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The New “Buy-Right” Movement in Health Care

by Scott MacStravic

As I recall, it was sometime in the 1970s when Dr. Walter McClure’s idea of “Buying Right” emerged from the Interstudy think tank in Minnesota.  This was after I left said tank, but when I still had occasional contact with its thinkers, including McClure.  I expressed my doubt at the time that it would catch on, and though it was adopted by many employers at the time, it was ahead of its time.

Back then, the idea was for employers to “buy right” in terms of the best health insurance plans and provider networks, while simultaneously empowering their employees to “buy right” in terms of the most appropriate and cost-effective care and providers for their sicknesses, along with those of their dependents.  This would either drive the “wrong” treatments, plans, and providers out of business, or force them to become more “right”.  Clearly, the idea has had a renewed life in the form of consumer-directed, high-deductible health plans and health spending accounts, with more of the buying right the responsibility of consumers.

But another form of buying right is also emerging, with the label of “Value-Based” purchasing of insurance plans, design of employee out-of-pocket expenses, and integration of employee benefit programs.  And what makes this new approach so different from its thirty-odd-year-old predecessor is that what is being bought is no longer merely sickness care, but an entire armamentarium of benefits, pay-for-performance systems, learning systems, recruitment and retention strategies that are aimed at getting the absolute best employees and getting the most out of them.

Fortunately, the value that forms the major focus for this new approach includes the increased value that employers can gain from the strategy, and the increased value that employees can gain.  Its emphasis in the case of health care is not so much on sickness care as on preventing sickness from arising, or once arisen from needing any more care than is unavoidable.  In effect, what employers and consumers should both be “buying right” is health.

While it has taken thirty or more years to happen, this new buy-right approach seems to have far more support than the original version.  It has employer champions, such as Pitney-Bowes and Dow Chemical, which were major focuses of discussion during the World Healthcare Congress just completed.  It also has provider champions such as Mayo Clinic with its Health Solutions and Embody Health program, and the Centers for Preventive Medicine and The Prevention Plan programs offered by U.S Preventive Medicine®, which recently added USF Health in Tampa to its provider partners.

The poll taken of Congress attendees indicated that employers in the audience strongly supported the idea of employers continuing to play a strong role in the health of their employees, despite proposals for eliminating their “skin in the game”.  And employers see the real potential for partnerships among providers, insurers, employees and themselves, rather than merely careful purchasing, an idea echoed by Wal-Mart CEO Lee Scott at the end of the Congress, as well as by GE Healthcare CEO Joseph Logan.

Frankly, I think the idea was equally good thirty years ago, just not in sync with the market at the time, of either consumers or employers.  But it may be that its time has finally arrived, and that those who were able to hear about it during presentations at the Congress, as well as in private discussions with their peers and vendors who manned the booths, will take away both the motivation and the capability to make buy-right work at last, with the rightness of buying reflected in both health and prosperity for employers and consumers alike.