{"id":4657,"date":"2019-12-05T11:47:33","date_gmt":"2019-12-05T16:47:33","guid":{"rendered":"https:\/\/www.healthadvocate.com\/site\/?p=4657"},"modified":"2020-01-14T16:57:06","modified_gmt":"2020-01-14T21:57:06","slug":"reading-the-tea-leaves-benefits-2020","status":"publish","type":"post","link":"https:\/\/www.healthadvocate.com\/site\/article\/reading-the-tea-leaves-benefits-2020","title":{"rendered":"Reading the tea leaves"},"content":{"rendered":"\n

Insights\nand predictions on benefits and health care in 2020<\/em><\/p>\n\n\n\n

By Alan Goforth | BenefitsPRO<\/strong><\/p>\n\n\n\n

In the\n1950 film \u201cAll About Eve,\u201d Bette Davis spoke the famous line, \u201cFasten your\nseatbelts, it\u2019s going to be a bumpy night.\u201d That might sum up how many brokers\nfeel as they look ahead to the election year of 2020.<\/p>\n\n\n\n

\u201cThe\nelection will be the hottest topic in 2020, but most of what is discussed will\nnot be implemented until further down the road,\u201d says Emily Bremer, president\nand owner of Bremer Benefits in St. Louis. \u201cThe more urgent issue is that we\nare coming to a tipping point when it comes to the cost and transparency of\nhealth care that may not be able to wait until after the election. Surprise\nbilling, pharmaceutical trends and hospital price transparency are making the\nnews daily, along with the myriad of lawsuits cropping up on all sides.<\/p>\n\n\n\n

\u201cWithout\nreal government intervention or regulation, there is a wave of start-up\ncompanies and employer benefits strategies that is building to combat these\nissues using every tactic you can think of, from sending employees to Tijuana\nfor their drugs to direct contracting with doctors and hospitals, and many\nmore.\u201d<\/p>\n\n\n\n

Uncertainty\nabout election outcomes goes hand in hand with another key issue on the\nhorizon: economic uncertainty.<\/p>\n\n\n\n

\u201cThe state of the economy has the\npotential to have a big impact for all of us in the year ahead,\u201d says Dr.\nArthur \u201cAbbie\u201d Leibowitz, chief medical officer, cofounder and president\nemeritus of Health Advocate in Plymouth Meeting, Pennsylvania. \u201dIf there is a\nbusiness slowdown in 2020, it could have major repercussions across the\nbenefits industry.<\/p>\n\n\n\n

\u201cHowever,\nduring the last recession, our business actually increased as many employers,\nincluding our clients, made changes to their health care benefits to curb costs\nand realized the need for an effective and inexpensive service to help\nemployees deal with the changes and lower their overall health care costs.\nWe\u2019ll be watching this closely in the coming months.\u201d<\/p>\n\n\n\n

Predicting\nthe future is always an iffy proposition, and especially so in a contentious\npresidential election year. However, although it is difficult to predict\nexactly what the benefits industry can expect in 2020, it is possible to\ndetermine which issues are likely to dominate. BenefitsPRO asked a group of\nindustry leaders for their insights on what to expect on several hot-button\ntopics.<\/p>\n\n\n\n

Election\nand politics<\/strong><\/p>\n\n\n\n

\u201cThe\n2020 election will decide the future of the American health care system. We\nknow voters list health care as a top issue, so I expect to see candidates\nspending a significant amount of time on the campaign trail addressing their\nspecific vision for how our system should work. I view it as a responsibility\nof our industry to help provide our clients and family members with the\nappropriate context for evaluating the proposals that will be at the forefront\nof the debate.\u201d<\/p>\n\n\n\n

\u2014Scott\nWham, director of compliance services, Kistler Tiffany Benefits, Berwyn,\nPennsylvania<\/p>\n\n\n\n

\u201cDemocrats\nbelieve that health care is an issue that voters trust them with more than they\ndo Republicans. It appears unlikely that Republicans will promote the repeal of\nObamacare like they did in earlier elections. Republicans believe that tagging\nDemocrats with Medicare for All may make voters concerned about losing their\ncurrent employer-based health care and increased taxes.\u201d<\/p>\n\n\n\n

\u2014William\nSweetnam, legislative and technical director, Employers Council on Flexible\nCompensation, Washington, D.C.<\/p>\n\n\n\n

