Aon Hewitt Analysis Shows Lowest U.S. Health Care Cost Increases in More Than a Decade
Originally posted October 17, 2013 on https://www6.lexisnexis.com
In 2013, U.S. companies and their employees saw the lowest health care premium rate increases in more than a decade, according to an analysis by Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE: AON). After plan design changes and vendor negotiations, the average health care premium rate increase for large employers in 2013 was 3.3 percent, down from 4.9 percent in 2012 and 8.5 percent in 2011. In 2014, however, average health care premium increases are projected to move back to the 6 percent to 7 percent range.
Aon Hewitt's analysis showed the average health care cost per employee was $10,471 in 2013, up from $10,131 in 2012. The portion of the total health care premium that employees were asked to contribute toward this premium cost was $2,303 in 2013, compared to $2,200 in 2012. Meanwhile, average employee out-of-pocket costs, such as copayments, coinsurance and deductibles, increased 12.8 percent ($2,239) in 2013, compared to just 6.2 percent in 2012 ($1,984).
For 2014, average health care costs are projected to increase to $11,176 per employee. Employees will be asked to contribute 22.4 percent of the total health care premium, which equates to $2,499 for 2014. Average employee out-of-pocket costs are expected to increase to $2,470. These projections mean that over the last decade, employees' share of health care costs-including employee contributions and out-of-pocket costs-will have increased almost 150 percent from $2,011 in 2004 to $4,969 in 2014.
"There are many factors that contributed to the lower rate of premium increases we saw over the past two years that we don't expect to continue in the long-term. These include the lagged effect from the economic recession on health care spending and continued adjustments as employers and insurers phase out the conservatism that was reflected in earlier premiums due to uncertainty around economic conditions and health care reform. Additionally, employers and insurers will now be subject to new transitional reinsurance fees and health insurance industry fees," said Tim Nimmer, fellow of the Society of Actuaries, member of the American Academy of Actuaries and chief health care actuary at Aon Hewitt. "While we are seeing pockets of promising innovation in the health care industry, we expect to see 2014 premium increases shift back towards the 6 percent to 7 percent range overall."
Costs by Plan Type
On average, Aon Hewitt forecasts that companies will see 2014 cost increases of 7.5 percent for health maintenance organization (HMOs) plans, 6.5 percent for preferred provider organization (PPOs) plans and 6.5 percent for point-of-service (POS) plans. That means that from 2013 to 2014, the average cost per person for major companies is estimated to increase from $10,880 to $11,696 for HMOs, $10,222 to $10,887 for PPOs and $11,450 to $12,194 for POS plans.
| Year | HMO | POS | PPO | National |
| 2014* | $11,696 | $12,194 | $10,887 | $11,176 |
| 2013 | $10,880 | $11,450 | $10,222 | $10,471 |
| 2012 | $10,375 | $10,955 | $9,955 | $10,131 |
| 2011 | $9,833 | $10,553 | $9,508 | $9,662 |
| 2010 | $9,103 | $9,464 | $8,790 | $8,903 |
| 2009 | $8,461 | $8,778 | $8,363 | $8,380 |
| 2008 | $7,975 | $8,321 | $8,004 | $7,983 |
*Projections
Costs are plan costs (premium or budget rate) on a per employee basis. They include employee contributions, but not their out-of-pocket costs (i.e., co-payments, coinsurance).
2013 Cost Increases by Major Metropolitan Area
In 2013, major U.S. markets that experienced rate increases higher than the national average included Los Angeles (6.9 percent), Orange County (6.9 percent), Washington DC (5.3 percent) and San Francisco/Oakland/San Jose (4.8 percent). Conversely, New York City (1.6 percent), Milwaukee (2.1 percent) and Atlanta (2.4 percent) experienced lower-than-average rate increases in 2013. Of note, Minneapolis saw a decrease in rate increases at -0.1 percent.
