Introduction

While “localization” is a hot topic in healthcare right now, the reality is that healthcare has always been local — a reflection of the relationship between a provider and a patient in a specific market. The dynamics of that market shape how care happens and specifically how local healthcare is delivered using metrics that quantify clinical outcomes, provider access, and cost.

Employers are becoming more willing to embrace market-specific approaches in their efforts to provide the highest quality and most cost-effective health benefits programs, including how to connect their people to high-performing doctors and hospitals.

Here’s what we can expect to see in this next wave of localization.

An Evolving Approach to Data

Information is driving the localization of healthcare — specifically, there is a growing wealth of data, unavailable before, that can pinpoint where people can receive the best care for their specific needs. Instead of just saying “This hospital is better than that one,” employers and their people can now access information about which providers have the best record of outcomes for specific types of surgeries or procedures.

So while one clinic may have a better overall reputation than another, if you’re having a colonoscopy, it may turn out that a lesser-known facility actually has a superior track record of patient outcomes and lower costs for that procedure.

As the available data in healthcare cost and quality advances, there is a clearer picture of the wide variability not just from hospital system to hospital system, but among hospitals within the same system, in the same market. This variance between providers can be as much as 300 percent¹.

One hospital system may have the best overall quality rating in a large city, but it may include individual hospitals with the worst scores for a given procedure.

People want to know where they can get the best care, and employers can help guide them to make the best decisions for their wellbeing while also cutting excess cost and waste from their programs.

Enhanced Consumer Access to Information

Americans often equate quality care with large, well-marketed hospitals, but they are becoming more aware of the variance in medical outcomes within their local geographies. This is due in part to the Affordable Care Act (ACA), which has promoted programs to reward hospitals for focusing on better medical outcomes at a lower price point.

Employees and their families want reliable information on the best providers in their communities. Until recently, that information was often hard to find and understand. But as healthcare consumers have gotten smarter, they are more alert to the realities of both costs and clinical quality. They are reading the popular press and sharing on social media, and they have seen the variability in care even within their circles of friends and family.

They recognize that healthcare outcomes vary widely, and want the best for themselves and their families. This represents a significant opportunity to help employees and their families understand the differences in the relative costs and clinical outcomes between different providers. Employers are in a position to help close this gap.

The Rise of Guided Decision-Making

The next territory to be explored in the localization of healthcare is how this trove of new information gets from employers to employees.

People generally don’t like to be told by their employer what to do when it comes to their health. But that doesn’t mean they don’t appreciate thoughtful direction in the form of a guided-decision framework.

In this process, counselors who are trained healthcare experts work directly with individuals in a personalized, private process to assist with their healthcare decisions. They don’t make decisions for people, but they do lend a hand in gathering and interpreting the appropriate data on the employee’s behalf.

Armed with this granular data on medical procedures at specific locations in that person’s area, these counselors steer people toward the best outcomes and greatest efficiencies. They act as trusted navigators who point out the best path forward so that patients receive the best care at the best price.

By empowering employees with this data and funneling it through a guided-decision framework, employers can help improve the odds that their people receive the best care possible for their individual needs at an appropriate price.

¹ https://billadvocates.com/cost-variances-for-healthcare-procedures/