Sur­vey: Changes ahead

Em­ploy­ees to pick up more of the cost

Modern Healthcare - - The Week In Healthcare - Jen­nifer Lubell

Large em­ploy­ers are mov­ing for­ward with plans to sig­nif­i­cantly al­ter their health ben­e­fits even though such re­vi­sions sub­ject com­pa­nies to new re­quire­ments un­der the health re­form law. And al­though some cost-con­trol ef­forts em­power con­sumers, some providers worry that the trend to­ward more cost-shar­ing means hos­pi­tals will con­tinue to get stuck with the tab and pa­tients will be dis­cour­aged from get­ting care they need.

A sur­vey of 72 large em­ploy­ers re­leased last week by the Na­tional Busi­ness Group on Health found 53% of the sur­vey’s re­spon­dents planned on mak­ing changes to their ben­e­fit plans, de­spite the po­ten­tial of los­ing their grand­fa­thered sta­tus un­der the new health re­form law.

“While the health re­form law has forced em­ploy­ers to eval­u­ate their health­care ben­e­fit strate­gies and de­cide whether to com­ply with the law or lose grand­fa­thered sta­tus, they haven’t lost sight of the fact that con­trol­ling ris­ing costs re­mains one of, if not, their high­est pri­or­ity,” NBGH Pres­i­dent Helen Dar­ling said dur­ing a news con­fer­ence to re­lease the sur­vey find­ings. “They have to foot the bill, not the govern­ment.”

Sur­vey re­spon­dents es­ti­mate that their health­care ben­e­fit costs will in­crease an av­er­age of 8.9% next year, com­pared with 7% this year. To pay for those in­creases, which in part come from provider rate in­creases, em­ploy­ers plan to use a wider va­ri­ety of cost-shar­ing strate­gies, Dar­ling said.

Sixty-three per­cent of em­ploy­ers plan to in­crease the per­cent­age em­ploy­ees con­trib­ute to premi­ums in 2011, up from 57% who raised their em­ploy­ees’ share in 2010. Ad­di­tion­ally, 46% plan to raise out-of­pocket max­i­mums next year, com­pared with just 32% in 2009.

To hos­pi­tals in par­tic­u­lar, in­creased cost-shar­ing poses con­cerns. About a quar­ter of hos­pi­tal bad debt and char­ity care re­lates to un­der­in­sured pa­tients who can’t af­ford their co­pays and de­ductibles, Amer­i­can Hos­pi­tal As­so­ci­a­tion spokes­woman El­iz­a­beth Li­etz said. “While this may lower costs for one in­surer or em­ployer, these costs get passed along to oth­ers.”(Aug. 9, p. 28)

Cost-shar­ing, how­ever, isn’t the only strat­egy that em­ploy­ers are us­ing to con­trol health­care costs next year, and it’s not the most pop­u­lar, ei­ther. Con­sumer-di­rected health plans ranked first among strate­gies to bring down costs, with well­ness ini­tia­tives and in­creased em­ployee cost-shar­ing rank­ing sec­ond and third, re­spec­tively.

More than 60% of em­ploy­ers said they will be shift­ing to con­sumerdi­rected plans in 2011, which, as a Govern­ment Ac­count­abil­ity Of­fice re­port pointed out last week, at­tract health­ier pa­tients who spend less and gen­er­ally use fewer health ser­vices.

An in­creased em­pha­sis on con­sumer-di­rected care and well­ness ini­tia­tives means that pa­tients will be pay­ing more at­ten­tion to the care they’re re­ceiv­ing, NBGH of­fi­cials said.

Atul Grover, chief ad­vo­cacy of­fi­cer with the As­so­ci­a­tion of Amer­i­can Med­i­cal Col­leges, sees the sil­ver lin­ing—and po­ten­tial con­se­quences—from these ex­pected changes. “Any­thing that helps to en­gage the pa­tient in their own care is po­ten­tially pos­i­tive,” Grover said. “Many times, pa­tients have ex­pec­ta­tions that are driven by what they have seen ad­ver­tised or what test they feel is nec­es­sary to rule out the most lethal con­di­tion—no mat­ter how rare. If pa­tients think about costs, it may help to fa­cil­i­tate the kind of con­ver­sa­tions that pa­tients will” ul­ti­mately ben­e­fit from.

On the down­side, in­creased cost-shar­ing can dis­cour­age pa­tients from re­ceiv­ing needed care, Grover con­tin­ued. “This is one rea­son that pub­lic health ad­vo­cates pushed so hard to get rid of cost-shar­ing” for pre­ven­tive and screen­ing ser­vices, he said. “Higher cost-shar­ing can lead to what we call ‘er­rors of omis­sion’—when as­pects of care that are im­por­tant are left out be­cause the pa­tient is more concerned about cost than the risk to their health,” he said.

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