Illinois, state employees can cut health spending without sacrificing care
Health care weighs heavily on Illinois' budget. The state spends nearly $11,000 a year for every man, woman and child covered by the health insurance plan for state workers. For a family, the annual cost of a state health plan is equivalent to that of a new minivan.
Those costs are unsustainable — for the state and for state employees. Gov. JB Pritzker and Springfield lawmakers need not accept this status quo.
By nudging state workers to receive care at independent physician practices and outpatient-surgery centers — instead of more expensive hospital-owned facilities — lawmakers can simultaneously ease the burden on taxpayers and help government employees access top-notch care.
The same medical procedure costs more when performed in a hospital rather than in an independent setting. An analysis of the 50 most common procedures conducted by the medical group I lead, Duly Health and Care, last year found that hospital payment rates from one large insurer were 31% higher than rates from independent providers. Those higher rates are one reason insurance premiums keep going up.
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For patients, hospitals' higher costs can translate into thousands of dollars in additional out-of-pocket expenses.
Research shows that independent physician practices provide care that is just as good — if not better — than that delivered by hospital-based providers. Physician-owned practices report fewer preventable hospital admissions and fewer readmissions than their hospital-owned counterparts. Patients also tend to be more satisfied with the care they receive at independent practices over hospitals or health care systems.
Unlike hospital-based providers, independent doctors can take the time to get to know their patients. Patients may be able to see their doctors more quickly. That can enable them to take action before a health problem has the chance to fester, which also obviates the need for costly follow-up care.
Last November, the governor's budget office forecast that state health care spending would rise by $1.1 billion over the next year. Surely, it's preferred to get the best bang for the health care buck. Shifting more of the care the state pays for to the independent physician practice setting — whether by educating employees about the savings, ensuring that independent practices are in-network or contracting directly with independent practices — could do just that.
Dr. Paul Merrick, chief physician executive and chairman, Duly Health and Care, Oak Brook
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