Employer Actions to Mitigate Trend
"Health care remains a top priority for U.S. employers, and most are taking action to prepare for increasing cost, risk and change," said Jim Winkler, chief innovation officer for the U.S. Health & Benefits practice at Aon Hewitt. "As the health care industry continues to evolve, employers realize that a traditional 'managed trend' approach will be less effective in mitigating costs increases over time. Instead, they are exploring innovative new delivery approaches, requiring participants to take a more active role in their own health care planning, and holding health care providers more accountable to reduce unnecessary expenses and create more efficiency in the way health care is purchased."
Recent Aon Hewitt research shows that 72 percent of employers focus their health care strategy primarily on programs that improve health risk and reduce medical costs. As the health care landscape continues to evolve, employers will look to reduce costs using a mix of traditional and non-traditional approaches. These include:
Innovative Approaches to Providing Employer-Sponsored Coverage - Private health exchanges are becoming increasingly attractive to organizations that want to offer employees health care choice while lowering future cost trends and lessening the administrative burden associated with sponsoring a health plan.
In this model, employers continue to financially support health insurance, but allow employees to choose from multiple group plan options and insurance carriers via a competitive, health insurance marketplace.
According to Aon Hewitt research, about 28 percent plan to move into a private health care exchange over the next three-to-five years. Eighteen large employers, includingWalgreensand 2013 participantsSears Holdings,Darden Restaurantsand Aon plc, are offering health benefits this fall through theAon Hewitt Corporate Health Exchange, the nation's largest multi-carrier private health care exchange.
Plan Design Strategies - Aon Hewitt's research shows that consumer-driven health plans (CDHPs) have surpassed health maintenance organizations (HMOs) as the second most popular plan option offered by employers. A growing number ofemployers are offering CDHPs as the only plan option. While just 10 percent of companies do so today, another 44 percent are considering it in the next three to five years[1].
Managing Dependent Eligibility and Subsidies - Many employers are reassessing the way they offer and subsidize health coverage for dependents. Specifically, they are:
Reducing the employer subsidy for covered dependents. Aon Hewitt's research shows that 54 percent of employers are considering reducing subsidies across all dependent tiers in the next three-to-five years. Implementing or increasing surcharges for adult dependents with access to coverage elsewhere. Aon Hewitt's research shows 69 percent of employers have implemented or plan to implement surcharges for adult dependents. Adopting a unitized pricing approach, where employerscharge per dependent. While just 4 percent of employers currently adopt this approach, another 47 percent are considering it in the future. Assessing the eligibility of covered dependents in their plans. A recent Aon Hewitt survey shows that two-thirds ofemployers have completed a program audit of covered dependents to ensure only those who are eligible will remain on the plan.
Increased Cost Sharing - As health care costs increase overall, the amount of money employees will need to contribute out of their paychecks-both in premiums and out-of-pocket costs-is continuing to climb. Today, employees' share of the overall health care premium is 22 percent, compared to just 18.6 percent a decade ago. Additionally, Aon Hewitt's research shows that 47 percent ofemployers have increased participants' deductibles and/or copays in the past year, and another 43 percent are considering doing so in the next three-to-five years.
According to Aon Hewitt, employers are increasing cost sharing through:
Altering plan designs, including shifting from fixed dollar copayments to coinsurance models, where employees pay a percentage of the out-of-pocket costs for each health care service. Increasing deductibles out of pocket limits and cost sharing for use of non-network providers.
Wellness and Health Programs - With employers facing the impacts of rising health care costs and declining health of the population, employees can expect to see more employers offering programs that encourage them to take a more active role in managing their health. For example, 75 percent of employers offer health risk questionnaires (HRQs) and 71 percent offer biometric screenings such as blood pressure and cholesterol.
New Provider Payment Strategies - A growing number of employers want to ensure that the health care services they are paying for are actually leading to improved patient outcomes and are seeking to hold providers more accountable. According to Aon Hewitt's research, 53 percent of employers said that moving toward provider payment models that promote cost effective, high quality health care results will be a part of their future health care strategy, and one in five identified it as one of their three highest priorities.
About the Data
Aon Hewitt's data is derived from the Aon Hewitt Health Value Initiative database, which captures health care cost and benefit data for 516 large U.S. employers representing 12.8 million participants, more than 1,200 plans and $61.2 billion in 2013 health care spending.
