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"Be the Change" in 2018

Kalli Ortega
January 15, 2018


A quote that has always resonated with me and been a source of inspiration is Gandhi’s “Be the Change You Wish to See in The World”.  For me, the message in his words is that if we want to see change in something, we must act, walk the walk, and “be” that change.  The fourth quarter of 2017 was a whirlwind of activity and as I work with my clients and partners to plan for the year ahead, “Be the Change” has appropriately become our theme for 2018. 

So many employers are fed up with healthcare costs spiraling out of control, the ever-increasing confusion for themselves and their employees in navigating through the healthcare system, and so much more.  For most of you, the cost of your benefits package is one of the largest budget items, often one of the top two or three. As such, the escalating costs of the current system is simply not sustainable. So, how do we change this trajectory and frustration?  How do we maximize our high-cost benefits and then plan for strategic improvement in the year to come?  The status quo must be challenged, and a mindset shift is necessary.  This will take changing how you currently evaluate and choose your vendor partners as well as how you roll out and maintain your healthcare programs.  While there is no doubt that Fire Districts, specifically those with union membership, are traditionally slower to adopt change, there are ways that you can “be the change” for your organization in 2018. 

Where we are now?

By now, most of you have moved to high deductible health plans to save on insurance premiums, some type of consumer-driven program (HSA or HRA), and telehealth/teledoc programs.  Some of you are also educating your members to take advantage of the cost transparency tools built into your current health plan (usually fully-insured) and free price-shopping mobile apps.  These strategies have been a fine start and have saved money for years, but how do we take a more active role in controlling health care costs?

The first step is understanding what the problem really is for your organization. A small number of your members (only 5-6%) are driving most of your health care costs, and those costs are typically driven by conditions that, with proactive management, can be reduced.  Success in managing these costs requires quality preventive health programs and moving to health plans with full cost transparency. 

Where are we going?

Employers are moving towards programs with value-based primary care and pricing.  Value-based Primary Care (VBPC) and Direct Primary Care (DPC) are concepts that you will hear more often in the coming years and should become familiar with. Simply speaking, these are primary care providers with practice models based on the value (ratio of quality to cost) they deliver rather than the traditional “fee-for-service” model.  Large employers with self-insured health plans are reducing costs while improving healthcare for their employees with VBPC/DPC foundations.  Their success with VBPC/DPC can be cost saving strategies for Fire Districts as well.

You are already familiar with the “wellness” or “preventive care” benefits included with health insurance plans and many of you already have a head start through your practice of annual NFPA 1582 physicals.  Further yet, there are some of you who are also versed in leveraging the preventive benefit through your health plan as well as certain grants that can offset the cost for member physicals.  As you plan for 2018, evaluate that program and ask the following:

  1. Vendor Alignment: Do you have a specific vendor for your annual physicals?
    1. If so,
      1. do you work with your vendor to set goals each year?
      2. are these goals aligned with the expected value provided by your vendor?
      3. are you able to leverage your health plan and workers comp grants to offset vendor costs?
    2.  If not,
      1. examine what has held you back from formally partnering with a value-based vendor for your physicals. Can you work with your internal committees/boards to consider a change in 2018? 
      2. have you asked your benefits workers comp partners for assistance in developing a program?
      3. have you contacted your neighboring Districts to see what their practice is?


  1. Quality Reporting: What are the statistics for the physician/practice with which you are aligned?
    1. What percentage of patients were evaluated in 2017 using the NFPA 1582 criteria?
    2. What were the quality outcomes (e.g., number deemed fit for duty, number in review for metabolic syndrome, etc.)?
    3. Are all items from the NFPA 1582 standard included as well as those recommended by the US Preventive Services Task Force (USPSTF)?
    4. Are the above reported in appropriate detail to the individual patient, you as the purchaser, and available in HIPPA-compliant format for general knowledge.
  2. Coordination of Care: Does your vendor act as the primary care physician (PCP) for your members, do they have independent PCPs, or a combination of both?  Establishing protocols for encouraging a model to actively coordinate care, as needed, between PCP(s) and specialists is key.

Active value-based primary care with quality reporting and intentional coordination of care for proper disease/chronic illness management is a good foundation for change that you can start with in 2018.    As you endeavor to evaluate your program, I strongly recommend seeking the advice of your benefits and workers comp/liability partners.  You don’t have to go it alone, lean on your partners to help you be the change for your organization.

This is just the beginning.  More ways to impact change to come in 2018.  Until then Happy New Year and Cheers to Good Health!


NIAFPD FireGuard Online: Winter 2018 Edition