\u201cPolitics and health care reform are\nclosely connected in the current environment. Health care reform, the\nAffordable Care Act and other proposed plans are front and center on both sides\nof the aisle, and with the election right around the corner, I expect this\nfocus to remain. While it\u2019s too early to predict what the final outcome will\nbe, we do know this will be a key issue in debates next year.\u201d<\/p>\n\n\n\n

\u2014Arthur Leibowitz<\/p>\n\n\n\n

\u201cMedicare\nfor All will be front and center, but I\u2019m pretty sure that not all Democrats\nagree that this is a good solution. Use of the term \u2018Medicare\u2019 is intentional,\nas it has positive connotations with most Americans. However, Medicare for All\nis not Medicare as we know it today. People need to get clear on that and be\neducated.\u201d<\/p>\n\n\n\n

\u2014Suzy\nAlberts, account director, Comprehensive Benefits Inc., Southfield, Michigan<\/p>\n\n\n\n

Health\ncare reform<\/strong><\/p>\n\n\n\n

\u201cIt\nremains to be seen how employer-based health plans (including consumer-directed\nhealth-care plans) will fare under a Medicare for All program. At one end of\nthe spectrum, the favorable tax treatment of employer-provided health plans\nwill be eliminated and everyone will go into a Medicare-like health plan. On\nthe other end would be the continued availability of employer-sponsored health\nplans, giving everyone the opportunity to buy into a lower-cost Medicare-like\nhealth plan as an alternative. I anticipate a spirited discussion, particularly\nsince labor unions, an important constituency of the Democrat party, want to\ncontinue to provide tax-free health care benefits as part of the collective\nbargaining agreements negotiated for their members.\u201d<\/p>\n\n\n\n

\u2014William\nSweetnam<\/p>\n\n\n\n

\u201cThis\nused to mean health insurance reform to most people, but I think the tide is\nfinally turning. People are beginning to understand what all of the cost\ndrivers are. And hopefully that will lead to better conversations and more\ninnovation going forward.\u201d<\/p>\n\n\n\n

\u2014Emily\nBremer<\/p>\n\n\n\n

\u201cThe\nonly health care cost issue that\u2019s even being considered is whether the\ngovernment becomes the single-payer. Then they can set prices. I don\u2019t think\npeople understand the repercussions that would have on health care in the\nUnited States. Providers can\u2019t survive on the Medicare pay scale.\u201d<\/p>\n\n\n\n

\u2014Ken\nStevenson, vice president, employee benefits, Earl Bacon Agency, Tallahassee,\nFlorida<\/p>\n\n\n\n

Health\ncare delivery<\/strong><\/p>\n\n\n\n

\u201cDomestic\ntourism, reference-based pricing and specialty drug programs are the three\nareas of greatest impact to the bottom line for organizations. While not all\nemployers are ready, we are at least educating them on what is in their market.\nEmployers are looking for innovative solutions to solve their complex problems,\nand this is exciting to me. The conversations are shifting. We are seeing a lot\nof conversation around the RAND study\u2014it\u2019s bringing providers, pharma and\ncarriers\/TPAs.\u201d<\/p>\n\n\n\n

\u2014Susan\nRider, consultant, Gregory & Appel, Indianapolis<\/p>\n\n\n\n

\u201cPrimary\ncare continues to be a challenge. We need more physicians in this space, and\nhopefully DPC and concierge medicine will make internal medicine more\nattractive to medical students and residents as a field. The ER also continues\nto be a problem. I am grateful for the many terrific urgent care centers that\nhave cropped up around the country, but there are just times when you need the\nER.\u201d<\/p>\n\n\n\n

\u2014Emily\nBremer<\/p>\n\n\n\n

\u201cI\nbelieve we\u2019ll continue to see a push for more accessible primary care delivered\nby non-physicians. Access to primary care is foundational to positive health\noutcomes, and employers of all sizes are interested in removing barriers to\nprimary care for their employees and their families. While many large companies\noffer on-site health clinics to their employees (as well as their families),\nthe vast majority of companies cannot afford to maintain an on-site health\nclinic. I\u2019m excited by the number of nurse practitioner\/physician assistant-led\nprimary care clinics entering the market looking to partner directly with\nemployers at a reasonable price-point.\u201d<\/p>\n\n\n\n