Can Obamacare Beat Your Employer's Insurance?
Originally posted October 14, 2013 by Susan Ladika on https://finance.yahoo.com
If you already have health insurance through your job, you're probably wondering whether Obamacare will give you some new options. Will you be able to comparison-shop for a plan on the new online exchanges that might be better than your employer health insurance? The answer is a big, resounding "maybe."
Like almost everything else having to do with health care reform, there are plenty of nuances and caveats. Trying to decipher them and choose the best health insurance plan for your situation "makes homeowners insurance seem really simple," says Brian Haile, senior vice president for health policy at the tax services company Jackson Hewitt.
Exchanges will be open to all, but ...
The exchanges are online health insurance marketplaces set up under the Affordable Care Act. In 34 states, the marketplaces operate through the federal government's HealthCare.gov website, while 16 states and the District of Columbia are running their own exchanges.
Even if your employer already offers health insurance, there's nothing to prevent you from shopping on your state's exchange. However, if you decide to leave your work-based plan and purchase coverage on the exchange, you "may not qualify for some of the benefits that the uninsured have," notes E. Denise Smith, a professor of health care management at Gardner-Webb University in Boiling Springs, N.C.
Here's the big hiccup: Unless your employer's coverage for an individual is considered unaffordable under the law (that is, if your share of the premiums costs more than 9.5 percent of your household income) or inadequate (picking up less than 60 percent of the cost of covered benefits), you aren't eligible for a government subsidy to help pay for your insurance. Subsidies are one of the things that can make plans on the new state exchanges appealing.
Subsidies in the form of tax credits are available even if you earn up to 400 percent of the federal poverty level, currently about $46,000 for an individual and $94,000 for a family of four. The subsidies vary based on income and the size of your family.
Trade in your employer plan?
And that brings us back to the central question: If you have employer health insurance, should you check out the Obamacare exchanges anyway? There are differing opinions.
"It would generally not benefit an employee to leave their employer-sponsored plan," Smith concludes, adding that your employer would be under no obligation to help pay for an exchange plan.
Haile says you may not be able to do better than your work-based coverage. "Look at how robust your employer plan is" and the benefits it provides, such as whether it includes dental and vision care, which are not part of the essential health benefits that must be offered with plans sold in the Obamacare exchanges, he says.
Still, if your employer-sponsored health insurance seems to eat up a big chunk of your budget, you might want to explore your options on the state exchange, Haile says.
Few workers have 'unaffordable' plans
Again, one of the key criteria of whether you'd qualify for subsidized insurance through your state's exchange is if your share of the premium for an individual health plan where you work would amount to more than 9.5 percent of your household income. Whether you take more expensive family coverage doesn't matter; the benchmark is what an individual policy would cost.
The rule means that someone earning $40,000 a year and paying $3,775 for individual coverage would not be eligible for a subsidy, says Brian Poger, CEO of Benefitter, a software company that's helping employers navigate their way through health care reform. That same worker paying even more for family coverage would still not be eligible because, again, the premium for an individual is less than $3,800 (or 9.5 percent of $40,000).
The 9.5 percent-of-income threshold is one that few workers would meet, according to one recent study. The ADP Research Institute found that only 8.6 percent of employees are required to pay premium contributions that would meet the Affordable Care Act's definition of "unaffordable."
How will you know whether your premiums and income put you in that group and make you a good candidate for an exchange plan? Right now, it's a little unclear.
"The answer is sort of a mish-mash," Haile says. Many of Obamacare's employer requirements were delayed until 2015, though companies were still supposed to provide notices by Oct. 1 telling workers whether their current coverage would be considered affordable. But the U.S. Labor Department says there's no fine or penalty for failing to provide the notices.
Exchange coverage for family members
Under those same delayed "employer mandate" provisions, companies with at least 50 full-time workers will be required to offer health insurance to their workers and the workers' dependent children in 2015. But coverage for workers' spouses will not be mandatory, notes Christine Barber, senior policy analyst at Community Catalyst, a health care advocacy group.
