Move over mainstream: Alternative health options a road to better value
A number of employers are seeking alternative ways to get better value for their healthcare spending. Read this blog post to learn more about alternative health options.
While employers may be the largest purchasers of healthcare outside of the federal government, rarely does one organization have enough influence when negotiating with the powerful health plans and provider systems. As a result, employers — and ultimately the consumers for whom they purchase healthcare services — pay the price.
Instead of taking these lumps of coal sitting down, there are a growing number of employers on the cutting edge of healthcare purchasing seeking alternative ways in 2019 to get better value for their healthcare spending. They are looking for the diamonds in the rough.
In more than half of the healthcare markets in the U.S., providers have merged reducing competition and leaving employers and consumers with little choice for their care. Employers must stop insisting that health insurance products provide access to the broadest network of healthcare providers — if providers know they’ll be kept “in network” no matter how they behave, employers and payers further reduce their negotiating position. Employers also should band together to be sizable enough to call the shots, but this rarely happens.
While this lack of market power and influence is a major frustration for employers, it’s far from the only one. Educated employers also know that the healthcare system produces uneven quality and high prices have nothing to do with excellent care. The amount an employer pays for a service merely represents the relative negotiating strength of the health insurance carriers and providers.
As prices continue to drive healthcare cost growth, Americans are finding their healthcare unaffordable and are willing to trade choice for affordability. Many Americans no longer view having the ability to pick any doctor they choose as essential if it means increased premiums and cost-sharing that comes at the expense of other basic needs. These shifting attitudes represent an opportunity for employers seeking diamonds to pursue the following new healthcare benefits options. Here are some.
Narrow networks: Health insurance plans built around a narrower network that cuts out care providers who are outlandishly expensive or have a particularly poor record on quality. Alternatively, center a smaller network around a direct contract with an accountable care organization selected for its potential to deliver higher quality and value. More commercial health insurance carriers and lesser known third-party administrators are offering and supporting these options. Premiums and cost-sharing are typically lower for the consumer than with broader network plans.
Centers of excellence (CoE): Steer patients to designated high-quality providers with expertise in a given medical area who are willing to enter into an alternative payment arrangement or offer a more reasonable price in return for more patients. Make CoEs attractive through more generous coverage or make them mandatory if employees want an elective or non-emergent procedure (e.g., bariatric or spine surgery). Either way, employers reduce the risk that employees will receive subpar or low value care.
Alternative sites of care: Increase access to and use of alternative sites of care including onsite or near-site clinics and telehealth services. These enhance the convenience of primary or behavioral healthcare for employees and can help the employer better control referrals to overpriced hospitals or specialists.
So, move over mainstream. When it comes to the tactics employers use to purchase healthcare, alternative is likely to become less fringe. Narrow networks, CoEs or alternative sites of care may not solve all of the frustrations. But employers’ pursuit of these new models sends a strong signal that lumps of coal aren’t going to cut it. Employers are on the hunt for a shinier, more attractive set of solutions.
SOURCE: "Move over mainstream: Alternative health options a road to better value" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/move-over-mainstream-alternative-health-options-a-road-to-better-value?brief=00000152-1443-d1cc-a5fa-7cfba3c60000
Why chiropractic services could be the next big thing in wellness
Could chiropractic services be the next big thing in wellness? The American College of Physicians' care guidelines recommends the conservative, non-pharmacologic treatment chiropractors provide. Read on to learn more.
The next popular wellness perk could be offering chiropractic services at on-site medical centers.
On-site or near-site clinics typically offer services to employees including first aid, occupational health, condition management, wellness and ancillary services — and increasingly chiropractic care.
Employees, healthcare administrators and physicians are recognizing the health and employee satisfaction benefits of integrating chiropractic care into multidisciplinary settings, research suggests. Care guidelines from the American College of Physicians recommend the conservative, non-pharmacologic treatment chiropractors provide. Employers are finding that adding chiropractic care to their worksite health center teams reduces direct costs of care, decreases opioid prescriptions for neuro-musculoskeletal episodes and improves health outcomes.
