Rising Health Care Costs: Driving Factor Causing Changes to Employer Health Plans, SHRM Survey Finds

Get the latest trends in healthcare benefits in the survey conducted by SHRM.

Original Post from SHRM.org on July 13, 2016

Rising health care costs remain a primary driver for how other benefit costs are allocated, as employers continue evaluating the impact of the Affordable Care Act.
According to a new survey from the Society for Human Resource Management (SHRM), preferred provider organization (PPO) plans (offered by 84 percent of U.S. employers) continue to be the most common type of health care coverage. However, consumer-directed health care plans such as health savings accounts (HSAs) increased from 2012 and 2015, as did employer contributions to HSAs compared with 2012 (both by 7 percent).


Other health care findings:
  • Ninety-six percent of organizations offered some type of health care plan to their employees.
  • Mail order prescriptions have gone down by 6 percent over the past five years.
  • Eighty-five percent of organizations offer mental health coverage, compared to 91 percent just last year.
  • Organizations were evenly split as to whether they offered coverage to spouses who had access to health care coverage through another employer, or if there was a spousal surcharge for health care coverage.
  • Several new health-related items added to the survey this year: health care services such as diagnosis, treatment or prescriptions provided by photo or video (23 percent), high deductible health plan not linked to an HSA or a health reimbursement account (HRA) (17 percent), genetic testing coverage for diseases such as cancer (12 percent) and a smoking surcharge for health care plans (20 percent).


View the full survey online.


Read the full press release on this survey here.


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CDHP cost advantages extend for years

Originally posted March 30, 2015 by Alan Goforth on www.benefitspro.com.

Consumer-directed health plans can help contain health care spending for years after they're put into place, according to the first major study of its type.

“Do ‘Consumer-Directed’ Health Plans Bend the Cost Curve over Time?" released by the National Bureau of Economic Research, analyzes the three-year effects of CDHPs.

“We estimated spending trends for three years across … the country in an analysis estimating CDHP impacts, without the threat of individual level selection bias,” the authors of the study wrote. “We find that health-care cost growth among firms offering a CDHP is significantly lower in each of the first three years after offer. This result suggests that, at least at large employers, the impact of CDHPs persists and is not just a one-time reduction in spending.”

An unrelated study by the Society for Human Resource Management found that 19 percent of respondents that offer employee coverage said consumer-driven plans were the most-effective means of controlling the rising cost of health coverage.

Annual health care spending, according to the research bureau's findings, was 6.6 percent, 4.3 percent and 3.4 percent lower on average for the first three years, respectively, for companies with CDHPs when compared to companies without them.

CDHPs, which combine high deductibles with personal medical accounts, were designed to reduce health-care spending through greater patient cost-sharing. Several studies have shown that they reduce spending during the first year, but little research had been conducted into the longer-term economic impact. One concern was that CDHP enrollees would decrease their use of necessary care, which would lead to increased spending in the long term due to greater complications.

The National Bureau of Economic Research analyzed data from 13 million individuals in 54 large U.S. firms.

“We find that spending is reduced for those in firms offering CDHPs in all three years,” the report said. “The reductions are driven by spending decreases in outpatient care and pharmaceuticals, with no evidence of increases in emergency department or inpatient care.”

Researchers found that the CDHP savings effect varied considerably across spending category:

  •  Prescription drugs. Compared with firms not offering CDHPs, annualized spending growth on pharmaceuticals was 5 to 9.5 percentage points lower in the three years after firms offered CDHPs.
  •  Outpatient services. Spending growth on outpatient care was 3 to 6.8 percentage points lower in the first three years relative to non-offering firms.
  • Emergency room use. No differences were detected in cost growth for emergency room care in any of the first three years after a CDHP was offered.

Researchers caution against drawing implications for populations other than the ones studied.

"The results presented here are limited to large employers," the report said, "and therefore may not extend to Medicaid beneficiaries, the individual or small group market, or to the health insurance exchanges where, on average, deductibles and out-of-pocket maximums are higher and/or enrollees have fewer financial resources."

However, the longer-term study should alleviate some previous concerns.

“These findings do not support either the concern that decreases in spending will be a one-time occurrence or that short-term decreases in spending with a CDHP will result in increases in spending in the long term due to complications of foregone care,” it said.

