Progress? Yes, progress. Today, Catalyst for Payment Reform (CPR), an independent, non-profit employer coalition working to drive improved value in health care, released their 2014 National Scorecard on Payment Reform. The scorecard reports a 29-percentage point increase in provider payments linked to provider performance and outcomes instead of fee-for-service arrangements. These risk arrangements are evolving rapidly and the market is responding to employer demand and the collective efforts of CPR. However, with this level of swirl comes an increased need for financial vigilance by employers so that they are sure they have visibility into these varying arrangements and that members are benefiting from them.
Workplace stress is an issue that virtually every organization faces. Whether it stems from personal or financial matters, or is generated by the work environment itself, stress can have a substantial negative effect on an organization’s performance. A recent report by United Nations’ International Labour Organization (ILO) examined several studies to quantify the impact of stress in workplaces around the world. Work-related depression in the European Union alone is estimated to cost a whopping €617 billion. In the face of such staggering costs, what can employers do? The ILO identifies several measures employers can implement to mitigate these costs, ranging from social support systems where workers feel comfortable discussing conflicting demands between work and home, to training and education that provides information on psychosocial risks. It also provides a comprehensive list of tools for the assessment, management and prevention of risks and work-related stress for various countries and in multiple languages that employers can readily utilize. And while it’s important to be aware of what tools are available to help manage workplace stress, recognizing potential barriers for implementation is also key: taking a regional perspective, the study found that while limited understanding of psychosocial factors and work-related stress is one of the most prevalent barriers to implementation in the Americas, it’s less of a factor in Europe and Central Asia. The strategies described in the report, which are summarized in a recent Huffington Post article, provide a valuable checklist for international employers in particular to evaluate their efforts to create a positive and healthy work environment.
Hand in hand with stress management practices, health management policies are vital to the overall well-being of an organization’s workforce. The HERO Health and Well-Being Best Practices Scorecard in Collaboration with Mercer© - International Version (an online assessment tool designed by the Health Enhancement Research Organization and Mercer) provides an up-to-date inventory of best practices that can help employers identify gaps and opportunities, assess their programs against industry norms, and assist in strategic health management planning for companies based outside of the U.S. With the US and International versions of the HERO Scorecard available, organizations now have a consistent tool to assess their health and well-being efforts in worksites around the world.
A new report from the Congressional Budget Office has been widely covered in the press, from many different angles. Here’s our takeaway, through the employer lens:
- 155 million people – 57% of the population under age 65 – get their health insurance from their employer. That’s a lot! The employer voice is important and needs to be heard, especially after the election when the new President will take steps to implement his/her health policy.
- The number of people covered by employer-sponsored plans is projected to decline to 152 million by 2019. The decline is due mostly to lower-paid workers migrating to Medicaid or qualifying for subsidized coverage in the public exchange – and not to employers’ dropping coverage. Truth is, there has been very little change in the percentage of employers offering health insurance to their employees.
- The value of the Federal tax break for employer-based health care coverage is estimated to be $266 billion this year. This is something to keep an eye on. Many policymakers would like to tap some of that money to help pay for health care for those who do not have it. The ACA’s “Cadillac” tax wasn’t the first attempt to do that – and it likely won’t be the last.
The reason for the staying power of employer-sponsored health plans in the post-ACA era? Employers have been working hard to meet the challenges of providing sustainable health benefit programs that meet workers’ needs, and the great majority of employees like their employer-sponsored plans. Together, employers continue to pioneer the way forward in effectively and efficiently providing quality health care coverage to most Americans and their families. Their voice is and will continue to be an essential contribution to the ongoing health care policy debate.
