1. Looking Out For You: How to be a
Better Health Care Consumer

2. What is The Alliance?
> Employer-owned, not-for-profit health
care purchasing cooperative.
> Freedom to choose from 63 hospitals
and 10,365 professional service
providers.
> Creates resources to help you and your
family become more informed about
health care choices.

3. Today’s Goals Discussion
> Increase your
awareness of the safety
and quality of our health
care system and its
impact on you.
> Provide tools to help you
become a wise health
care consumer.
> Help you maximize the
effectiveness of each
health care encounter.
> Health Care Quality
and Cost.
> What You Can Do
Today.
> How to Make the Most
of Each Health Care
Visit.

4. What is Health Care Quality?
> Doing the right thing
> Doing it at the right time
> Doing it the right way

5. Quality Problems
> Underuse
 Care that would benefit patients isn’t given.
> Overuse
 Care that is unnecessary or where the risks
outweigh the benefits.
> Misuse
 Complications caused by patients who do not
follow doctors’ orders & doctors who misdiagnose
their patients.
In doctors’ offices and clinics, adults receive only 55% of
recommended care (preventative, acute and chronic)!

6. Cost In Perspective
> Self Funding
 The employer assumes the financial risk of
providing health care benefits to
employees.
 The employer pays for employee medical
claims out-of-pocket as they occur.

7. Share in Your Medical Decisions
> Let your provider know that you want to be an active
partner in your health care.
> Do your own research:
 www.the-alliance.org
 www.webmd.com
 www.crbestbuydrugs.com
> Ask why?
> State your preferences.
> Compare your expectations with those of your
provider.
> Accept responsibility.

8. Did you know?
8 out of 10 Internet users have
searched online for information on at
least one major health topic.
That translates into about 95 Million
American adults who use the Internet to
obtain health information.
* 2011 Pew Internet Project and California HealthCare Foundation

9. Ask Questions
> 3 Good Questions to Ask:
 What is my main problem?
 What do I need to do?
 Why is it important for me to do this?

10. Bring a Friend or Family Member
> A personal representative, or health
advocate, can:
 Get information and ask questions when
you can’t.
 Remind you about instructions and help
you make decisions.
 Find out who to go to if you are not getting
the care you need.

11. Remember…
> Let your doctor, nurse, or pharmacist know if
you still don’t understand something.
> You don’t need to feel rushed or
embarrassed if you don’t understand
something.
> You can ask your doctor, nurse, or
pharmacist a question as many times as you
need to.
> Be honest with your doctor, don’t tell them
what you think they want to hear.
Asking questions helps you understand how
to stay well or get better!

12. Did you know?
> A survey of 1,100 patients revealed…
 68% of patients said that they would not inform
their physician that they had failed to comply with
a prescribed drug therapy.
 83% said that they would never communicate with
their physician that they did not plan on buying a
prescribed drug.
 1/3 of all hospital admissions are due to poor
medical adherence. This equates to $300 Billion
annually.
*The Adherence Estimator, McHorney CA. Curr Med Res Opin, in PubMed

13. Keep and Bring a List of All the
Medicines You Take
> Give your doctor and pharmacist a
list of all the medicines you take,
including non-prescription medicines.
 This includes vitamins and herbal
supplements.
> Tell them about any allergies you
may have.
Medication errors are the most common type of medical error!

14. Did you know?
The average doctor to patient
interaction during an office visit is less
than 10 minutes.
Often clinics will schedule office visits
as short as 8 minutes in a physician’s
calendar to maximize the number of
patients they will see in a day.

15. Making the Most of Each Visit
-Before the Visit-
Before you go, bring along all of the
following information:
> Current insurance card
> Social Security number
> Emergency contact information
> Employer information
> A referral or order, if required
> Any previous x-rays, if requested
> An interpreter, if needed

16. Making the Most of Each Visit
-During the Visit-
> State your main concern first.
> Describe your symptoms.
> Describe past experiences with the
same concern.
> Ask questions about things you don’t
understand.
> Take notes, even if you understand
what is being said.

