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Mercer

The nonprofit organization Catalyst for Payment Reform is hosting a series of webcasts this month focused on “Addressing Today's Leading Challenges.” I was invited to cover behavioral health -- specifically, the changing behavioral health landscape for employers and the need to develop innovative strategies to bend the cost trend and improve care.

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When employers are working on strategies to manage health benefit cost, behavioral health benefits aren’t often top of mind. After all, only about 4% of claims are related to treatment for behavioral health problems.  But what’s missing from that picture are claims for comorbid conditions – other health problems that go along with the mental illness or behavioral health issues.  According to one analysis, together these account for 22% of total medical spend. [1]

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This New York Times article offers an interesting “compare and contrast” analysis of public exchange plans versus employer-sponsored plans. Whether you’re satisfied with benefits on the public exchange really comes down to your perspective. If you were among the millions who were previously uninsured, you’re likely to be happy with your exchange coverage. If you came to the exchange after having had employer-sponsored coverage, the story is very different. A more limited choice of providers in the health plan network and higher out-of-pocket requirements are among the chief differences noticed by those coming off employer plans. In the end, a typical plan on the public exchange “looks more like Medicaid, only with a high deductible.” So while the public exchange is helping to fill a gap in the U.S. health care system, it’s not proving to be a source of comparable coverage for early retirees or those who would like to quit a corporate job to freelance or start a business. And each year, as these plans get skinnier, we’re seeing fewer employers that would even consider dropping the company plan to send employees to the public exchange.

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The IRS has released draft instructions for 2016 Forms 1094-B and 1095-B, confirming that health insurers and self-insured employers can expect few changes when reporting minimum essential coverage (MEC) provided to individuals in 2016. The Service posted preliminary 2016 versions of these forms in June, but instructions noting what's new became available only last week. The IRS uses data from this reporting to administer assessments under the Affordable Care Act’s individual mandate provisions. Separately, the IRS earlier released draft 2016 employer shared-responsibility forms and instructions that applicable large employers will use to report coverage offered to employees and their dependents.  

 

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One way to improve engagement is to provide plan members with their own personal “health guide”.  Mercer is helping plan sponsors do that a couple of different ways. Mercer also just announced an alliance with Accolade: Mercer Complete Care, powered by Accolade. Check out this interview with our leader of specialty consulting services, Jean Moore, and Rob Cavanaugh from Accolade as they provide their perspective on the alliance and why we think it has the potential to enhance engagement. Now is a good time to consider the tools you are providing your employees and family members to help them access the right health care, and how that is working to support smart consumerism and effective use of care.

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Way up there on the list of things not to like about the U.S. healthcare system is the extreme variation in prices charged for the same service from one provider to the next – variation that is very often unrelated to quality of care. While employers are tackling this problem in a few different ways, there isn’t a ton of data to show how well any of these strategies work. So I jumped on the recent New York Times article reporting on one mega-employer’s attempt to achieve more standard pricing while still allowing members to choose their providers – reference-based pricing. The employer in question is the California Public Employee Retirement System, or Calpers for short, and the experiment included 450,000 of its members.

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There was an interesting study published in JAMA this week that compares the health status of low-income individuals in two states that expanded Medicaid (Arkansas and Kentucky) with a state that did not (Texas). Respondents in Arkansas and Kentucky were 5% more likely to than their peers in Texas to say they were in excellent health at the end of 2015. This is a wider gap than was seen when the same question was asked at the end of 2014, when Medicare expansion was a year old. Because it takes time for someone to benefit from having insurance – due to the time it takes to actually get care and then for the care to have a positive impact on health – we may see continued improvement in Arkansas and Kentucky relative to Texas. While the study does not prove that Medicaid expansion caused people to be healthier, it makes sense that having insurance would have a positive impact on one’s health. This made me wonder whether the ACA has also had a positive impact on the health of those in employer-sponsored plans. Certainly the mandate for 100% coverage for preventive care comes to mind, although many employers covered preventive care prior to the ACA (and utilization is still not what we would like to see). Will the individual mandate mean more individuals seek coverage in employer-sponsored group coverage, and will that in turn result in better health in the workforce? Ultimately, it may be that because so many aspects of employer-sponsored coverage have changed since the law passed, it will be difficult to attribute any change in the health status of employed Americans (good or bad) to the ACA.

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Opioid abuse. You’ve probably read lots of stories about it recently, but have you seen the stats? They’re alarming, to say the least: There has been a fourfold increase in opioid prescriptions from 1999 to 2010 and a fourfold surge in deaths due to overdose.

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The IRS has released draft instructions for 2016 Forms 1094-C and 1095-C, highlighting changes that employers can expect when reporting health coverage offered to full-time employees and dependents in 2016. The instructions give more detail about the minor revisions shown on the 2016 draft forms issued last month. The IRS uses data from this reporting to administer Affordable Care Act (ACA) assessments on employers and individuals, as well as eligibility for premium subsidies on the public insurance exchanges.

 

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Employee Benefits News posted a slideshow illustrating the differences between Clinton and Trump on the current state of healthcare in the US. Spoiler alert: there are not that many differences! The areas where they are aligned include:

  • Cadillac tax – both want it repealed
  • Cost – both think it needs to go down
  • Prescription drug costs – both want Medicare to set drug prices
  • Insurer consolidation – both oppose
  • Transparency – both support
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This interesting piece in Kaiser Health News sheds some light on a real gap in healthcare: Physicians are barely trained in medical school on how to identify and treat addiction. In fact, only a few hours in the course of four years of medical school are devoted to teaching addiction medicine. Schools have been so slow to change that medical students at Harvard University, for example, have started conducting their own training on how to buy and administer drugs that reverse the effects of an overdose. And Stanford’s medical school adjusted its curriculum so that lectures on addiction will no longer be folded into the psychiatry series as a side note, but instead will be presented as a separate unit, relevant to future doctors in any subspecialty – and that training will continue when the students leave the classrooms for clinical rotations. As the story notes, medical schools have traditionally avoided teaching about addiction, partly because so many doctors have viewed it not as a disease but as a vice resistant to treatment in a medical context. But as this outmoded view fades, pressure is being put on medical schools to expand their curriculum in this area. While this is good news for employer sponsored plans, it will obviously take time for providers to be better trained on addiction treatment.

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Mental health parity is nowhere close to the top of most lists of benefit concerns. After all, the Mental Health Parity and Addiction Equity Act (MHPAEA) is eight years old and has never received the attention paid to other laws. Its rules are complex, requiring comparison of mental health/substance use disorder benefits with medical/surgical benefits in six separate classifications.

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