The Greater Salem Chamber was the first NH Chamber of Commerce to begin a major study of healthcare costs in December 1999. The decision followed the results of member focus groups that identified healthcare costs as a major concern.
After two years of study, it became clear that health education and changing behavior to reduce the need for healthcare services were the only sure ways to slow the growth of healthcare costs.
GOAL/QPC in cooperation with members of the healthcare community developed seven modules of health education. Harvard Medical School provided the majority of input into the program. Two pilot sessions were taught in Salem, NH companies in 2002 and 2003 and received high marks.
Meanwhile, several other state chambers had banded together to work on the problem of healthcare costs. Participating chambers included Manchester, Concord, Nashua, Keene, Dover, and North Country (?). These chambers focused on a new state chamber plan modeled on a national plan that went out of existence in the early 1990s.
In late 2001, both efforts joined. It was eventually decided to merge the two approaches with Bob King as the chair. The chambers conducted a study and the results are informative. Also see the results of the Adult Uninsured Committee study.
One of the major discoveries of the new effort was that a major driver of costs was the fact that many patients with chronic illnesses do not follow protocols. In fact, separate meetings with each of the states three largest employers led to the conclusion that less than 20% of patients with asthma, diabetes, and chronic heart disease follow protocols and the cost of treating these patients for unnecessary admissions to emergency rooms and inpatient hospitals represents 45% of the total cost of healthcare in the state.
Key aspects of the chamber healthcare plan include:
Target is to reduce costs of health insurance to members by up to 50%.
- The plan will put all of the chamber plan members in one group. Currently organizations with fewer than 10 employees pay up to an additional 20% for administration. (Under SB110 it will be up to 30% spent as administration surcharges.)
- The plan will provide 3 levels of deductibles. The highest deductible will result in a premium savings of up to 25%. The plan will provide for low cost self-insurance so employees need not bear the brunt of the extra deductible. Some companies may also want to self-insure and pay the deductibles when they occur. The deductibles are for hospitalization and emergency visits, which are rare in the lives of most employees.
- The chamber program has a major focus on wellness. It includes health education and significant cost penalties for employees with chronic illnesses or adverse factors such as smoking or obesity (35 pounds or more over target weight). This feature is expected to save plan members up to another 10-20% by the third year of the plan. If your employees are sickly and are not willing to follow protocols, they will pay a lot more out of their pockets and will probably not like this plan or their employer for selecting it.
- The plan will encourage selection of the best doctors and hospitals and those who charge reasonable rates. Initially each participant will be informed of which are the best hospitals for each major procedure. Eventually this will be expanded to include doctors and will factor in costs. Eventually the plan will also rate doctors on quality and will rate both doctors and hospitals on costs. Those participants who go to high quality hospitals and doctors who charge a reasonable rate will have little or no co-pay. Those who do not will have significant co-pay amounts. This feature is expected to bring another 10% saving by the third year of the plan.
Of course many factors such as new pharmacy and procedures will continue to raise the cost of care. These target numbers are not a guarantee but rather the targets that plan administrators have set for themselves in designing the plan.
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