"If your spouse isn't covered by your employer's insurance and doesn't have insurance through his or her own employer, your spouse could shop for insurance on the exchange and potentially qualify for a subsidy," Barber says.
Others who might find it valuable to shop on the exchanges are working singles under the age of 30 who don't have health issues and would be able to purchase a catastrophic plan, Haile says.
Catastrophic plans available on the state exchanges will have low monthly premiums but high deductibles. According to Haile, they're not eligible for subsidies.
All workers at a particular company often pay the same rate for their employer health insurance, regardless of age or medical history, he says. Opting for an Obamacare catastrophic plan "could be cheaper if you're the young kid on the block," especially if your co-workers are decades older, which could drive up everybody's insurance costs.
Health Care Reform Heightens Employers' Strategic Plans for Health Care Benefits
Original article can be found at https://online.wsj.com
Original source: Towers Watson
NEW YORK--(BUSINESS WIRE)--August 21, 2013--
The breadth of health care reform is prompting changes and ushering in emerging opportunities for employers, according to a survey of 420 midsize and large companies by global professional services company Towers Watson (NYSE, NASDAQ: TW). While employers remain concerned about a predicted 5.2% increase in 2014 health care costs and the risk of triggering the excise tax* in 2018, most (82%) continue to view subsidized health care benefits as an important part of their employee value proposition in 2014.
However, the 2013 Health Care Changes Ahead Survey found that a majority of employers do anticipate making moderate to significant changes in their health benefit programs for all employees and retirees by the beginning of 2016. It also revealed a clear disparity in how employers view public and private exchanges. Nearly 30% of employers have confidence in public health insurance exchanges as a viable alternative to employer-sponsored coverage in 2015. In contrast, private exchanges are more appealing, with 58% having confidence in them as a viable alternative. In short, employers are intrigued by the potential of private exchanges to control cost increases, reduce administrative burdens and provide greater value.
Employers remain committed to sponsoring health care benefits, and nearly all (98%) plan to retain their active medical plans for 2014 and 2015. However, they will look to private exchanges as a potential delivery channel. This arrangement enables them to maintain their role as plan sponsor, but outsource certain aspects of plan management to an exchange operator. Nearly three-quarters (74%) of companies surveyed reported that as they evaluate private exchanges for active full-time employees, they will want evidence that private options deliver greater value than the current self-managed model.
"The health care landscape is changing rapidly thanks to health reform, continued cost escalation, the emergence of health benefit exchanges, and new provider contracting and care delivery arrangements," said Randall Abbott, a senior health care consultant at Towers Watson. "While employers are grappling with how to comply with health care reform right now, they are evaluating new health care designs and delivery approaches for their employee and retiree populations that will ultimately transform the look of employer-provided health plans over the next three to five years. In particular, employers recognize the impact of the excise tax requires strategic planning now to create a glide path to 2018."
Initiatives to Avoid the Excise Tax
More than 60% of employers believe that they will trigger the excise tax in 2018 if they don't make adjustments to their current benefit strategy. Nearly the same percentage also say the excise tax will have a moderate or significant influence on their strategy.
To combat the increase in employee health care costs and avoid the excise tax, nearly 40% of employers will be changing their plan designs for 2014. In addition to emphasizing employee wellness and health improvement approaches, employers are looking to increase their use of supply-side strategies and aggressive vendor management techniques. For 2015 or 2016, they are considering providing outcome-based incentives (49%), offering a benefit differential for use of high-performance networks (47%) and using value-based benefit designs (40%). Employers will also be focused on reducing coverage subsidies for spouses and dependents, as well as implementing spousal coverage exclusions or spousal premium surcharges when other health coverage is available.
"Employers are balancing many competing factors as they revisit their financial commitment to health benefits and their ability to maintain a sustainable plan in the face of annual cost increases and the excise tax. They see health care benefits as an important part of their total rewards mix. And as they weigh new options, they will be looking to keep their plans affordable and viable for the long term," said Ron Fontanetta, a senior healthcare consultant at Towers Watson. "In the next two years, many employers will evaluate their strategic options for active employees, and wait to see how exchanges evolve and the broader market responds. We are likely to see a much different -- and much faster -- pace of change in retiree medical plans."
