When looking after patients, their care and welfare is the top priority. However, the costs entailed cannot be forgotten, particularly when there are multiple parties involved. It is important to contain costs, so they are affordable for the patient, covered by their insurance policy, and not leaving insurers to cover huge medical bills, all while ensuring the patient is receiving the quality care and treatment required. Balancing price and patient care is fundamental to cost containment, but while this balancing act is taking place, those involved – whether patient, family, healthcare staff or insurer – must not be forgotten. Therefore, having clear lines of communication within these relationships is vital for all parties and to ultimately benefit the patient.
How to keep costs down but care quality up
When performing this balancing act, cost containment companies follow different processes, but through it all they have two primary focuses: not overextending financially and making sure the patient gets the care they need. As Gigi Galen, President of Star Healthcare Network, summarised: “[The] goal is to save as much money as possible for our clients and not losing sight of quality healthcare.”
One method of guaranteeing fair pricing and quality care is by building a network of preferred providers. Having this relationship with the providers directly means that cost containers can keep up to date with the treatments and care they are offering, the quality of both, and the inevitable prices.
Executive Director of GMMI, Inc. Monica Rummelhoff explained: “Directing our clients’ members to preferred providers that we know offer excellent care and fair prices is an essential part of what we do.” Rummelhoff also said that, once a patient arrives at a treatment facility, the in-house medical team continues ‘to assess and monitor the case’.
Another way cost containers manage the price of medical care is by having an overview of the whole case. Gitte Bach, CEO of New Frontier Group, described the company as having an ‘overarching end-to-end approach’ and a ‘cohesive process that looks at each person’s case holistically’. She said: “Working from a point of view where we understand all perspectives is important, so we can see what is top of mind for all stakeholders – patients, specialists, pharmacists, payers, family members – who need to work together for the lowest cost and best outcome solutions.”
Monitoring the situation externally by maintaining a trusted provider network and appreciating the perspectives of all parties are the fundamental ways of containing healthcare costs – both of which are developed through effective communication strategies. “When it comes to medical care, communication can make or break a case,” emphasised Dr Ferial Ladak, Chief Medical Director at Global Excel.
While negotiating the search for the best prices and the expectations of top-quality healthcare, it is vital to not forget that those providing the care must be treated fairly and respectfully. Those on the frontline are fundamental, but in the grand scheme of things, such as discussions over policy wordings, cost negotiations and booking medical transportation, they could be neglected; this must be avoided.
Cost containers must therefore acknowledge the work of the healthcare staff. New Frontier Group has ‘clear plans on how to build strong relationships based on trust and communication’, which ‘involves working closely with clinical teams to understand their concerns and priorities’. Bach added: “It’s also important to provide clear and timely information about insurance coverage and reimbursement policies. We can help ensure that medical staff are invested in providing the best possible care for insureds, while also working to control costs.”
This view is echoed by Galen: “Most providers are not a one-shot deal, so managing a good relationship with the staff and letting them know you are there to help obtain what the provider needs and continuing to establish a long-term relationship is important,” she said. Making the staff feel not just recognised but also appreciated is a clear way to avoid alienating them.
We ensure that providers are compensated promptly, fairly and accurately for services, and build longterm relationships based on mutual respect and trust
Dr Luis García, Vice President of Case Management and Claims Administration at Redbridge, explained that medical staff are involved throughout its processes. “We involve the treating medical staff in our decision process from day one,” he said. “First by requesting the medical documentation related to the specific case, then sharing with them case details from the insurance perspective, keeping a close follow-up and constant updates of our evaluation and type of coverage.” He added: “If needed, in some cases, a peer-to-peer session is set up between the specialist in our medical team and either the attending physician or an expert on the provider side.”
Rummelhoff summarised: “Building relationships with preferred providers helps keep costs down because it’s mutually beneficial for both parties.” Bach agreed, explaining how to maintain these relationships: “We ensure that providers are compensated promptly, fairly and accurately for services, and build long-term relationships based on mutual respect and trust.”
The cost of cultural differences
It is a fundamental truth that all cultures have their own customs, which is one of the reasons why people enjoy travelling: to experience these differences. It is not just tourist hotspots where the cultural differences will be apparent, but also in healthcare settings, which could lead to further alienation of healthcare staff – even if it is unintentional.
