NATIONAL SURVEY OF EMPLOYER -SPONSORED HEALTH …...Extensive questionnaire covers a full range of...
Transcript of NATIONAL SURVEY OF EMPLOYER -SPONSORED HEALTH …...Extensive questionnaire covers a full range of...
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H E A L T H W E A L T H C A R E E R
M E R C E R ’ S
N AT I O N A L S U R V E Y O F
E M P L O Y E R - S P O N S O R E D
H E A LT H P L A N S 2 0 1 7
Robert Valdez
Emery Chen
Attachment.3
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Oldest
Marking 32 years of measuring health plan trends
Largest
2,481 employers participated in 2017
Statistically valid
Based on a probability sample of private and public employers for reliable results
Employer size groups in presentation
Large: 500+ employees/Jumbo: 20,000+ employees
Most comprehensive
Extensive questionnaire covers a full range of health benefit issues and strategies
Supplemental questions
All survey respondents with 5,000 or more employees were asked to complete a set of
supplemental questions, focused on health benefits strategies that are typically pioneered
or adopted soonest by very large employers. 231 employers with 5,000 or more
employees, including 87 employers with 20,000 or more employees, completed this
AB O U T M E R C E R ’ S N AT I O N A L S U R V E Y O F E M P L O Y E R -
S P O N S O R E D H E ALT H P L AN S
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Top Stories 1
Plan Cost, Offerings and Enrollment 2
Medical Plan Management 4
Special Coverages and Services 5
Quality and Value 3
C O N T E N T S
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4 Copyright © 2018 Mercer (US) Inc. All rights reserved.
TOP STORIES
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T O P S T O R I E S
• Employers utilizing the greatest number of best practices have significantly
lower trend than those who are using fewer best practices
• Most employers still use a national strategy to select provider networks, but
some are beginning to look for the best options by location and even using
incentives to steer to these options
• Accountable Care Organization (ACO) arrangements are becoming more
prevalent, but reporting on efficacy and performance is limited
• While elimination of out-of-network (OON) benefits is still not very prevalent,
more employers are considering changes to OON reimbursement and
eliminating coverage for certain provider types
• Specialty Rx spend is on the rise and more than half of employers are
considering a specialty Rx vendor (separate from PBM or medical carrier)
• More employers are requiring use of Centers of Excellence (COE) for coverage
• Special coverages and services, like those related to gender reassignment, are
prevalent among jumbo employers (20,000+ employees)
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BASICS WELL-BEING QUALITY AND VALUE
• Offer CDHP
• HSA sponsor makes a contribution to
employees’ accounts
• Offer voluntary supplemental
health insurance
• Use/planning to use bundled solution
for health benefits (including private
benefits exchange)
• Transparency tool provided by
specialty vendor
• Mandatory generics or other
Rx strategies
• Steer members to specialty
pharmacy for specialty drugs
• Collective purchasing of Rx benefits
• Offer optional (paid) well-being
programs through plan or vendor
• Company vision/mission statement
supports a healthy workplace
culture
• Offer technology-based well-being
resources (apps, devices,
web-based)
• Use incentives for well-being
programs
• Well-being strategy includes focus
on intrinsic motivation to improve
health
• Spouses and/or children may
participate in programs
• Smoker surcharge
• Have conducted analysis of
employee behavioral health issues
• Provide stress management,
resiliency, or mindfulness
programs
• Offer health advocacy program
• Offer a Surgical Center of
Excellence
• Offer a COE other than for surgical
(oncology, orthopedics, cardiology,
women’s health)
• Primary care on-site clinic
• Telemedicine utilization of 5%
or higher
• Employees have incentives to use:
– Medical homes
– Accountable care organizations
– Other narrow network
• Reference-based pricing
E M P L O Y E R I N N O VAT I O N I S H E L P I N G T O S L O W
C O S T G R O W T H
R E S P O N D E N T S ’ C O S T T R E N D S W E R E A N A LY Z E D B A S E D O N T H E I R
U S E O F 2 4 B E S T P R A C T I C E C O S T - M A N A G E M E N T S T R AT E G I E S
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E M P L O Y E R S U S I N G M O R E B E S T P R AC T I C E S T R AT E G I E S
R E P O R T L O W E R T R E N D S
Actual increase in total health plan cost
5.4% 5.5%
2.9%
1.4%
Employers with 5,000+ employees Employers with 20,000+ employees
Employers using the fewest best practices Employers using the most best practices
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8 Copyright © 2018 Mercer (US) Inc. All rights reserved.