8 tips to share with employees to ensure a successful open enrollment

Originally posted on https://ebn.benefitnews.com.

As open enrollment season approaches, benefit managers are moving into high gear as they prepare to answer employee questions and concerns about their 2015 benefits. And as employees take on more responsibility for their health care, it’s more important than ever for them to understand how they can make the most of the programs and benefits their employers are offering.

Here are eight tips from benefits consulting firm Aon Hewitt that benefit managers can share with employees to help ensure open enrollment runs smoothly.

1. Take an active role.

Employers are taking steps to make enrollment quicker and easier. “Many companies are designing the process so it is similar to an online retail shopping experience, where employees can access decision support tools and other resources that can help them narrow down their choices and weigh them against their specific needs,” says Joann Hall Swenson, health engagement leader at Aon Hewitt. “Employers are also stepping up their efforts to clearly communicate what is changing from previous years, using a variety of communication methods.” Encourage employees to take advantage of the resources you provide.

2. Assess your and your dependents’ health care needs.

Understanding their past needs and estimating their future needs will help employees determine what adjustments they may need to make in their benefits selections for 2015. Encourage employees to start by reviewing how much they’ve spent in the past year out-of-pocket, the costs of their regular prescriptions and the number of doctor visits they’ve had. If they are participating in a flexible spending account, encourage them to re-evaluate their contribution levels based on their actual and anticipated expenses for 2015. It’s also important to think about any life changes that may impact their decisions, such as an addition to the family or the development of a new medical condition that may impact health care expenses.

3. Evaluate your plan’s provider network.

Over the past few years, there have been many changes taking place in the provider community, including doctor’s groups joining together and hospitals and health systems re-contracting with insurers. As a result, health plan options may include vastly different combinations of doctors and hospitals than in the past. Most employers and health plans offer a number of tools and resources that can help employees assess the cost impact and quality of different providers as they make their enrollment decisions.

4. Evaluate whether a consumer-driven health plan is right for you.

CDHPs often have lower premiums, which make them an attractive option for individuals who want to reduce the costs taken out of their paychecks each month. While employees may have a higher deductible to meet, many employers couple these plans with health reimbursement accounts or health savings accounts, which employees can use to help pay for eligible out-of-pocket health care costs. HSAs are the most common, and allow employees to save money by contributing, on a pre-tax basis, up to $3,350 in 2015 or $6,650 if they have family coverage, with no use-it-or-lose-it rule. In addition, employers may also contribute to the HSA. It’s important for employees to understand how the employer’s contributions work so they can maximize this subsidy.

5. Determine the best source of coverage for your dependents.

If an employee’s spouse, partner or adult children have access to health coverage elsewhere, including through their employer, it may be more cost effective for them to enroll in this coverage instead of being covered by you. Encourage employees to carefully review and compare these plans to ensure they are choosing the coverage they need at the most favorable cost.

6. Take advantage of health and wellness programs.

Many employers offer a wide range of health and wellness programs, such as health assessments, weight loss programs and health coaching, to help employees get and stay healthy. Taking part in these programs can help employees understand their current health status, and they might even be able to take advantage of a financial incentive for doing so.

7. Understand how your employer coverage works in comparison to ACA exchanges.

2015 will be the second year of coverage available to Americans through the marketplaces, commonly referred to as “public exchanges.” In most cases, individuals with coverage through their employer will not be eligible for federal tax credits for purchase of insurance through the marketplaces. Employees can visit healthcare.gov to learn more about the marketplaces.

8. Take a holistic view of health and financial wellness.

As employees assess their health plan options for 2015, it’s important for them to look holistically at their health and financial well-being, including health care, income protection (e.g., life and disability insurance) and retirement planning. Does their spending reflect their needs and priorities? For example, if they aren’t contributing to your 401(k) plan, remind them that now might be a good time to start. Beginning to save earlier in their careers will help ensure they’re on track to meet their long-term savings goals.




HDHP Use Doubles for Nonprofits

Originally posted by Kathryn Mayer on https://www.benefitspro.com

For many nonprofits, just having traditional medical coverage is so 2009. Consumer-driven plans, like HDHPs, are the new rage.

