Employer-sponsored health care is still the single largest source of health care coverage for Americans. And because they live in a competitive world and costs have rising, employers have often been at the forefront of efforts to control spending and improve quality. Large companies are heavily influenced by the major benefit consulting firms and one of those firms, Towers Watson, has given us its perspective on important trends shaping employment-related health benefits today. (TW Paper) Towers Watson’s overall premise is that employers face a complex and uncertain health care environment, one to which they are responding in a variety of ways. According to Towers’, 81% of companies expect to make near-term changes to their health care strategy; 61% are seeking value-based provider partners; 50% intend to offer only an HSA or HRA-type plan; 68% will put in place spousal surcharges or exclusions; 76% will implement outcomes-based incentives for health behaviors and 68% are going to implement restrictions on specialty drug use.
The eight trends of most significance are legislative and regulatory uncertainty in the aftermath of the reform law, including 1) issues related to the employer mandate, the high-value plan excise tax, and defining who is a full-time employee; 2) the redrawing of the provider system, both in terms of consolidation which limits competition and in the creation of new care sources, such as retail and onsite clinics and use of telemedicine, and related changes in the who and how of medical practice, with expanded use of nurse practitioners and physician assistants, as well as continuing (so far disappointing) development of medical home and accountable care models; 3) a new model of diagnosis and treatment based on individual biochemistry and evidence-based medicine; 4) new entrants in providing health coverage, like Oscar in New York, as well as in providing care, like the retail clinics; 5) health technology which enables greater provider/patient connectivity, mobile health, remote monitoring, etc. etc.; 6) realignment of patient care and health management, primarily in the form of providers who have responsibility for all of a patient’s care and care coordination; 7) decisions about how to use the private and public exchanges for various company population segments; 8) and keeping employees happy and productive through all these changes and especially in light of the greater cost-sharing they are being asked to bear.