Why do we always report on these surveys of employers? Mostly because since so many Americans are covered by employment-based health plans; but also because employers tend to be more innovative that the public sector. TowersWatson releases results of a survey in January of 444 large and mid-sized companies regarding emerging health care trends over the next three years. (TW Survey) 84% are planning to make significant changes to their health plan by 2018, with continued cost management the ultimate focus. Employers expect a 4% cost increase in 2015 after taking into account benefit design changes (5.2% rise before such changes), compared to 4.5% in 2014. While these increases are low compared to those a decade ago, they are still well above most companies’ ability to raise prices and so they continue to eat into margins. Employers still view it as imperative to reduce the rate of health cost spending growth to no more than the rise in general inflation. Also weighing on these firms is that 40% calculate that they will trigger the excise tax in 2018. One response from the survey; while 17% of the respondents said they have a high-deductible plan as the only option in 2015, 50% said they probably will by 2018. Another response in that 41% said they may adopt a defined contribution strategy by 2018.
Other key cost control strategies articulated by these companies include greater use of spousal surcharges when the spouse has health coverage available elsewhere; 61% said they will do this in 2018 compared to 32% using the surcharge in 2015. And 53% said they likely will reduce spousal and dependent subsidies, meaning coverage for anyone other than the employee will cost more. Companies are using more data and analytics to evaluate both plan performance and employee behavior changes. One result is that they intend to use more select provider strategies; greater use of centers of excellence and provision of a narrow network option is expected to triple by 2018. 80% say they will be offering and encouraging use of telemedicine by 2018. Specialty pharmaceutical use, especially through the medical benefits is another ongoing area of focus. In regard to employee engagement in health, 66% of firms say they are working actively to develop a culture in which employees are accountable for their health (are you listening, Medicaid?); and 51% intend to use more financial incentives to encourage that culture. Respondents also intend to make available more education and decision support tools for members in regard to provider selection, price and treatment choices. Finally, while 17% see private exchanges as an option for 2016, 37% do for 2018.