According to a survey from benefits administration firm PPI Benefit Solutions, among nonprofits, the use of traditional medical plans has decreased from 96 percent in 2009 to 83.6 percent in 2013. Meanwhile, the use of high-deductible health plans has nearly doubled, increasing from 22 percent in 2009 to 43.5 percent in 2013.

PPI surveyed more than 250 small to mid-sized nonprofit organizations nationwide.

“Nonprofits are really struggling to maintain a comprehensive benefits package, and consumer-driven plans like HDHPs, health savings accounts and flexible spending accounts can be great, lower-cost options,” said Karen Greco, director of marketing for PPI Benefit Solutions. “The growth in these plan types, combined with the appeal of a predictable benefits budget, is also driving a lot of interest in alternative funding and enrollment solutions like defined contribution with an online marketplace that offers a wide array of product options.”

More nonprofits also are adding voluntary benefits, the report found. More employers, since 2012, are offering voluntary dental (offered by 20.3 percent of employers), life (49.7 percent), critical illness (9.6 percent), accident (34.5 percent) and transit reimbursements (24.3 percent) to their employees.

Other findings from the PPI report include:

Increased importance on automated benefits administration and enrollment: 77.2 percent of employers (up from 28.8 percent in 2012) consider benefits administration platforms to be very important and the 44.3 percent of employers (up from 9.6 percent in 2012) who believe employee self-service portals to be very important.

Help needed with understanding PPACA: 60.5 percent of nonprofits said they haven’t calculated the cost of compliance with regulations under the Patient Protection and Affordable Care Act.

Brokers wanted? Nearly 85 percent of nonprofit employers said they’re committed to delivering health and welfare benefits to their employees but are “seeking solutions to help manage costs and improve employee engagement.”

2013 rise in employer health costs lowest in years

Originally posted November 20, 2013 by Dan Cook on https://www.benefitspro.com

Is it the lull before the storm?

Employers, it appears, worked hard to hold down health plan cost increases this year. A Mercer study released Wednesday reported that the increase — just 2.1 percent over last year — was the lowest hike since 1997.

But don’t count on another new low in 2014.

Employers told Mercer they expect health plan costs to jump 5.2 percent next year if they keep on looking for – and finding -- ways to restrain health costs.

If they chucked all those efforts, employers say, the increase next year would be more along the lines of 8 percent.

Let’s not rain on the cost-reduction parade quite so quickly. Employer health costs have been reined in of late, and the efforts should be recognized.

The best performance came from the employer group represented by those with 10 to 499 employees. Their costs nudged up just 1 percent this year over last. Even large employers experienced just a 3.7 percent increase — still lower than the overall 4.1 percent increase in 2012 vs. 2011.

Part of the reduction in cost came from the increasing popularity of high-deductible health plans for employees, the study said. Consumer driven health plans are now entrenched in the workplace and offer savings to employers. As the study said:

“Nationally, enrollment in CDHPs rose from 16 percent of covered employees in 2012 to 18 percent in 2013. This is the same portion that enrolled in HMOs. In the Midwest, CDHP enrollment is now more than double that of HMOs (27 percent compared to 10 percent).  CDHPs are an important option for employers looking for a low-cost plan to make extending coverage to additional employees more affordable. The average cost of coverage in a CDHP paired with a tax-advantaged health savings account is 17 percent less percent than coverage in a PPO and 20 percent less than in an HMO.”

Employers also point to wellness plans as contributing to lower costs, although most can’t quantify the contribution.

As Mercer’s Julio A. Portalatin, president and CEO, said, “The good news is that employers have already taken decisive action to slow cost growth so they will be in a better position to handle the challenges ahead. But the impact of the ACA on enrollment levels remains a huge question mark.”

Employers pointed to the uncertainties of the implementation of the Patient Protection and Affordable Care Act as drivers for next year’s anticipated uptick.

They expect to be providing coverage for more workers in 2014 as the PPACA kicks in, which will add to their costs. “Next year, because of the individual mandate (contained in the PPACA), it is likely that fewer employees will waive coverage for themselves and more will elect dependent coverage – although the extent of the change is difficult to predict,” the study said.

Tracy Watts, Mercer’s national leader for health reform said “there are a lot of unknowns when it comes to enrollment.”