\u2014Scott\nWham<\/p>\n\n\n\n

Technology<\/strong><\/p>\n\n\n\n

\u201cExpect\nincreased implementation on all fronts. Our agency uses quoting tools, online\nenrollment portals, CRM software, new group online submissions to the carrier,\netc., that were not in place even two or three years ago. While there is a cost\nto these tools, they create greater efficiency in our office procedures and\nallow us to streamline. We can also more easily access client information and\nprovide quicker service. Carriers are increasingly using technology to track\nand manage care, claims and behavior, as well.\u201d<\/p>\n\n\n\n

\u2014Debbie\nStocks, Your Benefits Partner, Glen Allen, Virginia<\/p>\n\n\n\n

\u201cWhat\nmost people don\u2019t know is that there is a movement behind the scenes to get\naway from 834 EDI data exchange by health carriers. It\u2019s been done that way\nsince the mid-1970s. If Employee Navigator is successful with its pilot of\nUnitedHealthcare changing to HTML, that could be a game changer for data\ntransfer.\u201d<\/p>\n\n\n\n

\u2014Ken\nStevenson<\/p>\n\n\n\n

\u201cWe\nwill continue to see more use of technology to streamline every aspect of the\nbenefits industry. It provides better access to information to the consumer,\nresults in fewer errors and makes managing benefits much easier. However, not\nall consumers will be adopters due to lack of access and education.\u201d<\/p>\n\n\n\n

\u2014Suzy\nAlberts<\/p>\n\n\n\n

\u201cTechnology\nis both a boon and a bane to our industry. Health insurance was way behind\nP&C and other industries. Now we are playing catchup and experiencing\ngrowing pains. Every time someone comes out with some fabulous new app or\nwebsite, all I can think of is the direct in-person communication that too\noften will be eliminated because it isn\u2019t \u2018needed\u2019 anymore. While I am grateful\nfor the technology tools that make it easier to communicate across distances\nand store information in an easily accessible way, I worry about formats that\nfocus more on being pretty than being functional, and result in losing direct\nemployee interaction.\u201d<\/p>\n\n\n\n

\u2014Emily\nBremer<\/p>\n\n\n\n

Industry\nConsolidation<\/strong><\/p>\n\n\n\n

\u201cI\nbelieve we will continue to see major industry players looking to consolidate\nand create economies of scale. Some are likely looking to be a player if we\neventually see more health care reform (i.e., Medicare for All). The FTC and\nother agencies will be closely scrutinizing these deals so we don\u2019t create a\nwhole new set of problems with markets controlled by one or two companies.\u201d<\/p>\n\n\n\n

\u2014Suzy\nAlberts<\/p>\n\n\n\n

\u201cAcross the country, we\u2019re seeing\nhospital systems consolidate at a rapid pace and compete with each other to own\nthe \u2018feeder points\u2019 throughout their regions. As more physician practices are\nowned by hospitals and consolidated by health systems, the landscape of care\ndelivery will continue to change. Access to care will continue to be a consumer\nchallenge and costs may rise as availability of other options decreases. We\nalso expect continued increases in accountable care, patient-centered medical\nhome care and other integrations across the medical care system. Physicians will\ntake on additional financial risk for population management and outcomes as\npatients are likely to be increasingly confused by the nature of these new\narrangements.\u201d<\/p>\n\n\n\n

\u2014Arthur Leibowitz<\/p>\n\n\n\n

\u201cWe\ncontinue to see consolidation. Personally, I work for a firm that remains\nfiercely independent and that is not up for sale. This has allowed us the\nfortune of being able to remain nimble to meet client needs.\u201d<\/p>\n\n\n\n

\u2014Susan\nRider<\/p>\n\n\n\n

Business\nstrategy<\/strong><\/p>\n\n\n\n

\u201cCustomer\nservice is still the top priority; it\u2019s how I have grown my business and\nretained my clients. We\u2019re just streamlining our operations to be more\nefficient and effective in dealing with client service.\u201d<\/p>\n\n\n\n

\u2014Debbie\nStocks<\/p>\n\n\n\n

\u201cThis\nyear is a difficult one, with double-digit increases. We continue to stress the\nimportance of developing a three- to five-year strategy rather than a Band-Aid\napproach. We do work with many employers that are forward thinking and want to\ndo what\u2019s right for their staff while incorporating cost-containment strategies\nto help for the future. Communication is key, and it\u2019s not a once-a-year\nstrategy, but rather several touchpoints throughout the year.\u201d<\/p>\n\n\n\n

