Macro-Trends That Effect Healthcare Benefit Strategies

Eight macro-trends for employers to consider when creating a healthcare plan

A report published by Willis Towers Watson states that in this shifting healthcare landscape, employers must be aware of these changes to understand how it will effect choosing a healthcare plan.

Legislative Uncertainty

When the Affordable Care Act (ACA) was passed, employers became more uncertain in regards to strategic healthcare planning.

According to the article, employers have been reluctant to use public health exchanges, but once the idea is generally more accepted, more employers will take action.

Another pertinent issue is the excise tax that needs to be considered a business risk.The authors noted that scenario planning must be done in order to lessen this risk.

Staying below the excise tax level will require optimal health plan performance, improvements in workforce health, a shift to point-of-care cost sharing, or adoption of a restricted network, according to the article.

Redefinition of Healthcare

Consolidation has been a large part of redefining healthcare over the last decade.

Provider consolidation allows healthcare facilities to be better integrated for care. It also allows physicians to be salaried rather than independent practitioners.

There has also been a shortage of primary care physicians, however, this population is projected to increase from 16,000 currently to 50,000 or 55,000 by the year 2023, the authors wrote.

Study authors attribute this change to baby boomer physicians retiring as the general population ages.

Although there is a shortage of physicians, there is also much more technology and self-care applications that patients can use rather than going for an in person appointment.

Another factor that is shaping healthcare is the shift towards value-based care. This shift is causing hospitals and physicians to restructure.

Rather than getting paid regardless of the quality of care, physicians and hospitals are assuming more risks and must provide top quality care in order to be reimbursed.

CVS and other retail pharmacy chains have opened their own clinics, which have also been seen as reshaping the healthcare industry, according to the study.

The Changing Practice of Medicine

Physicians typically look at symptoms and diagnose a patient based of this information.

Today’s precise medicine, however, causes physicians to tailor treatments based on the individual patient. One treatment for all is not always a viable option, especially for diseases such as cancer.

New Entrants and Disintermediators

In more recent years, a healthcare market that used to be dominated by major national health plans has seen new entrants.

These new entrants are typically start-ups that offer services and care traditional health plans do not offer.

New options may cause tension among employers, who now have to decide between even more health plan options.

Healthcare Technology

Not only is healthcare changing due to digital health records, but tablets, smartphones, and apps are also contributing to these changes.

The general public is now able to assess and monitor their symptoms online and find patient support.

Current technology allows for virtual monitoring, which reduces the need for in-person visits to the physician and provides new tools for delivering care to patients.

Additionally, many patients keep track of their diets, physical activities, sleep, heart rate, and other aspects of their health. New technology such as Fitbits make this easy and accessible to all patients who wish to monitor their health.

A benefit of this trend can be seen by physicians who are now able to personalize their patient’s healthcare in a low-cost way. Access to care can also become 24/7 without raising costs.

Patient Care and Health Management

Physicians and primary care teams need to oversee patients to make sure that they are adhering to directions given to them whether it is for the flu or a chronic condition, according to the article.

Physicians, however, likely do not have the time nor receive the compensation to make that concept a reality for all patients.

A shift away from third party health providers towards a particular provider is attributed to the passage of ACA.

Healthcare providers are now creating care teams to help with chronic conditions and other factors. It is predicted that most primary care facilities will also provide care for chronic illnesses.

Exchanges

Public exchanges (health insurance marketplaces) give patients the opportunity to purchase health insurance based on their individual needs.

According to the article, as exchanges develop further, employers will likely encourage the use of these exchanges through COBRA participants, early retirees, and part-time workers.

Currently, public health exchanges are not able to be used by large employees, but will be in 2017.

Medicare retirees, in particular, have had access to private exchanges for almost a decade and it has been popular with large employers.

Private exchanges may be an option for employers who wish to optimize their employee’s healthcare plan.

The article notes that private exchanges are expanding to include group benefits and emphasize decision support and subsidy transparency.

The Changing Employee Value Proposition

Employers are now rethinking the way they have been dealing with health benefits.

The article states that employers are now considering different arrangements for varying segments and the use of private exchanges to include more options for their employees.

Some employers have chosen to adopt a defined contribution strategy. This means that the employer pays a set amount or an amount that modestly increases, as their employees pay the difference.

Flexible benefits are also gaining renewed interest to some employers, the authors noted.

Employers, of course, will need to assess the value of the program in regards to employee needs, as well as the urgency for change.

Things to Remember

In the current tumultuous healthcare landscape, a shift towards value must be well-thought out, have clear intent, and must be able to adapt to any changes, the article concluded.

Authors suggest that employers: accept uncertainty; strive for value; recognize that cost in healthcare is driven by until price; embrace health technology and associated changes; align the company’s health strategy with the organization’s brand; and understand that not acting is not an option.