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Employers are Experimenting with Innovative Health Plan Designs

About half of employers are experimenting with innovations in health plan design in order to reduce costs and improve quality for beneficiaries.

Nearly half of large US employers are experimenting with innovative health plan design

Source: Thinkstock

By Thomas Beaton

- Just under half of employers participating in a survey from the National Business Group on Health (NBGH) are actively experimenting with innovative health plan designs that aim to foster new approaches to care delivery.

NBGH found that employers expect healthcare costs to rise by 6 percent in 2019 without any efforts to reduce costs. However, employers still expect costs to rise by 5 percent if they incorporate traditional cost containment strategies into their plan designs.

More than a third of employers are concerned about smaller groups of very high-cost claimants, the survey showed.  Other pressing challenges include specialty pharmacy services (21 percent), degenerative conditions like cancer or musculoskeletal diseases (16 percent), and general healthcare inflation (14 percent).

Employers are taking a more proactive role in promoting healthcare delivery that emphasizes the components of value-based care, NBGH said.

“The survey revealed stark changes from the past in how employers view their role in health care. More and more, they see themselves as driving innovations,” NBGH explained. “This new trailblazing attitude became evident from a surprising finding: Close to 50 percent of the responding employers are playing an activist role in revamping how healthcare is delivered.”

Contracting with ACOs and HPNs

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Thirty-five percent of employers are directly contracting with accountable care organizations (ACOs) or high-performance networks (HPNs), NBGH found.

Employers said they would increase their use of ACOs and HPNs if they had more market information about provider organizations. Additionally, employers said they would increase ACO or HPN contracting if these organizations had the highest quality, and most cost-effective, providers.

“Employer confidence is still somewhat ‘wait-and-see’ regarding the ability of ACOs to meet their objectives to reduce costs and improve the consumer experience and health care quality,” NBGH said. “Currently, employers are more confident about the ability of ACOs to improve healthcare quality than to reduce costs.”

Coordinating care through Centers of Excellence

Employers have steadily increased their use of centers for excellence (CoEs) to coordinate care and improve quality, the survey found. Employer CoE use is expected to grow from 79 percent of employers in 2016 to 88 percent in 2019.

Seventy-four percent of employers contract CoEs for organ transplants through their health plan. Fifty-eight percent of employers contract CoEs for bariatric surgery and 38 percent use CoEs for orthopedic services. In addition, 34 percent of employers contract CoEs for cancer care.

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NBGH said that employers are also slowly adopting the use of bundled payments to enhance the cost-effectiveness of CoEs. Seventy-three percent of directly contracted CoEs between employers and providers are expected to be structured through a bundled payment model.

Providing resources for mental health, behavioral health, and opioid abuse

The number of employers launching anti-stigma campaigns for behavioral health treatment is expected to increase from 18 percent in 2018 to 30 percent in 2019. Additionally, the number of employers supporting worksite behavioral health counseling is expected to grow from 19 percent in 2018 to 25 percent in 2019.

For 2019, 58 percent of employers said they will offer employees self-directed resources for mental health concerns and 39 percent will offer a flexible work schedule so employees can seek mental healthcare as needed.

Employers are also attempting to address the impact of the opioid crisis in their workplaces by designing health plans with limits on per-employee opioid supplies, CDC prescribing guidelines, and benefits that cover alternative therapies.

Leveraging virtual care delivery systems

Fifty percent of large employers said that implementing virtual care solutions is a top priority for their 2019 healthcare strategy. Fifty-two percent say virtual care will play a significant role in the future of healthcare delivery.

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In addition, 40 percent of employers say AI will play a very important rule in future healthcare delivery.

Telehealth services are the most popular virtual care feature offered by US employers, the survey found. Ninety-five percent of large employers in the US offer telehealth consults to their employees.

Employers also offer virtual care services including virtual mental health services (65 percent), digital health and lifestyle coaching supports (58 percent), and virtual weight management services (54 percent).

Enhancing employee cost management and engagement

The availability of cost management tools for employees is expected to increase from 66 percent of employers in 2018 to 71 percent in 2019.

Sixty-five percent of employers are expected to offer employee tools for managing healthcare claims in 2019, and 63 percent are expected to offer employees self-directed online decision support tools.

“In addition, more employers continue to add high-touch concierge services to help employees understand their benefits and navigate the healthcare system—up to 39 percent from 28 percent just two years ago,” NBGH said.

The results of the survey indicate that employers are building efforts to proactively reform healthcare delivery to benefits employees and reduce costs for plan sponsors.

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