quality innovation is the Southern California Schools Voluntary Employees Benefits Association (VEBA), a cooperative labor-management trust program committed to achieving the highest quality and most cost-effective benefits programs for every eligible education employee in Southern California. VEBA covers 86,000 members in 32 school districts, representing 70 percent of the San Diego educational employee population.

In choosing which benefits to offer their members, VEBA had in mind helping those members with the most serious and critical conditions. Fifteen percent of VEBA members account for 85 percent of their total healthcare costs given the severity of condition, frequency of misdiagnosis, and resulting incorrect treatment paths. To address the quality gap, VEBA identified and implemented an innovative health care program called Best Doctors.

The goal of VEBA healthcare benefits program is to provide the best quality care by offering innovative benefits to achieve the highest quality of life. VEBA understands that quality care costs less.  VEBA worked with consultant group Towers Perrin to find services and tools to bolster healthcare quality and was introduced to Best Doctors.  This company works with hundreds of employers providing trusted medical expertise to seriously ill patients and their treating physicians. VEBA saw that Best Doctors could give their members the tools they needed to get the right care.

Quality = Right Diagnosis + Right Treatment

The Best Doctors service is included as part of the benefits plan to VEBA members and their eligible dependents. They simply call Best Doctors if they are diagnosed with a serious medical condition. Medical experts help the member answer their most pressing questions — is my diagnosis correct? Am I getting the right treatment? In this way, the service is able to improve the quality of care and provide its members with the peace of mind that comes with knowing they are on the right track to get better.

Within half a year of enrolling its members into Best Doctors, one VEBA member’s life had been saved and more than 50 others are on track to better care with the right diagnosis and treatment. Best Doctors has seen misdiagnoses happen more than 20 percent of the time and wrong treatment plans 60 percent of the time.

Take for example Barbara Smith, a high school teacher in San Diego. Barbara went to her physician with severe neck and back pain and headaches. When the pain medicine her physician prescribed didn’t work, he suggested that Barbara see a chiropractor, who in turn referred her to an orthopedist who ran an inconclusive MRI. Barbara was then referred to an acupuncturist, and finally a pain management specialist. This last doctor suggested an epidural to address the pain.

Like many patients, Barbara was scared and confused by her fragmented healthcare experience. While preparing for the epidural, the attending doctor told Barbara that she should have had a bone scan prior to the epidural. This did not help Barbara’s confidence in the system. The scan revealed a cancerous tumor on her neck bone; cancer treatment was needed right away. Two months into the treatment new acute symptoms occurred.

Barbara shared her disappointing healthcare experience and results with her employer who suggested Barbara utilize the Best Doctors benefit, a medical expertise service.

"Best Doctors gave me the hope and security that I would be okay," said Barbara.  The Best Doctors medical experts stepped in immediately, analyzing her complete medical history, tests, and diagnosis. Best Doctors navigated Barbara through her complex medical condition, demystifying the diagnosis and adjusting treatment so today Barbara is well. Best Doctors gave Barbara confidence that she would receive the proper diagnosis and proper treatment. She was also pleased that Best Doctors would partner with her current physician. And anticipating the future, Best Doctors recommended that Barbara’s children have genetic testing so they could be prepared for, if not avoid, their mother’s condition.

This kind of approach represents a true strategy for quality improvement. The point of care is where healthcare decisions are made that lead down the right path or the wrong one. The most important contribution anyone can make to the improvement of the quality of care is to make sure that each patient has the right diagnosis, the right treatment, and the best chance to get well. If we want to define quality as delivering healthcare that works, this is one answer we are looking for.

George McGregor is the general manager of the VEBA Trust specializing in health care trust management for labor/management trust funds. For more information, see VEBAOnline.com.