PLAN COST,
OFFERINGS AND
ENROLLMENT
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8.3% 9.1%
9.8%
8.2% 7.4%
8.0%
7.1% 6.3% 6.3% 6.5%
5.5%
6.9% 6.1%
4.1%
2.1%
3.9% 3.8%
2.4% 2.6%
4.2%
-0.7%
2.2%
1.0% 2.5%
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018*
Annual change in health benefit cost per employee – expected trend before plan changes
Actual trend – after plan changes
Overall inflation Workers' earnings
E M P L O Y E R S H O L D H E ALT H B E N E F I T C O S T G R O W T H
B E L O W 4 % F O R A F I F T H C O N S E C U T I V E Y E AR
Change in total health benefit cost per employee compared to CPI, workers’ earnings,
among all employers
* Projected
Source: Mercer’s National Survey of Employer-Sponsored Health Plans; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to
April) 1993-2017; Bureau of Labor Statistics, Seasonally Adjusted Weekly Earnings from the Current Employment Statistics Survey (April to April) 1993-2017.
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T O TA L A N N U A L H E A LT H C A R E C O S T P E R
C O V E R E D E M P L O Y E E
P E B B ’ S C O S T S A R E A B O V E B E N C H M A R K S
$17,976
$13,868 $12,880
$12,288 $11,697
$18,676
$13,132 $13,459 $12,615
$11,715
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
$20,000
PEBB Government 500+ Oregon 500+ National 500+ National 20,000+
*Total health benefit cost includes medical, dental, Rx, vision and hearing benefits
*Oregon PEBB includes Providence Statewide, Delta Dental of Oregon, and VSP
2016: Active Employees
2017: Active Employees
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G R O W T H I N C D H P E N R O L L M E N T S L O W S I N 2 0 1 7
Percentage of covered employees enrolled in each plan type, among large employers
1
1
1
1
<1
66%
68%
69%
65%
65%
64%
61%
56%
53%
52%
26%
23%
20%
21%
20%
18%
16%
16%
14%
14%
7%
8%
10%
13%
15%
18%
23%
28%
33%
34%
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Traditional indemnity plan PPO/POS* HMO CDHP
*Includes traditional indemnity plans beginning in 2013.
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H S A - E L I G I B L E C D H P S C O S T M U C H L E S S T H A N O T H E R
P L A N S , I N C L U D I N G P P O S W I T H H I G H D E D U C T I B L E S
AV E R A G E M E D I C A L P L A N C O S T P E R E M P L O Y E E , A M O N G
L A R G E E M P L O Y E R S
$12,611 $12,513
$10,019
$10,747
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
PPO HMO HSA-eligible CDHP PPO with deductible of$1,000 or more
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B E Y O N D C O N S U M E R I S M : E M P L O Y E R S R AT E T H E
S T R AT E G I E S C O N S I D E R E D C R I T I C AL F O R I M P R O V I N G
C O S T AN D Q U AL I T Y I N T H E F U T U R E
% employers rating as important / very important
5,000+
employees
10,000 or
more
employees
20,000 or
more
employees
Focused action to manage cost for specialty
pharmacy 82% 87% 83%
Monitoring and managing high-cost claimants 79% 79% 76%
Focused strategy for creating a culture of health 69% 70% 71%
“Point solutions”—high tech or high touch
support for physical/mental/financial health
issues
48% 49% 51%
ACO or other high-performance network
strategies 46% 50% 53%
Offering employees more plan or benefit options
with decision support tools 44% 46% 50%
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QUALITY AND VALUE
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I N P U R S U I T O F T H E B E S T C AR E
• Expert medical
opinion
• High-cost claimant
management
• Specialty Rx
solutions
• Health Advocacy
COST
QUALITY
EXPERIENCE • Value based care
• Centers of
Excellence
• Narrow networks
COST
QUALITY
EXPERIENCE
• Care silos
• Limited quality
oversight
• No focus on patient
experience
COST
QUALITY
EXPERIENCE
C U R R E N T S TAT E
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W H Y E X P E R T M E D I C AL O P I N I O N ?
