Repeal? Replace? It’s anyone’s guess. The one thing we can be certain about following this election is more changes are coming to health care and, as usual, employers will need to adapt. But regardless of what happens in Congress, what President Trump or Speaker Ryan propose, or who is the new head of CMS, my money is on some things staying exactly the same. Our employer-based health care system is not going away. I speak to a lot of health care leaders every day, and getting out my crystal ball, here are five health care trends I don’t see abating any time soon. With the right strategies, benefits professionals can stay ahead of the curve in trying to manage costs and quality in these turbulent times.
1. High deductible plans and cost sharing are here to stay. If anything, the new leadership’s plans place even greater reliance on HSAs. Most of us have already been getting our employees used to cost sharing, and this trend is expected to continue and even accelerate. But just offering high deductible plans is equivalent to throwing your employees into the deep end of the pool; several studies show employees don’t often shop around and do often skip needed care. Our own research last summer found that 42 percent of employees believe they don’t have the information they need to make important medical decisions. We want them to spend their money (and yours) wisely and go to high quality providers to get the care they need (and not care they don’t need). To accomplish this, savvy employers must continue to turn to strategies like partnerships with organizations that offer consumer education and navigation. We want our employees shopping around based on cost, but also based on quality.
2. Transparency will be huge. It has been a cornerstone of President-elect Trump’s health care policy platform since the beginning. And yet, we know from studies that very few employees who are offered price transparency tools actually use them. That is because price information alone is befuddling; it doesn’t help employees understand what care they need or who is the right doctor given their condition; and they’ve never been engaged consumers before. For these reasons, savvy benefits professionals will pair transparency tools with other tools or coaches who serve as a medical ally and help with consumer navigation.
3. A small percent of employees will always account for most of your spending. This mathematical fact isn’t going away, no matter who is in the Oval Office, so employers need a strategy to address the fact that 1.2 percent of employees typically account for 31 percent of employer health care spending. The name of the game here is intervention with your employees that have high cost conditions. In this realm, programs like surgical decision support, second opinion services, and shared-decision making can help ensure these employees choose better providers, and high-quality treatment options that are appropriate. Otherwise you may end up spending a fortune on spinal fusion surgery for an employee who really only needs physical therapy. Our own research has found, for example, a company can reap $5.6 million in direct savings if just a few hundred employees participate in surgical decision support for conditions that have huge variation in cost and quality. And when you are certain employees need that surgery, a strategy like reference pricing can help ensure they see a high quality, yet affordable, provider.
4. The march toward paying for value will continue. Part of the ACA may be repealed, but Republicans and Democrats alike agree on “MACRA,” which changes the way Medicare pays doctors by tying reimbursement to quality. What this means is that the commercial insurance sector will continue to follow suit, and we will continue to hear about “paying for value, not volume in health care.” Benefits professionals can get the most out of this trend — payment reform — by implanting benefit designs that pair well with payment reform. The nonprofit Catalyst for Payment Reform offers some great insights. For example, your benefit design and related services can encourage employees to have surgery at Centers of Excellence where the quality of care is better (and providers are paid based on value).
It is indeed time of great change, but as the old adage goes, the more things change, the more they stay the same. Health care costs will continue to rise, and quality will continue to lag and vary from provider to provider. As always, our challenge is to get employees more engaged in the process to steer them toward the care that is highest quality and most efficient. We want them to be consumers, but they can’t do that on their own. They need the right benefit design but also the right support and related programs and to help them understand and get there.