You can start by wading into Quizzify's ER Sticker Shock Prevent Consent…and then gradually go deeper until many of your ER visits and some* of your emergency inpatient days (think COVID) are covered.
You can “dial up” the Consent at your own speed to the point where, theoretically, 100% of your ER visits and about half your inpatient admissions (the non-electives) can cost about half what you are paying now. Whether it is more or less than half depends on your current contracts relative to Medicare for non-elective care, which always costs more than elective care relative to the Medicare benchmark.
That’s roughly a 12% to 15% reduction in overall spending. All by doing nothing other than paying a modest fee, and teaching your employees how to protect their rights.
No need to take our word for it. For Level 2 and above, we totally guarantee that except in Alaska and Hawaii, your ER bills will always be in the 3 figures. For every dollar we miss by, you receive $10 in free Quizzify services.
Level 1: Quizzify2go (Free)
Encourage employees to download and use the Consent. Some will download it. A fraction of those will have an ER visit, and a fraction of those will remember to use it. After that, they are on their own. Quizzify does support users with our hotline. We also reprice bills where ERs “forget” to send the correct bill and send a much higher one instead.
But when using Quizzify for free, each of those functions carries a $250 fee. Then it's up to your employee to contact the hospital to replace the original bill with the repriced one.
Expect the Consent to be used only rarely. Like many other benefits explained in Open Enrollment, employees don’t have an immediate use for it, so they aren’t paying attention.
Level 2: Quizzify2Go ($4 PMPY or less)
Added features include:
Introductory and followup email templates for you to circulate.
Free real-time support hotline
Free repricing when the ER “forgets” to honor your Consent and charges 4-5 figures instead
Free follow-up with the hospital to get them to honor the repriced Consent
Ungated doctor visit prep-and-questions (covering 100 topics, linked to calendar and quizzes – see antibiotics example below), to help employees generally in doctor visits but also remind them they also have this Consent
Guaranteed ROI. At $4 PMPY, which is our standard price for one year ($4000 minimum), you break even if roughly 1 in 300 people – meaning about 2% of ER visits – use it. (“Roughly” because this will vary by market.)
Expect about 10% of ER visits to include the Consent. With breakeven at 2% of visits, that’s a 5-to-1 ROI. Not to mention a lot of very happy employees.
Example -- note link to relevant quiz on antibiotics, hyperlinks to sources, and calendaring feature:
Level 3: In conjunction with Quizzify Classic
Quizzify Classic is our monthly health literacy quiz. Quizzify Classic also includes a home page for all employees that links in multiple places to Quizzify2Go, with occasional questions that link right to Quizzify2Go as well. This keeps Quizzify2Go front-of-mind.
Expect about 12% to 15% of ER visits and 5% of emergency admissions to include the Consent.
Continuing in the antibiotics theme, here is a screenshot of a question from our antibiotics quiz:
Level 4: Direct taxable or non-taxable incentives
Without going through the steps needed to change the benefits design, if you have a “points” program, you can give employees meaningful numbers of points for using the Consent, for both ER visits and admissions through the ER. (Just make sure the value of the points is less than the copay so you don't give people an incentive to use the ER.)
If you do not have a points program, you can reduce the copay for people who use the Consent, as part of the (non-taxable) health benefit. In a high-deductible plan, you shouldn't need to reduce the copay.
In conjunction with Level 3, you can expect 20% to 25% of ER visits to use the Consent, along with – just a guess – 10% of emergency admissions, for some* of the hospital stay.
Level 5: Direct placement of Consent on insurance card
If you have a TPA (or a sharing plan, which is technically not “insurance”), you have a fairly free hand in designing your insurance card. You can put the Consent right on the card. Indeed, this is so powerful that we have received the following feedback when proposing it:
The provost of a large state university, many of whose employees use the affiliated hospital, declined because: “If it gets back to the President that I am encouraging people to pay less than our contracted rate, I could get fired.”
A large retailer said: “We wouldn’t be able to get the plans to put this on their cards because it would undermine their pricing.”
Of course, the plans won’t put it on their cards, specifically because you are indeed "undermining their pricing" by getting a better deal than they did. That is the whole point. This is a feature, not a bug.
That response by itself tells you they know their “negotiated” prices are much higher than you can get with the Consent. And that’s why we offer a taped Consent to affix right onto the card instead.
This should increase use by 10%, up to 35%, at a minimum. You will never go higher than half. With the stresses in the ER and the natural tendency of employees to forget things and not even remember their rights when they are spelled out, half is about as much as you can achieve. Even so, with a breakeven at <2%, that is quite an ROI. It doesn't even include emergency admissions.
Level 6: Direct hospital contracting
"You never change things by fighting the existing reality. Build a new reality that makes the existing reality obsolete."
–Buckminster Fuller
The "existing reality" is that hospitals in many markets charge what the market will bear. But bringing the Consent into play in direct hospital contracting obsoletes that reality. Because you hold all the cards, so to speak. If you use Level 2 through Level 5 for a long enough time to get enough data points that the Consent works, you can leverage your experience to reduce hospital expenses across the board. There are two ways of doing that.
First, you can say that you will change the benefits design (and insurance cards) to dramatically increase use of the Consent. No matter what their market power, hospitals have a Hobson’s Choice:
Accept the Consent every time
Challenge it in Court, where they will almost certainly lose. The reason we set the level at 2x Medicare is to sound so reasonable that no jury would say it was too low, as they might if we said 100% of Medicare.
Once they lose in Court, their entire price structure is jeopardized. So far no hospital has been willing to take that risk. Wise decisions. One hospital had three attorneys listening in on our webinar about their overcharging...and immediately afterwards they all caved and agreed to a 95.3% reduction in their fee, to the 2x Medicare amount.
Second is the nuclear option: indicate that you will tell all the employers in the marketplace about your success using the Consent, if the hospital doesn’t negotiate a favorable direct contract. You don't need to negotiate on their terms. You've done that for decades and what do you have to show for it?
*"Some" because once an inpatient is "stabilized," a process that might take only a day or may not happen at all, the hospital is within its EMTALA rights to either transfer the patient or more likely charge the regular contracted network rate from the day of stabilization.