Statistics based on Grand Rounds’ research
84% adherence
to treatment plan
2x increase in
health literacy
30-40% lower mortality
20-25% fewer
complications
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E X P E R T M E D I C AL O P I N I O N
A M O N G E M P L O Y E R S W I T H 5 , 0 0 0 O R M O R E E M P L O Y E E S
13%
23%
64%
Offer expert
medical opinion
services M O S T I M P O R T A N T
O B J E C T I V E S F O R
O F F E R I N G E M O s
Assist patients who have
complex conditions 92%
Steer patients to
high-quality providers 85%
Lower medical plan cost 84%
Expand access to care 68%
Considering
offering
Do not
offer
Results from supplemental survey of employers with 5,000 or more employees
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H I G H - C O S T C L AI M S S U R V E I L L AN C E
N O T A L L H C C S U N AV O I D A B L E
C l i n i ca l assessmen t
C l i n i ca l r ounds
C la ims paymen t aud i t
F ocused c l i n i ca l aud i t
RESULT S MAY WARRANT ADDI T I O NAL SO LUT I O NS
MANAG E
C l i n i c a l S u rv e i l l anc e
Ea r l y Warn ing
Repo r t
La rge C la im P a id
Repo r t La rge C la im Paymen t P rocess
I mp rovemen t
MO NI TO R MI T I G AT E
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AN N U A L S P E C I ALT Y R X S P E N D N E AR LY
D O U B L E D I N J U S T 4 Y E AR S
G R O W T H F R O M $ 8 2 B T O $ 1 5 0 B F R O M 2 0 1 1 T O 2 0 1 5 ; 4 1 % O F T H E
W O R L D ’ S R X S P E N D I N U S B Y 2 0 2 0
$24.1 $28.1 $39.1
$13.1 $18.3
$30.2
$18.8
$7.8
$11.9
$17.7
$10.1
$12.2
$16.2
$24.8
$24.9
$28.9
$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
2011 2013 2015
Oncology Autoimmune Viral Hepatitis Multiple Sclerosis HIV Antivirals Other Specialty
Source: IMS Health
To
tal
$ S
pen
t in
Billi
on
s
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20%
17%
12%
61%
47%
13%
12%
31%
500+ employees
20,000+ employees
Offer lower cost-sharing if employees use the specialty pharmacy
Some/all specialty drugs excluded from retail pharmacy/medical benefit
M O R E T H AN H AL F O F E M P L O Y E R S AR E S T E E R I N G
E M P L O Y E E S T O S P E C I ALT Y P H AR M A C I E S
Encourage use of specialty pharmacies some other way
Do not attempt to steer members to any channel for specialty medications
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23%
62%
15%
28%
60%
12%
Offer throughspecialty vendor
outside the healthplan
Offer through healthplan only
Employees do nothave access to
transparency tools
5,000 or moreemployees
20,000 or moreemployees
M O S T E M P L O Y E R S C O N T I N U E T O O F F E R
C AR R I E R - B A S E D T O O L S F O R C O M PAR I N G
H E ALT H P R O V I D E R P R I C E AN D / O R Q U AL I T Y
Employers
with 5,000+
employees
Employers
with 20,000+
employees
Average
utilization rate of
transparency
tools
21% 30%
Offer incentives
to use 11% 13%
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES / NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
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D I G I TAL N AV I G AT I O N & H E ALT H AD V O C A C Y
W H AT AR E T H E Y ?
Digital Navigation and Health Advocacy employer healthcare solutions emerged to support
employees by helping them navigate today’s complex health care market and engaging
them in their health care decisions :
APPROACH Technology first – “Do it yourself” Telephonic first – “Hold my hand”
MODALITY
Primarily mobile app or web portal that
directs User to employer-sponsored
programs/solutions
Primarily via telephone; supported by
web portal and/or mobile app
OBJECTIVES
• Aggregate health benefits
programs/services
• Recommend appropriate solutions
• Own/resolve User issues
• Guide Users / drive engagement into
right programs at right time
DIGITAL
NAVIGATION (DN)
HEALTH
ADVOCACY (HA)
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v
O B J E C T I V E S F O R I M P L E M E N T I N G A H E ALT H
AD V O C A C Y P R O G R AM , W H E N O F F E R E D
30% with 20,000+ employees offer a Health Advocacy program
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES
60% 64%
46% 43%
32% 36%
29% 35%
Assist memberswith claims
issues
Direct membersto services
Improvetraditional healthplan customer
service
Provide betterintegration with
third-partyprograms
Very important Important
57%
Majority of employers agree
that the health advocacy
program has met objectives
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10% 6%
12% 10% 8%
16%
Accountable CareOrganization
Patient-CenteredMedical Home
Another narrowprovider network
Employers with 5,000 or more employees Employers with 20,000 or more employees
M O S T H E ALT H P L AN S I N C L U D E VAL U E - B A S E D
P R O V I D E R N E T W O R K S , B U T R E L AT I V E LY F E W
E M P L O Y E R S O F F E R E M P L O Y E E S I N C E N T I V E S T O U S E
T H E M
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES / NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
P E R C E N T O F
P L A N M E M B E R S
A T T R I B U T E D
T O A N A C O
Employers with 5,000+
employees 24%
Employers with 20,000+
employees 31%
Employers may want more performance data before offering
incentives. While 18% of respondents* report some cost
savings achieved with the ACO, most (70%) say they can’t
measure.