Healthcare costs for employers are expected to reach $15,000 per employee in 2019, according to the National Business Group on Health. The direct and indirect costs associated with low back pain are estimated between $85 billion and $238 billion, and expenditures for back pain are rising more quickly than overall health expenditures. To help stem that growth, as many as 65% of large companies are expected to offer on-site or near-site care by 2020, NBGH reports.
Employer focus on improving workers’ health and wellness has gained momentum in recent years, as evidenced by last year’s announcement from Amazon, Berkshire Hathaway and JPMorgan Chase that they would form an independent healthcare company for their U.S. employees. Another example is employers with self-funded health plans contracting with narrow, high-quality provider networks and even negotiating directly with local hospitals on their prices.
Clinics offer similar cost control and oversight benefits. More importantly, they offer faster and easier access to care that keeps employees healthy, motivated and engaged — and out of the emergency room or hospital. As such, 54% of large employers currently offer on-site or near-site clinics, while another survey showed that 94% of employers reported their clinics improved employee health and 95% said they contributed to increased employee productivity.
Each clinic’s services, cost-sharing, use privileges and staffing can be customized to meet the needs of a specific organization and employer benefit plans. These decisions should be reflective of the objectives of the sponsoring employer and the healthcare needs of the population.
While most healthcare clinics are located on-site or close to the workplace, a growing number are near-site or shared clinic locations, serving populations from multiple locations of the same employer or various employers. Additionally, more care is being delivered virtually. The objective is to provide easy access and immediate attention for employees, at little or no cost, for a host of services and products that an employee would normally have to leave the work site to obtain.
According to a recent survey by the National Association of Worksite Health Centers, the majority of employers reported their workers had expressed interest in chiropractic services at their clinics. The nationwide cost for treatment and management of low back pain and arthritis has reached $200 billion annually. Another study attributes two-thirds of these costs to lost wages and reduced productivity.
The fact that chiropractors deliver drug-free therapies should be particularly meaningful to employers in light of the country’s opioid abuse epidemic. The good news is a recent study published in “The Journal of Alternative and Complementary Medicine” concludes that for adults receiving treatment for low back pain, the likelihood of filling a prescription for an opioid was 55% lower for those receiving chiropractic care than for adults not receiving chiropractic care.
In particular, chiropractors follow evidence-based and value-based guidelines to promote safety and effectiveness. Findings like these and many others show that by adding chiropractic care, employers will strengthen the opportunity for cost savings, improved outcomes, greater worker productivity and stronger employee retention.
SOURCE: Lord, D. (25 January 2019) "Why chiropractic services could be the next big thing in wellness" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/why-chiropractic-services-could-be-the-next-big-thing-in-wellness?brief=00000152-14a7-d1cc-a5fa-7cffccf00000
No primary care doc, no problem: How millennials are changing healthcare
Do you have a primary care physician? Forty-five percent of 18- to 29-year-olds reported that they do not have a primary care physician. Read this blog post from Employee Benefit News to learn more.
Millennials, and Generation Z behind them, are changing the way they access healthcare. In fact, 45% of 18- to 29-year-olds say they don’t have a primary care physician. Instead, they’re opting for on-demand healthcare.
Traditionally, individuals and families see primary care physicians several times a year and build relationships with their doctors over time. Visiting the same primary care physician when an illness strikes, or for an annual wellness checkup, can help the doctor notice changes in a patient’s health and catch issues before they become more serious (and costly).
But for millennials, having a primary care physician isn’t necessarily a priority.
That’s in part because they seem to prefer on-demand healthcare options, such as urgent care, drug store clinics and telemedicine services, which are easily accessible and typically include shorter wait times. The number of urgent care centers reflects the trend — they’re projected to grow by 5.8% in 2018, according to the Urgent Care Association.