Health Care Coverage for Retirees and Part-Time Workers
With the existence of proven exchange solutions for Medicare-eligible retirees, the percentage of employers that are somewhat or very likely to discontinue their employer-sponsored plan for post-65 retirees will grow from 25% in 2014 to 44% in 2015. And with the advent of public exchanges making new solutions available for pre-65 retirees, the percentage of employers that are somewhat or very likely to discontinue their plan for pre-65 retirees will jump from 10% in 2014 to 38% in 2015.
Less change is expected for part-time employees. Only 11% are considering changes to their total rewards mix or design for part-time employees. Many part-time employees are likely to seek coverage through public exchanges.
Other Notable Trends and Data Points from the Survey
-- CEOs and CFOs have become increasingly involved in health care strategy decisions (36% and 46%, respectively).
-- Seven in 10 employers have a stronger commitment to improving employee health because of health care reform, while 71% have a stronger commitment to work with health care providers and suppliers to improve health care delivery and quality.
-- The use of personalized digital technologies to improve employee health engagement is on the rise. Forty-three percent of companies plan to use the technologies by 2014, and another 31% are considering its use for 2015 or 2016.
-- Half the companies surveyed provided employee communications that go beyond meeting compliance standards in educating employees on the law and its implications; 36% meet minimum compliance standards, and 14% go significantly beyond compliance to prepare employees for planned and potential strategic changes.
*Excise tax: According to the Patient Protection and Affordable Care Act, the federal government will impose an excise tax of 40% on insurers of employer-sponsored health plans, including self-insured employers, with an aggregate value of more than $10,200 for individual coverage and $27,500 for family coverage.
About the Survey
The 2013 Towers Watson Health Care Changes Ahead Survey offers insight into the focus and timing of U.S. employers' planned response to the Patient Protection and Affordable Care Act and the start of open enrollment for health insurance exchanges in the fall. The survey was completed by 420 employers during July 2013 and reflects respondents' 2014 -- 2016 health care benefit decisions. The responding companies comprise a broad range of industries and business sizes, and collectively employ 8.7 million employees.
Employers Push for Better Health Pricing
Originally published by Dan Cook on the BenefitsPro website.
Catalyst for Payment Reform told lawmakers this week that efforts to elicit better value for employer-sponsored health plans take a flawed approach to solving the pay-for-value problem.
The crux of the issue: health plans are being evaluated by the simplest measures rather than ones that dig deeper. For most purchasers of the plans, this only frustrates efforts to control costs and facilitate better outcomes for those covered.
“One of today’s biggest shortcomings is the separation of price and quality information,” Dr. Suzanne Delbanco, executive director of the group, said in an appearance before the U.S. Senate Committee on Finance.
“I think we have probably too many [quality metrics] now and not enough that focus on exactly those points where there’s the greatest opportunity for reducing harm and where there’s the greatest variation in performance. We tend to measure things that are easy to collect data on and that show very little difference between providers.”
Catalyst for Payment Reform represents major employers dedicated to finding better ways to evaluate their health plans to achieve greater efficiencies and better outcomes. Among the members: Safeway, Dow Chemical, 3M and CALPERS, the mammoth California employee pension fund.
Delbanco said her organization is promoting reference-based pricing, where purchasers establish the price of a particular service, and the patient pays any additional costs beyond that. CALPERS uses this approach in hip and knee surgeries.
Others who testified at the hearing on high prices and low transparency in healthcare included Giovanni Colella, CEO and co-founder of Castlight Health; TIME magazine contributing editor Steven Brill; and Dr. Paul Ginsburg, president of the Center for Studying Health System Change.
Five tips for saving on prescription drugs
Original article https://www.benefitspro.com
By Kathryn Mayer
No two pharmacies are alike.
According to an analysis by Consumer Reports, prescription drugs vary widely in price depending on where you shop. Failing to comparison shop could result in overpaying by as much as $100 a month or even more, depending on the drug.