“A big question is how many employees will enroll for the first time, given that the tax penalty for not obtaining coverage is relatively small. But an employer might wind up covering more dependents if others in the area have made changes to discourage their employees from enrolling dependents,” she said.

Other highlights mined from the Mercer data:

  • In 2015 employers, more large employers are going to be required to offer health coverage to workers. Among all large employers, 32 percent say they expect to be affected, while 48 percent of large wholesale/retail companies say they will have to offer coverage.
  •  Fifty-five percent of respondents said they now include same-sex domestic partners as eligible dependents.
  • Twenty-three percent of large employers vary the employee contribution amount based on tobacco-use status or provide other incentives to encourage employees not to use tobacco. That’s up from 19 percent in 2012. Among employers with 20,000 or more employees, 46 percent now use an incentive.

56% of employers offer CDHP, 44% may make it the only choice: Aon Hewitt

Originally posted October 09, 2013 by Jerry Geisel on businessinsurance.com

Once a rarity, consumer-driven health care plans have become a mainstream design among large employers.

Fifty-six percent of midsize to large employers responding to an Aon Hewitt survey released Wednesday said they now offer CDHPs. Such high-deductible plans are linked to health reimbursement arrangements or health savings accounts, which employees can use to pay for a portion of uncovered health care expenses.

The prevalence of CDHPs is expected to grow, as 30% of respondents said they are considering offering a CDHP in three next three to five years.

Because of their high-deductible feature, CDHPs are much less expensive than other plan designs, according to several studies. For example, a Kaiser Family Foundation survey released in August found that the average cost of family coverage through CDHPs was nearly $1,500 less per employee than coverage through a preferred provider organization.

“Employers are increasingly embracing plan designs that are cost-effective, promote consumer choice and accountability, and encourage employees to be more deliberate in how they spend their health care dollars,” Maureen Fay, an Aon Hewitt senior vice president in Norwalk, Conn., said in a statement.

Only health care option for some

In addition, many employers are considering making a CDHP their only health plan choice.

While just 10% of employers now offer CDHPs as their only plan, 44% said they are they are considering doing so in the next three to five years, according to the survey.

The findings are based on the responses of 837 employers, 57% of which had more than 2,500 employees.

Satisfaction with health plan costs improving

Originally posted July 23, 2013 by Andrea Davis on https://ebn.benefitnews.com

Employer satisfaction with health plan costs is going up, according to the J.D. Power 2013 Employer Health Plan Study, yet health plans may risk losing group business unless they improve satisfaction in other areas.

The study, now in its fourth year, measures six factors that affect employer satisfaction with health plans: employee plan service experience, account servicing, program offerings, benefit design, problem resolution and cost. Satisfaction with cost is improving as more consumer-driven health plans are offered to employees, which 82% of employers indicate are controlling costs.

Employer satisfaction with costs “went up significantly in all the attributes we measure. Significantly more employers are offering CDHP products to their employees and so that has been a cost shifting measure that they are satisfied with,” says Scott Hawkins, director, health care, J.D. “But one of the things we see on the member side is that when employees are put on those products and they don’t really understand them, their satisfaction is lower. So I think it’s really important that employers work with the health plans to help their members understand how to manage those costs once they’re on those products or they’re going to have dissatisfied employees.”

Fifteen percent of employers say they “definitely will not” or “probably will not” continue sponsoring coverage in five years.

Perhaps not surprisingly, cost satisfaction among employers that indicate they intend to continue sponsoring coverage in the future is 106 points higher (on a 1,000-point scale) than among those that intend to drop coverage (696 vs. 590, respectively.)

“You can minimize the impact on satisfaction with the members and employees if you offer value-added benefits. And one of the things we’re seeing in our data and the employer data is that while health plans are offering a lot of the primary and secondary services that the employees are asking for, a lot of the employers aren’t taking advantage of those things; they’re not offering them to their employees,” says Hawkins.

Simple things like gym memberships, health risk assessments, drug compliance plans for employees with chronic conditions, for example, “will help satisfy the members and help them feel they’re getting value for what they’re paying,” says Hawkins. “But what we see now is that a lot of plans are offering them to employers, but not many of them are taking them up on it.” He suspects cost is the main reason employers may be reluctant to offer these programs to employees.

