Connecting people to high-quality healthcare has always been our priority at Castlight. Now, in the midst of the coronavirus pandemic, our ability to help individuals navigate to appropriate, high-value care is essential.
During a recent webinar focused on provider quality and direct contracting, Castlight was joined by Sheila Savageau, US Healthcare Leader at General Motors, and Susan Hawkins, SVP of Population Health at Henry Ford Health System, who shared their approach to making high-quality care the easy choice for employees and their family members. Here we share some of the takeaways from the discussion.
The challenges of defining and understanding quality
Many consumers don’t have a clear picture of what defines a high-quality provider, with 59% of consumers defining quality by their relationship with their provider or by the doctor’s bedside manner. Quality is difficult to understand: there’s no one trusted source for provider quality data, word of mouth drives much of the decision-making when selecting a provider, and clinically validated quality metrics can be hard to surface and understand.
However, quality really matters. Choosing the best quality provider can double your chances of receiving effective care such as an annual check-up. It can cut in half your chances of receiving inappropriate care such as avoidable C-sections. It can also reduce your risk of complications after joint replacement surgery by 60%. This all translates to improved population health and wellbeing, along with lower costs.
Navigating to high-quality care
Castlight has a two step approach to navigating users to high-quality care. First, we calculate a quality score at the individual provider level. Our provider quality score is comprehensive–leveraging 240 metrics from 30 datasets, and covering 94% of providers and hospitals, as well as the 100 most common procedures.
Next, our Smart Match algorithm personalizes provider matches for each user, displaying the top five high-quality providers based on individual health history and search terms used. Our Smart Match algorithm takes into account the individual’s clinical conditions, their preferences, cost, and convenience and is tailored at the procedure-level to the specific search terms input by the user.
We prioritize simplicity with a single, easy to understand quality rating. However, users are able to click into the score to see how it is calculated for full transparency. Keeping the consumer at the center, we personalize the provider recommendations and cost estimates to the individual user. For example, an employee with diabetes will receive recommendations for providers with specific expertise in diabetes care, and estimated out-of-pocket costs are precise to the user based on their plan, coverage phase, and search location.
As a direct result of our quality score, we found that users who chose a high-quality primary care physician recommended by Castlight experienced 15% fewer inpatient days and 8% lower spend per patient per year than expected based on their risk cohort.
Direct contracting with a provider
When it comes to simplifying the search for high-quality care, one option for employers is a direct-to-provider contract. This was the case for General Motors (GM), who saw direct contracting as the highest impact way to influence outcomes in their population, direct employees to high-value care, and change the member experience. GM focused efforts on their large employee population in Detroit and established a strong partnership with Henry Ford Health System.
Castlight provides a comprehensive platform for GM employees with insights into price and quality for providers. In support of GM’s direct contracting relationship with Henry Ford Health System, Castlight’s search results prioritize Henry Ford providers first before recommending other providers in the broader network. As Sheila Savageau shared in the webinar, “If you’re looking for a provider, Castlight is your tool. We do not have independent tools set up within our carriers. Castlight is the key source of navigation.”
“If you’re looking for a provider, Castlight is your tool… Castlight is the key source of navigation.”
In their second year of direct contracting with Henry Ford, GM is seeing favorable results. They saw an increase in enrollment on the plan in the second year. Importantly, out-of-network utilization in the first year was very low, indicating almost all needs and preferences were met with the contracted providers.
Castlight is proud to support our customers to help simplify the search for high-quality care. For employers interested in understanding direct contracting–including GM’s process in identifying Henry Ford as their provider partner, the process for launching a direct contracting relationship, and additional considerations and opportunities–or for those looking for more information on Castlight’s quality scores, the full recording of the webinar is available here.