The Best Vision is Insight: Introducing the Surgery Quality Analysis by Goldfinch Health

“The best vision is insight.”

The quote—attributed to entrepreneur, Malcolm S. Forbes, of Forbes magazine fame—rings true in many parts of life. And it most certainly resonates if you’ve ever been in the position of an HR, insurance, or benefits professional staring at thousands of lines of medical codes or pharmacy claims…and trying to make sense of it.

How do you find information “needles in the haystack” of data? And, when you do, how do you put that information to work? It can be a daunting task.

That is exactly why we developed the Surgery Quality Analysis by Goldfinch Health. We process medical (and pharmacy as well) claims for 1-3 years and produce a brief summary of areas to watch and opportunities for improvement in one of the highest-cost areas of healthcare and employee productivity, surgery.

These reports include assessment of:

  • Outpatient vs. inpatient procedures (highlighting the potential for 40%+ cost-savings with outpatient procedures, and the formula for getting there)
  • Large incision (“open”) surgery vs. minimally-invasive surgery approaches
  • Opioid use post-surgery (unfortunately, what we find is the problem is far from solved, no matter what you may have heard from your health plan, PBM or state legislators)
  • Surgical complications benchmarked against industry standards

The picture that often emerges is one of not only opportunity but urgency. For example, we recently reviewed a population that showed, in the midst of Covid-19:

  • 18% reduction in major musculoskeletal procedures (back, hips, knees, shoulders)
  • And a 25% increase in steroid injections into joints

Of course, this means members in this population have put off surgery. But, in the end, most of those cases are inevitable. There will be a knee replacement or shoulder procedure needed. Due to the time, stress, and treatments that have occurred in the meantime, those members will report for surgery with diminished physical and mental health. It truly is a powder keg waiting to blow.

Another group believed strides had been made related to opioid use. A deeper look at the data revealed progress had been made—but not in the area of post-surgery opioid use, where painkiller use remained 3 times higher than national guidelines recommend.

Considering surgery often touches more than 60% of high-cost claimant cases, these insights provide the vision to act before healthcare and productivity costs overwhelm your budget.

To get your no-cost assessment, contact Goldfinch Health today!

Protect your people. Protect your plans with Goldfinch Health.