The consumer group says shoppers need to compare prices. Here are five other tips on how to save money on prescriptions, according to Consumer Reports.
Request the lowest price. Consumer Reports analysis reveals shoppers weren’t always given the best, lowest price. Make sure you ask.
Go generic. Generics are copies of brand-name medications whose patents have expired. The Food and Drug Administration requires generics contain the same active ingredients in the same strength as the brands they copy. In addition, a generic must be “bioequivalent” to its corresponding brand, meaning that it delivers the same amount of active ingredients into a person’s bloodstream in the same amount of time as the original brand.
Leave the city. Some grocery store and independent drugstores had higher prices in urban areas than rural areas, according to Consumer Reports. For example, CR shoppers priced a 30-day supply of generic Actos at a pharmacy in Raleigh, N.C., for $203, while another pharmacy in a rural area of the state sold it for just $37.
Get a refill for 90 days, not 30 days. Most pharmacies offer discounts on a three-month supply.
Look for additional discounts. All chain and big-box drugstores now offer discount generic-drug programs, with some selling hundreds of generic drugs for $4 a month or $10 for a three-month supply. Just make sure your drug is on the list. Offers vary and check the fine print.
55 billion reasons for consumer-driven care
Source: Benefitspro.com
In a report this week, we found out something we already knew—but probably not to this extent.
Our country’s health care system squanders a ridiculous $750 billion a year. That’s roughly 30 cents of every medical dollar spent. It happens through unneeded care, excessive administrative expenses and data, fraud and other problems, a report by the Institute of Medicine revealed.
Let’s go over some numbers. America spent $2.6 trillion on health care last year. And a third of that spending did nothing to make any of us any healthier. Our health care costs are rising faster than inflation, and it’s literally bankrupting many of us. It’s also killing us. By one estimate, the report says, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.
So what is going on?
The report breaks down the sources of overspending: Unnecessary services tops the list at $210 billion, followed by inefficiently delivered services ($130 billion), excessive administrative costs ($190 billion), prices that are simply too high ($105 billion), fraud ($75 billion) and missed prevention opportunities ($55 billion).
Though we’ve come a long way in health innovation—such as the management of previously fatal conditions—the report said, the American health care system is still falling short on “basic dimensions of quality, outcomes, costs and equity.”
Not that this is news. We know this. It’s apparent every time we see health report numbers or look at our own medical bills.
The question is what we can do about it.
The Institute of Medicine has recommendations: Fully adopt mobile technologies and electronic health records; increase transparency about the costs and outcomes of care; use better data; and move toward a system that rewards doctors for quality, not quantity, of care.
Sure, these are good ideas, but whether they'll happen any time soon is really a mystery. Sadly, it’s out of consumers’ hands.
But preventive care isn’t. There’s something each of us can do—get checked, get necessary and recommended health screenings, eat healthy, exercise, don’t smoke, be proactive about problems—the list goes on. Older people, the report notes, have a big problem with preventive care, and it’s especially problematic because they're more prone to serious and costly health woes.
It’s also worth noting that the report comes at an interesting time. The presidential race is tighter than anyone thought—and health reform and Medicare cuts are sources of major contention. President Obama didn’t even give mention the signature piece of his presidency, the PPACA, during his nomiation acceptance speech at the Democratic National Convention.
Seems like there’s a lot we—and Washington—can do to drastically cut health care costs while also improving care that doesn’t cost another trillion or so dollars to implement.
CHANGING TIMES
Companies are seeking alternate health coverage offerings in the face of a shaky economy and the potential impact of the health care reform law, according to a new report by J.D. Power and Associates. The study found that employers are considering such options as defined contributions, vouchers and exchange purchasing in an effort to control spiraling health care costs. Employers, however, seem committed overall to continuing to offer health benefits. The study found that only 13 percent of fully insured employers and 14 percent of self-insured companies said they probably or definitely will not offer employer-sponsored benefits in the future.
