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What's Really Going on in Healthcare - Trends Employers Must Know

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What's Really Going on in Healthcare - Trends Employers Must Know

  1. 1. What’s Really Going on in Healthcare… Healthcare Trends Employers Must Know for 2016-17 October 5, 2016 Presented by: Dominic Franchini, Vice President HORAN
  2. 2. Employee Benefits Consulting Wealth Management Life & Disability Insurance Setting the Table 2 The national average annual premiums for employer-sponsored health insurance is $9,727 and $10,641 per employee in the state of Ohio. $7,859 $6,350 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 Employer Share $2,782 $3,378 $0 $500 $1,000 $1,500 $2,000 $2,500 $3,000 $3,500 $4,000 Employee Share
  3. 3. Employee Benefits Consulting Wealth Management Life & Disability Insurance 3 Data analytics encourages action and leverages predictive models to guide future improvements in benefits strategy. Plan sponsors have data and metrics to evaluate the performance of their health plan and lower costs by reducing the plan waste and inefficiencies. Best practice utilization of financial reporting includes strategic focus on cost drivers and targeted disease management programs. Health Care Trend For 2016-17 1 Data Analytics
  4. 4. Employee Benefits Consulting Wealth Management Life & Disability Insurance 4 Emphasis is shifting from fee-for-service to outcome based reimbursement. Data creates transparency of strengths and weaknesses of various providers. Consumers have more control than ever in where they get care. Consumers are being incentivized to seek care at quality providers through narrow networks or lower cost alternatives. Health Care Trend For 2016-17 2 Quantity vs. Quality
  5. 5. Employee Benefits Consulting Wealth Management Life & Disability Insurance Large insurance mergers: Spike in alternative delivery models: 5 Health Care Trend For 2016-17 3 Industry Consolidation & Alternative Delivery Models
  6. 6. Employee Benefits Consulting Wealth Management Life & Disability Insurance Population health is a recurring theme for employers and is often improved by implementing a wellness initiative to promote healthy lifestyle, achieve savings and increase productivity. 6 Health Care Trend For 2016-17 4 Population Health Workplace Wellness Employer provided care • Flu shots • Mammogram/diabetic testing • Nurse on-site • On-site/near-site clinics Growth in incentives/penalties • Biometrics • Smoking • Primary Care
  7. 7. Employee Benefits Consulting Wealth Management Life & Disability Insurance 7 Health Care Trend For 2016-17 5 Technology Transparency on providers and cost • Engages employees with highly personalized information on cost, quality, medical conditions and treatments to help employees make the best possible health care decisions. Telemedicine • Enables employees to contact a doctor via telephone who can diagnose, treat and write prescriptions over the phone. Employee Engagement / Cafeteria Plans • Improve the success of population health management programs and wellness initiatives through innovative engagement and incentive tactics.
  8. 8. Employee Benefits Consulting Wealth Management Life & Disability Insurance 8 Health Care Trend For 2016-17 6 Health Care and Pharmacy Cost 2016-17 Medical and Pharmacy Trend Price inflation is the overwhelming driver of cost increases. Hospital services and brand-name medications are leading drivers of plan cost trend increases.
  9. 9. Employee Benefits Consulting Wealth Management Life & Disability Insurance 9 Prescription Drug Plan Strategies: Implement Specialty Pharmacy network Expand prior authorization Intensify pharmacy management program Expand step therapy Demand competitive PBM proposals with performance-based results and transparency. Source: Segal Consulting, 2016 Segal Health Plan Cost Trend Survey https://www.segalco.com/media/2139/me-trend-survey-2016.pdf

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