Tobacco surcharges have become increasingly prevalent in employer medical plans over the last few years. In 2015, 22% of large employers (500 or more employees) offered lower premiums to non-tobacco users, up from 12% in 2011, according to Mercer’s research. When tobacco surcharges are in place, the ACA requires that employers offer tobacco users a ‘reasonable alternative standard’ that employees can meet in order to avoid surcharges. In many cases this means offering a tobacco-cessation program. However, the use of surcharges has come under fire by the American Lung Association, which sees the additional costs imposed upon tobacco users as a roadblock to the care they need. Nonetheless, research has found direct ties between tobacco use and increased health care costs: the American Cancer Society estimates that from 2000 to 2012, tobacco-related health costs and productivity loss in the United States totaled $289 billion. When implementing a tobacco surcharge or smoking cessation program, clear communications to employees and incremental changes can help to prepare employees. As Mercer’s Steven Noeldner suggests in this Employee Benefit News article on the subject, employers “could begin by putting policies and practices in place that eliminate smoking on campus. Then they might offer nicotine replacement therapy and counseling as early as possible.”
Medicare data has long been used as a barometer for health care costs overall, but a new study illustrates the vast differences between Medicare spend and private insurance spend, per capita, in various regions and hospital systems across the country. While it may come as no surprise that spending levels differ between Medicare and private insurance, the extent of the discrepancy is startling. Grand Junction, Colorado, with the third-lowest rate of Medicare spending in the country, was exemplified as a model of better, cheaper health care in Atul Gawande’s widely read “Cost Conundrum” article in 2009. However, it turns out to be one of the most expensive health care markets for the privately insured. As Gawande points out in his take on the recent data findings in this New Yorker article, one of the reasons is that “Medicare can use its authority to set prices for hospitals. Private insurers can’t.” Private insurers must negotiate with hospitals and so the leverage of either party in a particular region is going to directly impact prices. The differences in cost also expose other problems in health care spending, including how hospitals are compensated (for quantity, rather than quality of services) and the lack of competition (meaning, no incentives to keep prices down). While the hospital payment system is not an issue that is going to resolved today, this study lends new urgency to the ongoing movement to transform provider reimbursement.
Increases in drug benefit cost per employee have outpaced total health benefit cost increases for the past couple of years, according to Mercer’s National Survey of Employer-Sponsored Health Plans. So while it’s not surprising that prescription drugs account for a bigger share of overall health spending, the rate at which the Rx slice of the pie is growing in employer-sponsored coverage in particular is dramatic. Recent analysis from the Kaiser Family Foundation shows that while retail drugs account for 10% of national health spending, they account for 19% of total health spending when looking at employer-sponsored benefits. Despite the staggering disparity, it’s possible that figure may even be understated, since it doesn’t account for medications administered in hospitals or physician offices. Employers have benefited from the positive impact of drugs going generic for several years, however that is now sharply slowing – just as a slew of new specialty drugs have begun entering the market. Strategies to manage this potential cost spike involve close attention to your formulary and also the place of service for some therapies. It’s important to act now. You do not want to be the last one to get on board with new strategies or it will cost you!
Catalyst for Payment Reform (CPR), with the release of their Employer-Purchaser Guide to Quality Measure Selection, helped separate some of the signal from the noise as employers continue to ramp up their focus on delivering higher quality yet efficient care to their members. CPR’s report addresses a question on many purchasers’ minds: Are the measures of quality that my health plans and providers focus on the ones that really matter? CPR’s report echoes Mercer’s perspective: Focus on a set of meaningful, practical and focused measures as a starting point to move the needle on improving performance. The report specifically flags measures in terms of implementation feasibility and provides employers with some “how tos” to move things forward.
Value-Based Care, in one form or another, is part of every employer’s plan. CPR’s Guide helps provide clarity to one of the most complex parts of the puzzle.
The long Labor Day week-end is in sight, and summer is quickly becoming a memory. Many of you are getting down to the wire on 2016 benefits decisions. Will 2016 be a year for big change? After all, we are closing in on the effective date for the excise tax on high-cost plans in 2018 … or are we? Some are holding out, as they have with other ACA milestones, in hopes that the Cadillac tax will be repealed. All the while, plan sponsors (and their advisors) remain actively engaged in the quest to find the perfect balance between cost, quality, and member engagement.
