The full implementation of the health reform law is shaping up to be a very bumpy, even traumatic event. Employers have a number of issues to deal with and a recent survey by the National Business Group on Health reflects some of the issues companies are grappling with. (NBGH Survey) Many employers report that they are reducing retiree health coverage and others are looking at taking advantage of the lack of a requirement to provide employees working under 30 hours a week with health care coverage. Employers’ concern about health costs is understandable, given that cost per employee are expected to reach $12,136 in 2013, up 5.1% from $11,457 in 2012. Most employers do not expect health care spending growth to drop to or below the rate of inflation in the foreseeable future. And one of their key strategies for coping with the cost increases is to pass an increasing share of them onto employees, as they have done for the last few years. In a most disturbing trend, employers are raising greatly contributions for spouse or dependent coverage and some are considering eliminating it.
They do expect significant changes in the health care marketplace, including the continuing development of new care access points like telemedicine, kiosks and on-site clinics; greater price transparency and provider reimbursement mechanisms that are more linked to provider performance. A general strategy that many employers embrace is the use of financial incentives, both for providers to render better and more cost-effective care and for employees and dependents to be more attentive to their health and their use of health care. And the financial incentives won’t be solely for participating in activities, but will be tied to actually improving health–losing weight, lowering blood pressure, improving blood sugar control and other similar items. While employers are watching exchanges closely, most are not intending to encourage employees to move to the public exchanges for coverage, although use of internal, private exchanges is rising rapidly. Account-based health plans continue to be popular as well, with a number of companies using them as a full-replacement approach. Finally, specialty pharmacy use and spending has risen dramatically as a problem that has management attention.