As healthcare renewals hit employers' desks, few will be surprised to find yet another increase —
But perhaps this is the year to ask other questions, for instance: What's driving these ever-increasing costs? Do they contribute to making my employees healthier? And now, more than ever: What can my company do to shift this momentum away from the never-ending 'lose-lose' abyss of today's
Addressing what's under the hood
Any steps to move the needle in the direction of affordability means getting to the heart of the cost drivers and exploring strategies that circumvent them. It starts with addressing the unsustainable healthcare status quo, which continues to allow:
- Inflated, wide-ranging price variations charged by high-cost hospitals (with no correlation to quality)
- A system that rewards rushed visits and questionably necessary tests, where insurers profit more on more expensive care
- Greater bargaining leverage for consolidated providers, especially hospitals
- Health insurance carriers making billions as drug company middlemen.
- An epidemic of chronic (often preventable) diseases affecting 50% of the population and 86% of healthcare costs
And perhaps the greatest enabler of unhinged healthcare costs is inertia — accepting
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How to take back the wheel
Employers have not only the power, but the responsibility to challenge the healthcare status quo. Healthcare is often the second largest company expense after payroll, so improving plan value and quality benefits employees as well as the company's bottom line. Further, employers — not Medicare or Medicaid — are the profit drivers for the providers of healthcare. Employer clout has been diffused and unchanneled — but there are opportunities to take action in pursuit of sustainable costs and employee affordability.
While some cost drivers have been deliberately opaque, others are expensive choices that can be remedied with bold alternatives. For instance:
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- Demand data. If your company has been paying inflating fully-insured premiums with no actionable insights to show for it, consider the detailed claims data and control a self-funded plan can offer.
- Promote the primacy of primary care. Those who regularly see a primary care doctor are healthier, happier and have
33% lower healthcare costs . Making primary care a cornerstone of a health benefits offering means employees have a medical home and can get the right level of care — whether preventive, chronic or urgent — and preventable issues don't have to become large costly concerns. - Offer a spectacularly simplified health plan. Eliminate the jargon, reduce obstacles like deductibles and coinsurance and take surprises out of the process. Offer a plan workers can understand and afford.
- Get picky about providers and PBMs. While many PBMs are wringing massive profits from the system, transparent PBMs are on the rise. Your company can make it a point to work only with providers and partners who demonstrate quality care at a fair, transparent price.
- Find partners who get it. Employers should hold advisors and consultants accountable for delivering plans that meet your goals, budget and priorities.
- Own your plan. The world is increasingly moving toward unbundled solutions with best-of-breed partners. There is no need to feel like you should be 'forced' to accept sub-optimal solutions that are bundled by mega-carriers for their own economic benefit.
Change is only going to happen by addressing the roots of rising costs to steer to a better system. By putting value over volume and choosing to make health plans significantly more cost effective, employers hold the power to drive home radical affordability on behalf of their employees and families.
