The landscape of healthcare is constantly changing and the political conversation around the cost of healthcare is typically tenuous, so Vibrant Health is creating ways to help patients better navigate the healthcare labyrinth. The physician leaders have created a Total Cost of Care (TCOC) Quality Committee to review claims data and referral practices to ensure our patients are receiving high-quality care at reasonable prices.

Vibrant Health physicians identified the concern of the cost of care as a point of emphasis when moving from a culture of “Volume to Value”. The innovative culture matched well to the changing climate in the insurance industry; and linked well to improving the patient experience by enabling them to understand their specialty referral options.

Changing Our Processes

“We understand and empathize with the financial burden our patients face from medical care expenses. We felt that reviewing the financial burden and quality-of-care related to our referral practices was our responsibility and could lead to insights about patient motivations and behaviors,” said Ben Morgan, MD, chairperson of the TCOC Quality Committee at Vibrant Health.

The insights have greatly changed the way Vibrant Health refers and informs patients about their cost for medical services such as Imaging and colonoscopy.

“Our referral staff has been trained on our findings and helps educate the patient to make the healthcare decision that best suits their needs. We relied heavily on insurer-provided data to provide quality score and price information and created a referral matrix where we track and evaluate monthly referrals. This allowed us to monitor trends and referral practices by specialty, location, reason for referral and referring provider, while taking into consideration cost, quality outcomes, and patient limitations such as transportation,” said Chris Tashjian, MD.

Empowering Our Patients

As a result, patients took a more active role in their healthcare decision-making process and elected to pursue cost-effective testing and procedure options. This innovation has created a new atmosphere in the Vibrant Health Family Clinics organization.

It has empowered our patient population and staff to be active contributors in their healthcare decision-making. It has given patients the power to question what’s best for their care and find solutions that fit their personal needs and concerns. They appreciate the education and time spent to ensure a comfort-level with their medical decision, said Dr. Morgan. And overall, it’s been really good for our business.  We have seen a decrease in Vibrant Health’s Total Cost Index, Resource Use Index and High Tech Non-ER Radiology Usage, said Dr. Morgan.

Our next step is to work more closely with hospital readmissions, and work to increase utilization of outpatient surgery centers.