\u2014Susan\nRider<\/p>\n\n\n\n

\u201cFlexibility\nhas been my watchword since 2010, and it will be in 2020 as well. Laws and\nregulations change, clients merge with other companies, carriers come out with\nnew products, or new opportunities arise. No two years have been the same since\nthe ACA appeared in our lives. As a broker and employer, I try to keep an open\nmind. I am always on the lookout for new ideas and revenue streams and know I have\nto be able to let go of what isn\u2019t working, even when I feel like I have\ninvested my heart and soul into it.\u201d<\/p>\n\n\n\n

\u2014Emily\nBremer<\/p>\n\n\n\n

Reasons\nfor optimism<\/strong><\/p>\n\n\n\n

Even\namid the uncertainty, however, brokers have reasons to be optimistic as they\nlook ahead to the new year.<\/p>\n\n\n\n

\u201cI\nalways have hope,\u201d Bremer says. \u201cI am probably the only optimist in insurance,\nbut I believe in this country and our capabilities. Change and transition are\nhard for everyone, and we have definitely been through a lot of change over the\nlast nine years. However, I always remember that this is the country that\ninvented personal computers, GPS systems, 3D printing and lasers. Not to\nmention putting a man on the moon.<\/p>\n\n\n\n

\u201cIt is\nhard to believe that when it comes to health care, our best idea is \u2018let\u2019s just\ndo whatever Canada is doing.\u2019 At our heart, we are a nation of innovators, but\nwe need to get to work and stop waiting for the politicians to solve our\nproblems for us.\u201d<\/p>\n\n\n\n

Brokers\u2019\nresolutions for 2020<\/strong><\/p>\n\n\n\n

It\nwouldn\u2019t be a new year without a few resolutions, and several brokers shared\ntheir hopes for the industry and their own businesses in 2020.<\/p>\n\n\n\n

\u201cFrom\na business perspective, I will be focusing on compliance and technology. Making\nsure that our clients have their bases covered from a compliance perspective is\nalways a moving target. We also need to work toward getting our clients up and\nrunning on technology platforms that streamline benefits management for them\nand for us. Because our agency\u2019s client-base tends to be in the small- to\nmid-size market, it\u2019s more of a challenge to find vendors that are a fit.\u201d<\/p>\n\n\n\n

\u2014Suzy\nAlberts<\/p>\n\n\n\n

\u201cIn the year ahead, we will continue to\ndevelop and innovate our services to meet the changing needs of consumers in\nthe ever-evolving health care environment.\u201d<\/p>\n\n\n\n

\u2014Dr. Arthur \u201cAbbie\u201d Leibowitz<\/p>\n\n\n\n

\u201cKeep\nan open mind, listen to client requests and find solutions that benefit both\nthe employer and employees.\u201d<\/p>\n\n\n\n

\u2014Susan\nRider<\/p>\n\n\n\n

\u201cMy\nresolution for myself and my employees is to step back and make time to put on\nour own oxygen masks first. We have been running and gunning for so long it has\nbecome the norm, and you have to take care of yourself and your health. I went\nto a great local women\u2019s conference this year where a non-profit leader said,\n\u2018You cannot pour from an empty cup.\u2019 So my resolution for 2020 is to stop\nfeeling guilty and fill that cup up to the brim.\u201d<\/p>\n\n\n\n

\u2014Emily\nBremer<\/p>\n\n\n\n

\u201cWe\nwill continue to promote consumer-directed health plans as a means of helping\nemployees become more conscious of health spending and providing them\nopportunities to finance their health care expenses. Even if the United States\nmoves to a Medicare for All world, individuals will need to be responsible for\nsome of the costs of health care and consumer-directed health plans should\ncontinue to be looked at as a way to help employees finance those health care\ncosts.\u201d<\/p>\n\n\n\n

\u2014William\nSweetnam<\/p>\n\n\n\n

\u201c2020\nshould be the year our industry offers a zealous defense of our value\nproposition. I\u2019ve seen a significant amount of ink in books, news articles and\nLinkedIn posts dedicated to questioning the value and motivations of our\nprofession, and this should be the year we fight back by telling our story or,\neven better, having our clients tell our story for us.\u201d<\/p>\n\n\n\n

\u2014Scott\nWham<\/p>\n\n\n\n

\u201cIt\u2019s not a resolution, but keep pushing the conversation for change. But the change is addressing delivery and outcomes tied to health care cost, not whether private insurance or government should be the payor but are just abused mechanisms for financing the ever-burgeoning cost.\u201d

\u2014Ken Stevenson <\/p>\n","protected":false},"excerpt":{"rendered":"

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