Then there is employers’ shift away from health maintenance organizations, which often required that each employee choose a primary care doctor at the start of the plan. HMOs also require a referral from the primary care physician to see specialists. Recent research shows that most often, employers offer preferred provider organizations (84%), while 40% offer consumer-directed health plans and 35% offer HMOs.
Finally, physician shortages are leading to longer wait times for appointments. The U.S. population continues to grow and age, which may lead to a shortage of 120,000 primary and specialty doctors by 2030, according to the Association of American Medical Colleges.
For employers, it’s important to understand the reasons behind the shift to on-demand healthcare and educate employees to ensure they can get appropriate medical attention when they need it.
One crucial part of this education is helping employees understand when they should visit urgent care versus the emergency room, and reminding them that telemedicine is available. More than 95% of large employers and just over one-third of small- and mid-size employers offer telemedicine benefits. But adoption rates among employees remain low — only 20% of large employers report utilization rates above 8%, according to the National Business Group on Health.
Ensure your employees know that the service is available throughout the year and help them understand the cost if any is associated with the service. You may consider offering $0 copays for telemedicine visits to encourage employee use.
Encourage employees to get a wellness visit each year to help uncover health issues and take steps to prevent others. One way to do this without forcing employees to wait for an appointment or commit to a doctor is to bring the service in-house. Increasingly, large employers are adding this service to help employees stay healthy. In fact, one-third of employers with more than 5,000 employees and 16% of employers with 500-4,999 employees now have onsite clinics. Another 8% of midsize employers plan to add clinics in 2019.
Providing health assessments as part of a health and wellness program is another way to get employees, especially money conscious millennials, in front of a doctor. Younger workers are likely to embrace incentives or premium discounts that are tied to a physician visit.
Direct primary care is yet another employer option to provide easy-to-access primary care. With direct primary care, employers partner with primary care physicians to offer a designated doctor for their employees. The benefit for employees is more face time with a doctor and the opportunity to get personalized care.
Importantly, employees who have known chronic issues should see a primary care doctor regularly to help monitor and manage their condition.
The trend toward seeking on-demand healthcare at alternative sites isn’t likely to reverse direction any time soon. Instead, it’s up to employers to understand why it’s happening and educate employees of all ages on their options for care.
SOURCE: Milne, J. (7 January 2019) "No primary care doc, no problem: How millennials are changing healthcare" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/no-primary-care-doc-no-problem-how-millennials-are-changing-healthcare?brief=00000152-14a5-d1cc-a5fa-7cff48fe0001
The case for self-funded health benefit plans and reference-based pricing
Small businesses are starting to explore self-funded plan designs that use reference-based pricing. Continue reading for more about self-funding and reference-based pricing.
Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design. Small businesses are seeing these savings, and they’re starting to explore how reference-based pricing can help them, too.
Before we get to why self-funded plan designs that use reference-based pricing are becoming more popular for small businesses, let’s review the basics.
Reference-based pricing is a methodology of calculating payment to providers for covered treatments and services using a “reasonable fee” based on a reference point. A common reference point is the Medicare fee schedule. Some self-funded health benefit plans calculate the reasonable fee as a percentage of the Medicare fee schedule to determine reimbursement for services rendered.
Bottom line: Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal of flexibility with a variety of arrangements and overall cost-savings.
So, what’s behind the recent trend toward reference-based pricing for smaller employers? A few key factors.
First, a self-funded health benefit plan design that uses referenced-based pricing can mean less expensive coverage for employees and employers.
When coupling a self-funded health benefit plan with stop-loss insurance, reference-based pricing provides an affordable way to extend coverage to employees through lower employee contributions. So, employees are happy because they’re saving money.
And employers are happy, too, because they’re allowing for more coverage to more employees. There’s a refund potential for employers if claims dollars are less than funded. There’s also a premium tax savings of around 2% since self-funded claim dollars are not subject to state health insurance premium taxes.