In both the fully insured and self-funded groups, employer satisfaction with program offerings, such as preventive health programs, disease management or wellness initiatives, is a key area of differentiation between employers that intend to offer coverage in the future and those that intend to drop coverage. In the program offerings factor, the gap in satisfaction scores between fully insured employers that intend to offer coverage in the future and those that intend to drop coverage is 104 points — 705 among employers that intend to offer coverage, compared with 601 among those that intend to drop coverage. Among self-funded employers, the gap in satisfaction scores between those that intend to offer coverage in the future and those that intend to drop coverage is also 105 points — 689 among employers that intend to offer coverage, compared with 584 among those that intend to drop coverage.

The 2013 Employer Health Plan Study is based on responses from 5,857 employers.


Survey: Employees don't want control over health care

Report reveals a sobering gap in employee readiness to handle and take on the shift toward consumer-driven health plans

Original article from https://ebn.benefitnews.com

By Tristan Lejeune

As more and more employers look at defined contribution health care and other insurance shifts, will employees be ready? Last year, J.D. Power and Associates reported that 47% of employers "definitely" or "probably" will switch to a defined contribution health plan in the coming years.

The third annual Aflac WorkForces Report reveals a sobering gap in employee readiness to handle and take on the shift toward consumer-driven health plans and defined contribution health. A majority of workers (54%) would prefer not to have more control over their insurance options, citing a lack of time and information to manage it effectively, while 72% have never even heard the phrase "consumer-driven health care."

Aflac and Research Now surveyed 1,884 benefits leaders and 5,229 wage-earners and found arresting disconnects in their expectations, plans and views of the future. For example, 62% of employees think their medical costs will increase, but only 23% are saving money for those hikes. A full three-quarters of the workforce think their employer will educate them about changes to their health care coverage as a result of reform, but only 13% of employers say educating their employees about health care reform is important to their organization.

"It may be referred to as 'consumer-driven health care,' but in actuality, consumers aren't the ones driving these changes, so it's no surprise that many feel unprepared," says Audrey Boone Tillman, executive vice president of corporate services at Aflac. "The bottom line is if consumers aren't educated about the full scope of their options, they risk making costly mistakes without a financial backup plan."

Aflac reports what many benefits leaders instinctively know: Consumers already find health insurance decisions intimidating and don't welcome increased responsibility. Fifty-three percent fear they might mismanage their coverage, leaving their families less protected than they are now. And significant ignorance remains: Plan participants are "not very" or "not at all" knowledgeable about flex spending accounts (25%), health savings accounts (32%), health reimbursement accounts (49%), or federal or state health care exchanges (76%).

According to the report, 53% of employers have introduced a high-deductible health plan over the past three years, and that trend shows no sign of slowing. Yet more than half of workers have done nothing to prepare for changes from HDHPs, the Affordable Care Act or other system shifts.

"It's time for consumers to face reality," Tillman says. "Ready or not, they are being put in control of their health insurance decisions - and that means having to make choices that could have a big impact on personal finances. If employers aren't offering guidance to workers on how to make crucial benefits decisions, the responsibility lies in the hands of consumers to educate themselves."

The U.S. government estimates that by 2014, household out-of-pocket health care expenses will reach an annual average of $3,301. More than half (55%) of workers have done nothing to prepare for possible changes to the health care system, Aflac reports, and their savings reflect that: 46% have less than $1,000 put aside for unexpected, serious illness or injury. Twenty-five percent have less than $500.

Tillman says that what surprised her most about the data is how people seem to be ignoring such a large, tectonic shift in the landscape. It's not exactly like health care reform has been subtle and creeping.

"There's no greater awareness, no greater education, and it's a sea of change that's taking place," Tillman says. "It's all over the news; it's everywhere. But people aren't any more moved to action and education."

What happens with health care, she says, "seems to be evolving," and there may be a reluctance on the part of consumers to jump in because "hey, it may change." The shift to CDHPs, however, seems to be building in momentum, and employees would do well to wake up. The entire point of that shift, after all, is that they will be on their own, but employers do need to make sure they know that.

