In America we have created the best healthcare system in the history of the world. But this system faces some difficult challenges. Employers need to rethink their healthcare focus from just buying an insurance policy to a managed, data driven healthcare strategy.
As cost goes up, employers either shift it to employees or absorb the cost themselves. This strategy is used by many employers and promoted by most benefit agents and brokers as a way to give employers a financial number they can live with.
It’s financially painful for both employer and employee but easy to implement and embraced by many human resources professionals. But as premiums go up more and more, cost is shifted to employees through higher premium contributions and higher deductibles and co-pays when they use medical services.
Another issue is that employers monitor discounts (price) but not utilization. This is like monitoring how much natural gas costs to heat your house but not how much natural gas you use. By spending a little more on insulation you save a lot on natural gas. By spending a little on prevention you could save a lot on health care.
Employers receive claims data reports, which is helpful but without a plan to effect an outcome it’s all just data. Unfortunately, health care is one of the few things in life we purchase without having a clue what it will cost, although that same quality health service can vary by hundreds and even thousands of dollars from one provider to another.
Employers also tend to focus solely on large claims, which is akin to looking in a rearview mirror. There is no effort or strategy in place to keep healthy employees healthy so they can avoid some of those large claims all together.
While employer-sponsored health fairs and wellness screens are nice events with plenty of good information, employers I’ve spoken with tell me they get low participation and it does little to engage employees to change behavior. So, what is the solution?
Here are eight employer strategies we are sure to see in 2015:
• Employers will be directly involved in helping manage the healthcare delivery system. Employers must educate their employees on where they can get high-quality care at the best price and reward employees that are good consumers.
• Employers will closely monitor utilization patterns and cost of the 25 percent of the population driving 90 percent of the cost. They will use this information to steer care away from high-cost emergency rooms to lower cost care options through education and plan design.
• Employers will receive executive reports analyzing trends, demographics, actionable clinical information, chronic disease reports, healthcare index factors, etc. This information will help employers provide benefits that are customized to provide better preventive care and lower cost.
• Employers will focus on healthcare provider process improvement programs and know the value of specific providers. They will look for business partners who can be a resource to their employees to help them avoid health risks rather than wait for poor health and pay for it.
• Employers will know the healthcare index of their population and focus on large claim prevention. Providing tools like health-risk assessments and wellness coaches for employees to avoid health risk before it becomes disease puts up a strong defense against large claims.
• Employers will implement chronic disease management programs, predictive analysis, nurse navigators, nurse practitioners and wellness coaches.
• Employers will focus on managing the 80-90 percent of their health benefit costs, which is claims rather than just the 10-20 percent that is administrative cost.
• Employers who make effective positive changes to the way they manage their health care will be rewarded with healthier more productive employees and lower cost for them and their employees.
Randy is a certified risk architect at Ottawa Kent in Jenison, Mich.