Moreover, self-funded health benefit plan designs that utilize reference-based pricing may also include transparency reports with aggregate health claims data and demographic information, which allow employers to better manage costs. Overall, anytime you can design a plan that’s beneficial for employees and employers, it’s a win.
Second, reference-based pricing can provide employees more flexibility when it comes to choosing a provider. Typically, an important feature of any health benefit plan design for employees is the ability to choose the provider they want. Some self-funded plan designs that use reference-based pricing give employees the chance to pick the provider that’s right for them. And, when employees are happy with their health plan, employers are usually pretty happy, too.
Finally, self-funded plan designs that use reference-based pricing can help employees become smarter healthcare consumers because of all the transparency and choice involved. When employees better understand the healthcare processes and system, costs come down for both the employee and employer. In fact, just understanding their coverage better may help employees better use their health benefit plans.
For example, using telemedicine when appropriate, establishing a relationship with a primary care doctor and using client advocacy services can all help employees better utilize their health benefit plans. In the end, employees get smarter about how they manage their care, and employers win with reduced costs.
These factors are driving more small businesses to consider reference-based pricing self-funded health benefit plan designs with stop-loss insurance. And, for good reason. These plan designs can give employers the opportunity to offer their employees affordable health benefits, provide more choice in their health plans and providers, and encourage more employee engagement. While moving to reference-based pricing may be too big of a leap for some employers, self-funding continues to provide a means for employers to offer comprehensive major medical health benefits at lower costs.
SOURCE: MacLeod, D. (6 December 2018) "The case for self-funded health benefit plans and reference-based pricing" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/the-case-for-self-funded-health-benefit-plans-and-reference-based-pricing
Healthcare waste is costing billions — and employers aren’t doing anything about it
Providing your employees with healthcare insurance is expensive. A large chunk of healthcare costs is being wasted by the healthcare industry, according to a new survey. Read on to learn more.
Providing the workforce with healthcare coverage is expensive, but a new survey of 126 employers suggests a large chunk of that cost is being wasted by the healthcare industry on treatments patients don’t need.
The healthcare industry wastes $750 billion per year on unnecessary tests and treatments, according to a survey from the National Alliance of Healthcare Purchaser Coalitions and Benfield, a market research, strategy and communications consulting firm. Some 60% of employers don’t take steps to manage their healthcare plan’s wasteful spending, despite the fact that the same percentage of employers view it as a problem, the survey says.
“While waste has long been identified as a key concern and cost contributor, employers are operating blind and need to look at a more disciplined approach to address top drivers that influence waste,” says Michael Thompson, National Alliance president and CEO.
Employers are under the impression that prescription drugs are the culprit behind the spending waste, and they are, just not as much as other services. Around 54% of health spending waste is caused by unnecessary medical imaging tests, such as MRIs and X-rays, the survey says. Specialty drugs, unnecessary lab tests and specialists referrals are also major money pits.
However, the survey data isn’t suggesting these procedures and treatments shouldn’t be covered by employer health plans. The tests and treatments are potentially life-saving, they’re just used more than they should be. Sometimes previous test results can help with a current diagnosis, but medical staff don’t always check patient files before ordering new tests.
Most employers don’t monitor unnecessary healthcare spending. The 34% of employers who do rely entirely on their healthcare vendors to do it for them, trusting that it’s being taken care of.
“The idea of reducing waste in the healthcare system can be overwhelming,” says Laura Rudder Huff, senior consultant for Benfield. “While employers ask themselves: ‘Where to start?’ this is an issue where even small steps matter. Employers can begin by collecting data to identify where the inefficiencies are in their workforce and community and use assets such as vendors and organizations like coalitions to realize market improvements.”
The survey also recommends employers enlist the services of Choosing Wisely, an organization that counsels patients and employers on healthcare plans and medical treatments.
SOURCE: Webster, K. (7 November 2018) "Healthcare waste is costing billions — and employers aren’t doing anything about it" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/healthcare-waste-is-costing-billions-and-employers-arent-doing-anything-about-it