Benefits "are a great expense to your organization, and to have your workers and the people that you're charged with protecting not aware, not informed of how the benefits offering could impact their lives, to me that's not really safeguarding a very expensive and important benefit," Tillman says. "It benefits the employee, obviously, to know: What are my benefits, what is my employer thinking about doing, what do I need to be studying. But at the same time, it's very important to employers ... because otherwise they're not getting a very good return on their investment."

Tillman says "frequent communication is paramount" for instituting changes like this - don't send out the message once a year and then forget about it. And never underestimate the value of a personal example as a teaching method.

"A lot of times employers and HR get into a communicate-only-at-open-enrollment mode," she says. "And, even if health care reform weren't about to happen, I'd still say as an HR professional, communicate throughout the year. Communicate via every method that you can - to be sure, at open enrollment, but also on your intranet. If you've got a portal, including things in mailers, the paper tables in the cafeteria. ... the more we can highlight a benefit by showing how other employees have utilized it, that's a really impactful case."




Many workers aren’t ready for health care reform

Original article https://www.kansascity.com

By Diane Stafford

National health care reform and cost-cutting by employers is changing the way many workers get health insurance, but a majority of employees may not understand what’s ahead.

The Aflac WorkForces Report, the insurer’s third annual employee benefits study, polled 5,299 employees across the country and found that three-fourths said they had never heard the phrase “consumer-driven health care.”

That’s a problem. Consumer-driven health care is the direction the nation is moving. It’s the underlying concept that requires individuals to take more control over their health care spending.

“It may be referred to as ‘consumer-driven health care,’ but in actuality, consumers aren't the ones driving these changes, so it’s no surprise that many feel unprepared,” said Audrey Boone Tillman, executive vice president of corporate services at Aflac.

There’s another problem. The survey found that more than half of the workers polled said they preferred not to have greater control over their health insurance options. Fifty-four percent said they don’t have the time or knowledge to manage the responsibility.

How will workers learn to navigate the world of health care and insurance choices? Seventy-five percent said they expect their employers to educate them about the details of reform.

There’s another problem. Only 13 percent of the 1,884 “benefits decision-makers” in organizations reached in a companion poll said they thought educating employees about health care reform is “important” to their organizations.

At least most employees realize they’re not ready. About half said they fear they will leave their families less protected if they make poor insurance plan choices.

The poll, released Wednesday, emphasized the education challenges as employers shift away from their health care benefits.

One-third of the employees polled said they weren’t knowledgeable about health savings accounts, three-fourths said they weren’t knowledgeable about the impending federal or state health insurance exchanges, half said they weren’t knowledgeable about health reimbursement accounts and one-fourth said they weren’t knowledgeable about flexible spending accounts.

All of those are benefits options for employers to subsidize employee health care in different ways or exit health benefits entirely.

“It’s time for consumers to face reality,” Tillman said. “The responsibility lies in the hands of consumers to educate themselves.”

Survey finds majority of employees want customizable benefits

Original article: https://ebn.benefitnews.com

By Tristan Lejeune

As employers increasingly cost-shift benefits, an inevitable consequence is employees wanting a larger say in how their benefit dollars are spent - making tailored and personalized benefit packages another step in the evolution of the consumer-driven paradigm.

"Once you get into the situation where employees now are all of a sudden consumers and [they]'re bearing a fair amount of the cost, with that comes a desire to be able to make a decision," says Mike Fish, vice president of voluntary benefits with The Hartford.

In a December 2012 survey of nearly 1,500 U.S. workers by TNS Omnibus, 86% say it is important to be able to customize all of their benefits to fit their individual lifestyle. Seventy-six percent of those surveyed by TNS Omnibus say it's important for them to design their own disability insurance instead of one-size-fits-all coverage chosen by an employer, and 82% would likely sign up for a disability plan that allows them the chance to choose the size of their payments.

Women and younger workers were particularly likely to favor customizable benefits. Only half of men, but 56% of women, agree that it is extremely or very important to be able to customize benefit choices to fit their lifestyle. Americans in their 40s are more likely to value the option than older workers, and millenials are more likely than any older group to say personalization is important.

"Consumers today can customize everything - from music and TV to clothing and cars, and our recent survey shows they want to customize their benefits, too," Fish says.