17. Making the Most of Each Visit
-At the End of the Visit-
> Am I to return for another visit?
> Am I to phone in for test results or login
online?
> What side effects or concerns should I
look for?
> When do I need to follow up?
> Anything else I need to know?

18. When You See a Specialist
> Know the diagnosis or suspected diagnosis.
> Learn about basic treatment options.
> Make sure the specialist has all test results
and records on your case.
> Make sure you know why the tests are being
done.
 Ask: Are these tests necessary?
 Don’t repeat tests!

19. If You Are Facing Surgery…
> Most surgeries are not emergencies.
> This means that you have time to make
sure that this surgery is the best
treatment for you.
> Refer to the toolkit to see important
questions you should ask if facing
surgery.

20. QUALITY and COST vary
in ways that affect your
life and your wallet.

21. Putting Quality in Perspective
Number of Americans who die each year from:
> Accidents and
Diseases:
 Breast cancer:
About 39,500
 Motor vehicle
accidents: About
43,000
> Quality and
Safety:
 Medical errors: About
98,000
 Infections acquired
while in the hospital:
About 90,000
> 25 – 75% of these
infections could
be prevented

22. Cost Matters Too
Cost varies:
 You could pay more for the exact same
type of care depending on which
hospital you choose.
What you pay is not related to the quality
of your care.
 High-quality care don’t always cost
more.

23. QualityCounts Inpatient Hospital
Report
> Overall Care for
Adults
> Birthing Care
> Major Surgery
 Hip and Knee Surgery
 Back and Neck Surgery
> Overall Heart Care
 Heart Surgery
 Non-Surgical Heart Care
 Balloon Angioplasty
 Bypass Surgery
 Heart Attack Care
 Aortic Valve Replacement

24. QualityCounts™ Outpatient
Procedures and Tests Report
> Surgeries:
 Removal of Adenoids
 Adenoidectomy & Tonsillectomy
 Arthroscopic Knee Surgery
 Cataract Surgery
 Laparoscopic Gallbladder Surgery
 Laparoscopic Hernia Surgery
 Ear Tube Insertion
> Tests:
 Bone Density Study
 Cardiac Perfusion Scan
 Colonoscopy
 Upper Gastrointestinal (GI) Endoscopy
> CT and MRIs
 Abdominal & Pelvic CT with
and without contrast
 Brain MRI with and without
contrast
 Head or Brain CT
 Lower Spine MRI
 MRI Joint of Lower Extremity
without Contrast
 MRI Neck Spine without
Contrast
 Thorax CT with Contrast

25. Brain MRI
(Dane County Example)
Specialty MRI Center
(Dane Co.) Dane Co. Hospital
Total Average Cost $2,304 $3,884
EE Deductible ($1000) $1,000 $1,000
EE Coinsurance (10% to $250) $130 $250
Total Employee Cost $1,130 $1,250
Cost Difference to EE $120
Total Employer Cost $1,004 $2,634
Cost Difference to ER $1,630

26. Laparoscopic Hernia Surgery
(Dane County Example)
Outpatient Surgery
Center (Dane Co.) Dane Co. Hospital
Total Average Cost $5,351 $8,812
EE Deductible ($1,000) $1,000 $1,000
EE Coinsurance (10% to $250) $250 $250
Total Employee Cost $1,250 $1,250
Cost Difference to EE $0
Total Employer Cost $4,101 $7,562
Cost Difference to ER $3,461

27. To access:
www.the-alliance.org
Click on:

28. The single most important way you
can help get safe, quality care while
reducing your costs is to be an
active participant in your health
care!

29. QUESTIONS?

30. Thank you for viewing this presentation
created by The Alliance.
If you would like to Learn More about The
Alliance please visit our website at
www.the-alliance.org
Call us at 800.223.4139 or email us at
thealliance@the-alliance.org