Benefits of VEBA Empower employers to improve the quality of care for their employees
- By Evan Falchuk
- January 1st, 2008
years ago, the Rand Corporation’s The
First National Report Card on Quality of Health Care in America reported
that patients in the United
States have a 50 percent chance of getting
the right care. The media jumped on the story, calling it “coin-toss medicine,”
and it helped spark a national quality improvement movement.
is quality in healthcare? Quality continues to be a hot topic in healthcare. As
of late, the industry has not looked at the issue of getting the right
diagnosis and treatment as the fundamental quality metric. A recent report by
the consulting firm Hewitt, entitled The Road Ahead: Emerging Health Trends
2007, shows that this may soon change. Employers are beginning to target the
root of the issue and are looking for solutions that influence the interactions
between providers and their patients.
focus on quality at the point of care is long overdue, creating an opportunity
for health plans and employers to adopt new ways to help patients partner with
their doctors. In particular there is a need to create the tools that patients
can use to make sure they are asking their doctors the right questions,
especially those patients diagnosed with serious and/or chronic medical
conditions and illnesses (like cancer).
these types of situations, healthcare quality can be vastly improved — without
question — by the availability of services that give patients the right
information to work with their doctors. Even some of the most rudimentary
information can be helpful, but when it comes to serious illness, the need for
focused, detailed information is even more important. The stakes are high and
the impact of error is great.
to Quality - VEBA
example of healthcare quality innovation is the
Southern California Schools Voluntary Employees Benefits Association (VEBA), a
cooperative labor-management trust program committed to achieving the highest
quality and most cost-effective benefits programs for every eligible education
employee in Southern California. VEBA covers
86,000 members in 32 school districts, representing 70 percent of the San Diego educational
In choosing which benefits to offer their members, VEBA had in
mind helping those members with the most serious and critical conditions.
Fifteen percent of VEBA members account for 85 percent of their total
healthcare costs given the severity of condition, frequency of misdiagnosis,
and resulting incorrect treatment paths. To address the quality gap, VEBA
identified and implemented an innovative health care program called Best
The goal of VEBA healthcare benefits program is to provide
the best quality care by offering innovative benefits to achieve the highest
quality of life. VEBA understands that quality care costs less. VEBA worked with consultant
group Towers Perrin to find services and tools to bolster healthcare quality
and was introduced to Best Doctors. This
company works with hundreds of employers providing trusted medical expertise to
seriously ill patients and their treating physicians. VEBA saw that Best
Doctors could give their members the tools they needed to get the right care.
Quality = Right Diagnosis + Right Treatment
The Best Doctors service is included as part of the benefits
plan to VEBA members and their eligible dependents. They simply call Best
Doctors if they are diagnosed with a serious medical condition. Medical experts
help the member answer their most pressing questions — is my diagnosis correct?
Am I getting the right treatment? In this way, the service is able to improve
the quality of care and provide its members with the peace of mind that comes
with knowing they are on the right track to get better.
Within half a year of enrolling its members into Best Doctors, one
VEBA member’s life had been saved and more than 50 others are on track to
better care with the right diagnosis and treatment. Best Doctors has seen misdiagnoses happen more than 20 percent of the time and
wrong treatment plans 60 percent of the time.
Take for example Barbara Smith, a high school
teacher in San Diego.
Barbara went to her physician with severe neck and back pain and headaches. When
the pain medicine her physician prescribed didn’t work, he suggested that
Barbara see a chiropractor, who in turn referred her to an orthopedist who ran
an inconclusive MRI. Barbara was then referred to an acupuncturist, and finally
a pain management specialist. This last doctor suggested an epidural to address
Like many patients, Barbara was scared and
confused by her fragmented healthcare experience. While preparing for the
epidural, the attending doctor told Barbara that she should have had a bone
scan prior to the epidural. This did not help Barbara’s confidence in the
system. The scan revealed a cancerous tumor on her neck bone; cancer treatment
was needed right away. Two months into the treatment new acute symptoms
Barbara shared her disappointing healthcare
experience and results with her employer who suggested Barbara utilize the Best
Doctors benefit, a medical expertise service.
"Best Doctors gave me the hope and security
that I would be okay," said Barbara.
The Best Doctors medical experts stepped in immediately, analyzing her
complete medical history, tests, and diagnosis. Best Doctors navigated Barbara
through her complex medical condition, demystifying the diagnosis and adjusting
treatment so today Barbara is well. Best Doctors gave Barbara confidence that
she would receive the proper diagnosis and proper treatment. She was also
pleased that Best Doctors would partner with her current physician. And
anticipating the future, Best Doctors recommended that Barbara’s children have
genetic testing so they could be prepared for, if not avoid, their mother’s
kind of approach represents a true strategy for quality improvement. The point
of care is where healthcare decisions are made that lead down the right path or
the wrong one. The most important contribution anyone can make to the
improvement of the quality of care is to make sure that each patient has the
right diagnosis, the right treatment, and the best chance to get well. If we
want to define quality as delivering healthcare that works, this is one answer
we are looking for.
McGregor is the general manager of the VEBA Trust
specializing in health care trust management for labor/management trust funds.
For more information, see VEBAOnline.com.
Falchuk, Esq., is the president and COO of Best Doctors. He can be reached at