As employers are looking to create dynamic cultures to recruit and retain, benefits have been known to be a driving force in this effort. Benefits are extremely important for your employees and most do not want Medicare for all. However, the cost is rising beyond employers’ budgets and this has caused reduced plans, higher deductibles and cost sharing strategies. As we care for our employees, we want to bring forth competitive plans and options that are affordable for the company and the employees, as individuals or those with families.
There are only a few medical carriers, however. Competition can be strong, as these carriers offer various plans worth considering. Blue Shield of California has Trio and Anthem-Vividy, which are Accountable Care Organizations (ACOs) that provide quality care with elite providers, such as UCLA and Cedars Sinai. These carriers, with their ACO models are committed to increasing patient engagement, improving quality of care, decreasing overall costs, and maximizing satisfaction for all their members and employer groups. The systems in which doctors and hospitals are paid are usually based on the number of services they deliver. ACOs pay their providers for keeping people healthy in an evidence-based, cost effective system known as value-based care. These models have creative incentives for providers to treat the whole person, rather than just writing prescriptions and ignoring poor health habits that cause “dis-ease” and then surgeries.
Blue Shield has 44 ACOs in 23 regions, serving 600,000 Californians. The results they post show they have reduced hospital admissions, decreased days patients stay in the hospital, saved more than $486 million in estimated healthcare costs and reduced ER visits. The focus is on the wellbeing of the patient.
Anthem Blue Cross has seen public and private payers shifting to the payment models based on value of the care delivered. The U.S. has faced unsustainable long-term health care costs. Anthem states that healthcare spending as a percentage of the Gross Domestic Product is projected to reach 19.6 percent in 2024. These carriers are aware it is imperative to transform the health payment and delivery systems in the United States. In 2012, twenty percent of medical claims payments totaling $65 billion — made by Blue Cross/Blue Shield Association’s members’ plans — were through VBP programs. Savings at that time were $500 million. Data has been a focus for all carriers as they provide a collaborative approach that includes care management, coordination and quality measurement. Providers in these models are in risk-sharing arrangements that offers incentives around quality affording participating providers a tangible way to share in the success of managing health care costs through shared savings.
CIGNA has a few options our employer groups find successful. Level Funded plans allow the employer to have a partially self-funded plan that can payback for successful claims years. CIGNA also provides an evaluation through an online member portal allowing members to see their physicians star ratings for health care quality measures. CIGNA and others in the healthcare industry are using data to help them test and improve health care quality measures regarding medication prescribing practices and opioid and alcohol use disorders. They are improving treatments for substance abuse disorders and this is a major goal of the industry since approximately 2.1 million people face opioid and other substance use disorders and more than 72,000 Americans died from opioid usage in 2017. Substance abuse and disease management is critical, and more importantly, the prevention of disease is top of mind.
Montage works with large group employers and has been offering wellness and safety programs for years. These include bio metric screenings for thyroid and stroke testing, heart health, measuring BMI, massage therapy, yoga, breathing techniques, Healthy Doc Talks and more for our employer groups.
In the past few years, carriers have come up with innovative ways to reach the larger employers’ employees from Blue Shield’s Wellvolution walking program, AETNA’s Get Active coaching and Attain, which rewards employees for achieving recommended steps per day. Anthem is catching the wave along with the others towards promoting healthy lifestyles with wellness dollars and incentives. United Health Care’s wellness programs for employees include Simply Engaged health assessments and bio metric screenings. Real Appeal offers digital smart scales and coaching for weight loss for qualified participants. CIGNA’s providers are seeing reversals in brain degeneration from deep breathing and are promoting yoga. These carriers’ websites are full of gym membership discounts and facts for healthy eating that promote good nutrition and fitness, which is key. Kaiser has a mobile unit that travels around offering various bio metrics screenings. Their “come to us approach” offers classes for smoking cessation, yoga classes and more, with a full calendar of events on their website. Their staffing model allows free data flow from doctor to patient other carriers are catching up with. When we visit our doctors, they now come in with laptops.
The Medicare liability today costs $30.7 trillion, enrollees are at 59, 516,383 members, while Medicaid recipients are at 76,706,050. CMS states healthcare spending is growing faster than the Gross Domestic Product (GDP) per year. National healthcare spending has been projected to grow 4.8 percent in 2019 reaching $3.8 trillion. Since the ACA’s individual mandate was repealed in 2019, the insured population has declined from 90.9 percent to 90.6 percent. The vast healthcare system comes with no easy answers and satisfying the multitude of populations with varying needs and desires is daunting. “One size fits all” is easier said than done.
The US flu spending is at $10.4 billion dollars annually and employees are missing approximately 17 million workdays, costing an estimated $7 billion per year in lost productivity that employers are paying out in sick days. So how do we impact change? Wellness.
The wellness industry is worth $4.2 trillion. The stats on wellness are increasing as more benchmarking studies come from our carriers and employers. We see in our book of business the impact of creating focused wellness and safety programs, as they save in premiums. It begins with ensuring employees are in the right benefit plans. Some have savings available in Health Savings Accounts (HSAs). In July, the IRS added a range of preventive care benefits for chronic conditions that may be provided by an HSA-qualified deductible health plan.
Everyone is focused on change and we have to be very smart about exactly what change we want. As employers, we know the impact of sickness at work and are investing in our employees’ healthcare and wellness, which saves in cost, promotes healthy days at work, reduces absenteeism and presentism, inspiring a culture that counts.
Danone Simpson, MBA, GBDS, is CEO of Montage Insurance Solutions. Learn more at montageinsurance.com.
