Kathryn Moody
\nHRDive | August 18, 2016<\/p>\n
Overall cost increases of healthcare benefits will hold steady at 6%, the National Business Group on Health announced\u2014but increases that are held in place are, alas, still increases. Sustainability of healthcare may be under threat, and if prices continue to rise at current rates, it could put serious pressure on healthcare affordability for employers, the CEO and President of the NBGH, Brian Marcotte, said.<\/p>\n
Or, to put it simply: Sooner or later, something\u2019s got to give.<\/p>\n
The NBGH annual report provides employers an outlook on the direction the change may be going. For the first time since the report began, specialized pharmacy was considered the No. 1 cost driver for healthcare spend, reflecting a general industry focus on specialized healthcare issues overall. To tackle these problems, employers are reaching for new tools that serve their general populations and provide high-touch care to their employees with more specific and specialized healthcare problems.<\/p>\n
HR Dive spoke with industry experts on to better understand what is going on and how employers are best solving these problems.<\/p>\n
Cost pushers: Growing prescription spend, patient responsibility<\/strong><\/p>\n Specialty prescriptions tend to be the very expensive drugs that cost $1,000 or more per dose, are challenging to dispense and have complex care management needs, Marcotte explained.<\/p>\n But employers may be asking: Why now? It\u2019s not like specialty prescriptions are a completely new entity.<\/p>\n Ten years ago, many Americans were participating in more traditional healthcare plans with many co-pays, said Jeff Oldham, Vice President of Consumer Strategy at Benefitfocus, so when they purchased specialty drugs, the drugs seemed cheap. Now that consumer-directed healthcare plans (CDHPs) have grown in adoption, more employees are seeing the full-cost of such drugs.<\/p>\n \u201cWhen people didn\u2019t previously need to be engaged, they didn\u2019t ask the right questions,\u201d he said. \u201cNow they are far more interested in understanding the price of drugs.\u201d<\/p>\n In turn, more employers are trying to manage the high costs as well as employee needs by creating specialty pharmacies, creating certain specialty tiers in pharmacy plans and generally paying more attention to employees who require such services, the NBGH report said. In particular, there is renewed focus on paying attention to where employees go for treatment, and potentially pushing employees to cheaper high-quality locations instead (a stand-alone clinic versus a hospital, for example).<\/p>\n Plan design \u201cis not the silver bullet,\u201d Oldham said. It\u2019s the same old problem of the new healthcare age: Employees have to be willing to change their behaviors, too. Often, money is the only way to encourage that change, which is one reason why CDHP adoption may have spurred employers to take a second look at their pharmacy programs.<\/p>\n Growth of specialized wellness and wellness tools<\/strong><\/p>\n Employers are increasingly focusing on \u201chigh touch\u201d care management programs. For example, opioid restriction and management has garnered more attention this year due to various reports on opioid abuses and concerns.<\/p>\n But in order to maintain such programs, employers are turning to third-party wellness management tech to ensure their success.<\/p>\n \u201cI was in the wellness space almost 10 years ago, and employers were blindly throwing money away when they didn\u2019t have a good understanding of core conditions that were impacting their healthcare spend,\u201d Oldham said. Now, more employers are using wellness tools to understand the top five or 10 conditions that could be affecting employees.<\/p>\n One powerful tool that has emerged as more employers adopt wellness programs is the telephonic consult. Telehealth is \u201ccommonplace\u201d now for most large employers, NBGH reports. By 2019, 97% of large employers are projected to have some form of telehealth in play. That rise is explained due to its cost-effectiveness. A $150 urgent care visit can be reduced to a $40 teleconsult, Marcotte noted, especially if an employee has a simple care need, like a cold or sinus infection.<\/p>\n Telehealth has also seen use in mental and behavioral benefit spaces, alongside the usual suspects of EAPs and self-help electronic resources, the NBGH report adds.<\/p>\n But the biggest trend that Oldham noticed is that more and more companies are putting effort into owning wellness data \u2014 literally. For a long time, most employers depended on insurance carriers to provide wellness data (BMIs, biometric screenings) and programming. Now, more employers are conducting research and analysis, and are \u201cfar better\u201d at understanding their data, Oldham said \u2014 which means more focus on specialized forms of care.<\/p>\n \u201cI think employers right now, when it comes to wellness, they have far more questions,\u201d he added. That\u2019s a good thing. It means that more wellness programs actually bring about outcomes.<\/p>\n Drilling down: The rise of concierge services and consumer choice tools<\/strong><\/p>\n As always, wellness and healthcare programs struggle with engagement, Marcotte said. In turn, many of the new wellness technologies focus on grabbing employee attention and integrating all of an employer\u2019s offerings. Consumer choice tools are a common example of this.<\/p>\n Another set of tools growing in popularity: concierge services. These tools are being used to address either specialty conditions or more broad health concerns, Marcotte said. Typically, concierge services provide employers with one phone number or access point that employees can use to gain information about their benefits and, in many cases, set up appointments. Trained nurses usually respond to the calls, and can assist in managing an employee\u2019s case.<\/p>\n Oldham was optimistic about such tools as well. He praised their \u201cbedside manner-type approach\u201d and the way such programs actually lean away from automation. A real nurse often does the research and work to connect employees to what they need.<\/p>\n \u201cIt\u2019s not inexpensive,\u201d he said, \u201cbut if I am a large employer, there are intense productivity gains.\u201d Especially if an employee doesn\u2019t have to search for a specialist while on the clock.<\/p>\n Health Advocate is one company that provides a concierge-like service. Their specialists are trained to ascertain the \u201chidden questions\u201d \u2014 issues employees may have but won\u2019t ask about outright at first. Such programs seem to be particularly effective for those with untreated mental health issues, especially in contrast to the typical EAP. <\/strong><\/p>\n \u201cEAPs dig their own hole,\u201d Bert Alicea, vice president, EAP+Work\/Life Services at Health Advocate, told HR Dive in June. Their focus on utilization does them in, he notes, and is part of the reason why such programs come with considerable stigma and engagement issues. <\/strong><\/p>\n Instead, Health Advocate and other concierge services present themselves as a \u201cresource\u201d for employees, a way for an employee to overcome a \u201ctemporary set-back\u201d no matter what is going on in their current life. <\/strong><\/p>\n \u201cThe one model of wellness, advocacy and onestop shopping, it can help get behind the many issues employees have,\u201d Alicea said. \u201cAnd many of those are medical issues.\u201d<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" Kathryn Moody HRDive | August 18, 2016 Overall cost increases of healthcare benefits will hold steady at 6%, the National Business Group on Health announced\u2014but increases that are held in place are, alas, still increases. Sustainability of healthcare may be under threat, and if prices continue to rise at current rates, it could put serious […]<\/p>\n","protected":false},"author":11,"featured_media":1331,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-1410","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-article"],"acf":[],"yoast_head":"\r\n