Rates charged for medical care and procedures in Wisconsin are typically higher than elsewhere in the country, says Ross Bjella, co-founder and CEO of Alithias, Inc., a Milwaukee company whose software products analyze insurance claims data and promote health care value for employers, employees, health care providers, third party administrators and brokers.
“Unfortunately, it’s not uncommon to see Wisconsin prices double that of the national average,” said Bjella, who is a returning speaker to the Innovations in Healthcare series at University of Wisconsin-Stout this fall.
The Health Care Cost Institute, an independent, nonprofit research organization, supports Bjella’s statement with national data at its website, guroo.com. The site lists, among other statistics, a national average cost of $761 for an MRI brain scan. In Wisconsin, the same procedure averages $1,931. National average cost for knee replacement surgery is listed at $33,560, while in Wisconsin the cost runs approximately $40,323.
Bjella cites two primary factors to explain discrepancies like these. First, he says regional monopolization means some health care organizations aren’t motivated to negotiate a lower price. Second, many Wisconsin health care locations are very highly rated for quality. “It’s extremely high quality care,” said Bjella, “but we pay for it.”
With ever-higher deductibles and out-of-pocket expense limits, many patients today find it exceedingly difficult to pay for health care, and employers are challenged by the prospect of offering health care benefits. As Bjella sees it, it’s time for a change in the consumer’s mindset. “The new reality is that it’s in your best interest to shop for care,” he said.
Bjella advises consumers to start thinking about value in health care. He encourages patients to talk with their providers to confirm necessity of procedures and consider potential cost-saving options, like whether an operation can be performed in a surgery center rather than a hospital. Employers, too, need to educate themselves about innovative methods to provide healthcare coverage and pursue transparency in quality and price, he said.
“Deductibles and costs are going to continue to go up, not down,” he concludes. “Ultimately, we’re all going to be affected, but forward-thinking companies want to address it now.”
Innovations in Healthcare is a three-day series to designed to engage decision-makers at companies with 50-2,500 employees. Presented by UW-Stout’s Manufacturing Outreach Center in partnership with True Network of Advisors, the series brings national experts, including Bjella, to a dynamic discussion of success strategies in health care management.