Lin Grensing-Pophal wrote a piece that ran this week in Human Resource Executive online titled “Tracking Healthcare Trends,” in which she discussed NBGH survey results and new design strategies employers are implementing in 2016. Yours truly got the last word: “I think these are really exciting times to be in our business … With each passing day, we just get more and more opportunities for different types of strategies. It’s a lot to take in, but I think that there are a lot of great opportunities for us to continue to not only manage costs, but to drive better quality and to maintain or improve the health of the population. Those are all good things.”
I really do believe that! Employer-sponsored plans have become the incubators for so many new innovations:
- New care-delivery models, such as accountable care organizations (ACOs) and other network-based models, that are designed to promote value-based care.
- Countless new gizmos that track activity, measure progress in fitness challenges, monitor medication adherence, or record metrics associated with diabetes or diet.
- Brand-new health plan models, such as Collective Health, that promise to exceed customer expectations for how good a health plan can be.
- Private exchange options, like Mercer Marketplace™, that have secured a foothold in the employer market and continue to grow in popularity.
- Consumer engagement models, such as Accolade, that boast member satisfaction and net promoter scores never before seen in the industry.
- Digital platforms like Jiff — a new Mercer collaborator — that provide an easy-to-navigate user experience to drive utilization of the right health care services, by the right people, at the right time.
If you haven’t yet explored the landscape of new options, take time to press the “reset button” and look at everything the market has to offer before you begin planning for 2017. I promise you will not be disappointed.
There were a lot of headlines last week when the federal government released US health care spending projections for the next 10 years. An average increase of 5.8% is predicted from 2014-24.That’s up from the historically low increases in 2007-2013 (under 4% annually), but still considerably better than the 9% annual increases of the three prior decades. As this article from The New York Times suggests, with the economy improving and more people gaining insurance under the ACA, you would expect overall spending on health care to rise. But what about the per-person cost of health coverage? Last year Mercer’s National Survey of Employer-Sponsored Health Plans found that employers experienced a 3.9% increase in per-employee cost in 2014 (compared to the 5.5% increase in overall spending announced by the government) and that they expected cost to rise by just 4.6% in 2015. The steps they’ve taken to slow cost growth in their own plans is one factor helping to keep US spending on health care in check even as more people gain coverage.
According to a new report from Pew Research Center, 64% of adults in the US own a smartphone. What they are doing with that phone just may surprise you. Almost two-thirds of adult smartphone owners have used their phone to look up information on a health condition. The younger they are, the more likely they are to use their phone for this purpose -- 77% of owners ages 18-29, compared to 39% of those age 50 and older -- which means the trend will only strengthen as the younger users age. But the internet is full of medical information that may not be credible. For the sake of your employees’ health, you may want to steer them to credible resources that will have a positive impact on the type and quality of care they receive. Just make sure that your employees can access those resources via their smartphones.
A recent analysis from the Kaiser Family Foundation shows that many non-elderly Americans with private insurance don’t have enough liquid assets to pay the deductibles associated with their health plans. Thirty-five percent don’t have the assets to pay a higher-range deductible of $2,500 single/ $5,000 family and 24% don’t have the assets to pay a mid-range deductible of $1,200 single/$2,400 family. Although the analysis focused on households with private insurance, we can assume that there are people covered by employer plans facing similar financial challenges. This data highlights the importance of employer efforts to provide strong decision-support and transparency tools and lower-cost medical options like telemedicine.
The Commonwealth Fund conducts a major survey on health insurance in the US every other year. They interview a random sample of adults in the US (more than 6,000 in this most recent survey) on their health coverage, medical debt, and access to care. Because they began the survey in 2001 and ask the same questions each year, it’s a good measure of the impact of health reform. The survey found substantial improvements in all three areas in 2014: more Americans have health coverage, fewer have medical debt or difficulty paying health bills, and fewer say they are putting off medical care because of cost. Of the three, the improvement was greatest in the reported ability to access care: the portion of working-age Americans saying that they delayed care because of cost fell from 43% in 2012 to 36% in 2014. This far outstrips the drop in the percentage who are uninsured, which fell from 19% to 16%. The finding presents an interesting counterpoint to the argument that the shift towards greater cost-sharing in employer health plans has resulted in employees putting off needed care.