Wellness programs could mitigate projected 2013 health care cost increases
By David Morgan
May 31, 2012
Source: https://eba.benefitnews.com
WASHINGTON | Thu., May 31, 2012 12:00am EDT (Reuters) — The cost of U.S. health care services is expected to rise 7.5% in 2013, more than three times the projected rates for U.S. inflation and economic growth, according to an industry research report from PricewaterhouseCoopers.
But premiums for large employer-sponsored health plans could increase by only 5.5% as a result of company wellness programs and a growing trend toward plans that impose higher insurance costs on workers, the firm concluded.
The projected growth rate of 7.5% for overall health care costs contrasts with expectations for growth of 2.4% in U.S. gross domestic product and a 2% rise in consumer prices during 2013, according to the latest Reuters economic survey.
Health care costs have long been known to outstrip economic growth and inflation rates, driving up government spending on programs such as Medicare and Medicaid at a time when federal policymakers and lawmakers are wrangling over how to trim the U.S. budget deficit of $1 trillion a year.
But PwC's Health Research Institute, which based its research on input from health plan actuaries, industry leaders, analyst reports and employer surveys, said data for the past three years suggest an extended slowdown in healthcare inflation from earlier decades when annual costs rose by double-digits.
"We're in the early beginnings of a shift toward consumerism in health care. And we think that you'll see more of that in the coming months and years," said Ceci Connolly, the health institute's managing director.
More than half of the 1,400 employers surveyed by the firm are considering increasing their employees' share of health benefit costs and expanding health and wellness programs in 2013, according to the report.
Connolly said health plans with higher deductibles and co-pays for workers tend to dissuade unnecessary purchases and offer lower premium costs for employers, while successful wellness programs can reduce the need for medical services.
The report said prospects for higher growth are also being held back by the consolidation of hospitals and physician practices, insurance industry pressure on hospital expenses, a growing variety of primary care options such as workplace and retail health clinics, price transparency and the increasing use of generic drugs.
Upward pressure on health care costs comes in part from a rebounding economy and the growth of new medical technologies, including robotic surgery and the nuclear medicine imaging technique known as positron emission tomography.
PwC's projection of 7.5% growth is nearly double a 3.9% rise in U.S. health care spending that the federal government says occurred in 2010, the last year for which official figures are available.
Employers fail at measuring wellness program ROI
BY AMANDA MCGRORY
As health care costs continue to rise, employers are on the lookout for ways to reduce spending, and wellness programs are becoming an increasingly popular solution. While research has shown that wellness programs can reduce costs, many employers are failing to measure their return on investment to get an accurate picture of how these programs impact the bottom line, says LuAnn Heinen, vice president at the National Business Group on Health, a nonprofit dedicated to representing large employers’ perspectives on national health policy issues in Washington, D.C.
“It’s important for everyone to look at what they’re spending on wellness per employee and look at that as a percentage of what they’re spending on health care,” Heinen says. “Most employers keep their wellness program investments small – only 2 percent of less of claim costs. There’s a body of evidence in different employer settings and over a number of years that suggests there is a return on investment of $2-3 per every dollar invested. When looking at these figures, a lot of companies might find that they’re underinvesting in wellness and prevention.”
Despite the importance of measuring ROI on wellness programs, it can be a struggle for employers because of the various components, Heinen says. Employees are coming and going, coverage policies could change, new insurance carriers take over – there are so many revolving factors in an employer’s reality that getting a real read of wellness programs can be difficult.
“We have a messy real world,” Heinen says. “The bottom line is you can try to collect and study a lot of data to determine the return on investment, but for all kinds of reasons out of your control, you don’t end up with valid information.”
Although measuring ROI is challenging, that’s not a reason for employers to give up, Heinen says. Instead, Heinen recommends that an employer divides its employee population into two groups: participants and nonparticipants. Between those two groups, an employer can look at the difference in claims over time. However, there are some problems with that approach.
“It’s easier to participate in wellness if you’re healthy, so maybe that person would have cost less anyway,” Heinen says. “Just because you participated in wellness doesn’t mean it was because of the wellness program that those people cost less, but at least you know there’s an association between people in the wellness program who tend to be lower cost, and it can give you that confidence that the more people participating in wellness, the better for your trend.”