Not being aware of cultural differences can affect various aspects of the healthcare journey and those involved along the way. “Practices, expectations, and communication styles may vary across different cultures which can impact the dynamics between medical staff, patients and payers,” affirmed Bach. “It is important to be mindful of cultural nuances, respect local practices and adapt approaches accordingly to maintain positive relationships among everyone involved in the process.”
García explained why this is so vital within Latin America, where he works: “A basic knowledge of the cultural differences is not only necessary but essential in order to be respectful, avoid misunderstandings, comply with some unwritten codes of conduct in each geographical area, avoid expressions or tones that might have a certain meaning for the Latin American culture and a totally different one for people in other countries,” he said.
Ladak agreed, giving some further examples of what to be conscious of: “In some countries, hospitals, clinics and other care facilities are closed on certain days. In some rural areas, communicating in local languages can make a great difference in getting the right information.”
Therefore, it is important to have that cultural awareness, but also know how to continue the essential and time-sensitive work alongside. Ladak explained Global Excel’s process: “We examine the broader context, combined with the situation of providers and compare it with standardised treatment guidelines and our own knowledge of medical treatments.” Combining the medical knowledge with awareness of the locality and its culture is key to maintaining a relationship of understanding and respect whereby all involved are focused on the successful treatment of the patient.
The impact that alienation can have must not be underestimated, not just on the healthcare workers directly, but on cost containers too. “Not being aware of the cultural norms may have not only a monetary impact but a negative effect also on the good relationship with the provider, [and] the level of trust and loyalty with the payer,” warned García. These relationships have been already established as critical to facilitating the lowest cost and highest quality of care. Therefore, ensuring their success by simply being aware of cultural norms is a small price to pay to avoid paying an even bigger one – both metaphorically and literally.
This advice comes from years of experience containing costs, working with healthcare staff worldwide and looking out for patients’ welfare. It also comes from experiences – both positive and negative – which have since become lessons for cost containment companies.
“From our positive experiences, we have learned the importance of effective communication, collaboration and cultural sensitivity,” said Bach. “Prompt and clear communication, along with a collaborative approach and early intervention leads to better outcomes for insured travellers, while maintaining positive relationships with medical staff.”
Bach also reflected on the negative experiences and how New Frontier Group used them to implement change: “[They] have taught us the significance of proactive measures to overcome language and cultural barriers. We have implemented initiatives such as language assistance services and cross-cultural training for our team to enhance communication and understanding with medical providers.”
Put simply, “communication and collaboration, or lack thereof, are the common denominators to both positive and negative experiences,” summarised García.
When it comes to medical care, communication can make or break a case
The Covid-19 pandemic is another experience that taught the world many lessons. It affected everyone, but in particular those working in or involved with the healthcare sector. This group includes the people working for cost containers, who ‘need support just as much as a patient and their families’, according to Ladak, but can often be forgotten. “The need for ever-increased empathy and sympathy internally and externally was truly brought to the forefront over the past couple of years,” she said. Looking over the whole process, Ladak further explained how Covid-19 impacted cost containment: “The pandemic changed many things, but it did reinforce our processes, our communication skills, and tightened certain relationships with all those involved – the patients, the family members, the providers and the corporate clients.”
Therefore, despite the difficulties that may arise – whether pandemic-related or not – it is important to learn from them, adapt practices accordingly and communicate these changes to all the interested parties.
Communication is key
The key aspect that has been reiterated multiple times by all is the critical value of communication. Whether this is in terms of developing relationships, maintaining a dialogue between all invested parties or the use of local languages, communication is clearly a fundamental part of successful cost containment.
It is impossible to organise quality healthcare at a reasonable cost for insureds if cost containers cannot communicate clearly with everyone involved. It is a difficult balance to strike, but it is what cost containers do every day. It can be made more complex when different healthcare systems, languages or cultures are involved, but there are ways of working through this, such as translators, experts on-site or well-trained global staff.
Requiring hospital treatment at any time is never an enjoyable experience for the patient, but when further unknowns are brought into the equation, this can make a difficult situation even worse. Therefore, it is crucial that the lines of communication between parties that are working for the patient’s benefit are established, developed, and maintained to ensure they are getting the best care possible and also for the right price.