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4% 12% 4%
85%
9% 18%
9%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Lower premium contributionin the medical home
Lower cost-sharing at pointof service (deductible,coinsurance, copays)
Other We don't actively encouragemembers to seek care from
the PCMH
Employers with 5,000+ employees Employers with 20,000+ employees
M E T H O D S U S E D T O E N C O U R AG E E M P L O Y E E S T O
S E L E C T T H E P C M H
Among employers that offer a PCMH
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES
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CONSIDERING
FOR 2016 OR 2016
35%
28%
16% 16%
2%
12%
51%
45%
35%
20% 20%
5%
15%
40%
Cost targets Qualitytargets
Utilizationtargets
Patientsatisfaction
targets
Other N/A - Noperformance
payments
Don't know
Employers with 5,000+ employees
Employers with 20,000+ employees
M AN Y E M P L O Y E R S U N AWA R E O F TAR G E T S U S E D
F O R D E T E R M I N I N G P E R F O R M AN C E PAY M E N T S
Among employers that offer ACOs
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES
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63% 59% 58% 57%
46%
0%
10%
20%
30%
40%
50%
60%
70%
Surgical (other thantransplants)
Orthopedics Cardiology Oncology Women'sHealth
(Infertility/pregnancy)
E M P L O Y E R S H AV E E M B R AC E D C E N T E R S O F
E X C E L L E N C E F O R A R AN G E O F T R E AT M E N T S
E M P L O Y E R S W I T H 2 0 , 0 0 0 O R M O R E E M P L O Y E E S
HOW EMPLOYERS STEER EMPLOYEES TO A COE: PAID TRAVEL. LOWER COST-
SHARING. CASH BONUS. 32% MAKE IT MANDATORY FOR COVERAGE.
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MEDICAL PLAN
MANAGEMENT
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M AN A G I N G O O N S P E N D : E M P L O Y E R S AR E B E G I N N I N G
T O C O N S I D E R C H AN G E S T O R E I M B U R S E M E N T O R
E L I M I N AT I N G C O V E R AG E F O R C E R TAI N P R O V I D E R S
15%
7% 4%
19% 26%
9%
Changingreimbursementmethodology
Excluding certaintypes of providers /
facilities
Eliminating OONcoverage (except
emergencies /network
deficiencies)
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES
20%
7% 4%
20%
42%
9%
Changingreimbursementmethodology
Excluding certaintypes of providers /
facilities
Eliminating OONcoverage (except
emergencies /network
deficiencies)
Have taken this step
Considering
Employers with 5,000+ employees Employers with 20,000+ employees
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R E F E R E N C E - B AS E D P R I C I N G
8% 7%
5%
13%
15% 16%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
5,000 or more employees 10,000 or more employees 20,000 or more employees
Currently use Considering using
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SPECIAL COVERAGES
AND SERVICES
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11%
28%
43%
47%
58%
55%
66%
11%
23%
23%
42%
43%
54%
59%
All large employers
20,000 or moreemployees
Modified physical work environment to promote physical activity
Healthy food choices in cafeteria, company meetings or events
No smoking anywhere on work campus
Offer onsite fitness facility
S T E P S TAK E N T O B U I L D A “ C U LT U R E O F H E ALT H ”
Large employers
Have policies to promote healthy work/life balance
Company vision/mission statement supports a healthy workplace culture
None of the above
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E M P L O Y E E S H AV E AC C E S S T O S U P P O R T F O R
B E H AV I O R A L H E ALT H
5,000 or more
employees
10,000 or more
employees
20,000 or more
employees
Stress management 77% 77% 80%
Resiliency 38% 37% 35%
Mindfulness 40% 38% 38%
Tele-therapy 40% 43% 50%
Texting/online coaching with mental health
experts 29% 24% 24%
Family support services for children with
disabilities 36% 33% 34%
No programs offered 16% 14% 12%
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C O V E R G E N D E R R E AS S I G N M E N T S U R G E RY, B Y
E M P L O Y E R S I Z E
31%
44%
52%
62%
4% 7% 7% 7%
0%
10%
20%
30%
40%
50%
60%
70%
500-4,999 employees 5,000-9,999 10,000-19,999 20,000 or more
Currently cover
Considering covering
MERCER NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS
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S E R V I C E S C O V E R E D I N AD D I T I O N T O G E N D E R
R E AS S I G N M E N T S U R G E RY
Among employers that cover gender reassignment surgery
18%
20%
51%
64%
82%
19%
19%
47%
67%
80%
Employers with 5,000+ employees
Employers with 20,000+ employees
Non-surgical gender reassignment treatment (hormone therapy)
Behavioral health services / counseling
Puberty suppression
None of the above, reassignment surgery only
Reconstructive procedures
MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES
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Attachment 3