An employer can also measure ROI by matching a participating employee to a nonparticipating employee who both represent similar demographics, Heinen says. For instance, an employer can take a nonsmoking 35-year-old woman following the wellness program and compare her claims to another nonsmoking 35-year-old woman who is not participating. These similar demographics do a better job of painting the true claims picture.
“It wouldn’t be a good comparison if all the employees participating were 25 and all the employees not participating were 45,” Heinen says “You want to match based on key demographics that drive costs and then you have a better chance of seeing the differences in the cost profiles is the wellness program and not their age or their smoking status or something else.”
Employers should keep in mind that calculating the success or failures of a wellness program takes time, Heinen adds. Considering the revolving workplace and the time and effort it takes for implementation, employers should give their wellness programs two to three years before they relying on the data.
“It takes a while to get enough people to participate, and then it also takes time to get information on their experiences and make changes,” Heinen says. “You really need at least two years.”
Not as Simple as Paying or Playing
By Jenny Ivy
With roughly half of employers saying they'll definitely be offering health coverage even after insurance exchanges begin, speculating with certainty (a bit of an oxymoron) that it's only a matter of time before companies drop health coverage is a futile argument.
Likewise, it's fair to say that there are several legitimate reasons for companies (particularly the bigger ones) to keep offering coverage, but we're only assuming the status quo won't change dramatically once health reform is in full effect. All you have to do is look at the numbers that are already dropping, and dropping hard. [See: Reform driving up health plan costs]
Studies, including the one released last week by Towers Watson and the National Business Group on Health, show there is a commitment among employers to do what they can to keep offering coverage in the near-term. Beyond 10 years, however, is when things get debatable. According to their employer survey, only 3 percent of employers are somewhat to very likely to discontinue health care plans for active employees in 2014 or 2015 without providing a financial subsidy. By the same measure, 45 percent of employers are somewhat to very likely to offer coverage to only a portion of their work force and direct the others to the exchanges.
While most employers will remain focused on sponsoring the design and delivery of their health care programs through 2015 (77 percent), they are much less confident that health care benefits will be offered at their organization over the longer term. Less than one in four (23 percent) companies are very confident they'll continue to offer health care benefits 10 years from now, down from a peak of 73 percent in 2007.
Unless there's a revolutionary way of delivering health insurance, employers will be circulating through all the options to combat high health care costs. The Towers Watson/NBGH survey shows health care costs per employee are expected to rise 5.9 percent this year, as compared to 5.4 percent in 2011. Health care costs per employee averaged $10,982 last year, and is expected to rise to $11,664 in 2012. Employees’ share of costs increased 9.3 percent during this period, to $2,764. This amount represents a 40 percent increase in costs from just five years ago, as compared to a 34 percent increase for employers over the same time period.
“As employers try to maintain the balance between containing costs and offering competitive total rewards packages, they are realizing that their future health care benefit choices are not quite as simple as ‘paying or playing,’” says Ron Fontanetta, senior health care consulting leader at Towers Watson. “In fact, there is a wide spectrum of design choices that will allow employers to develop a health care strategy that matches their unique objectives and workforce demographics.”
Besides actually cultivating healthier employees, the survey shows there are several emerging tactics they plan to use to control their costs:
- Spousal and dependent coverage surcharges: Roughly half of the companies (47 percent) increased employee contributions in tiers with dependent coverage, and about a quarter (24 percent) are using spousal surcharges, with another 13% planning to do so next year.
- Growth in Account-Based Health Plans (ABHPs): Nearly one in six companies (59 percent) are offering an ABHP today, and another 11 percent plan to do so by 2013. ABHP enrollment has nearly doubled in the last two years, from 15 percent in 2010 to 27 percent in 2012.
- Changing pharmacy landscape: Six in 10 companies have added or expanded step therapy or prior authorization programs, and 21 percent reduced pharmacy copays last year for those using a generic with a chronic condition (with another 16 percent planning to add this feature in 2013).
- Vendor management and transparency: Three in 10 companies (30 percent) have consolidated their health plan vendors in the past two years, and 11 percent plan to do so next year.