From the September 2015 issue of HealthCare Business News magazine
With the U.S. Supreme Court upholding the Affordable Care Act in June, many U.S. employers continue to implement strategies aimed at creating greater health care plan efficiencies and many more continue to seek deeper cost-saving opportunities.
As the benefits landscape continues to shift, there are several key trends that are likely to impact the decision making process for employers and health care providers, collectively shaping their expectations.
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A call for increased transparency into health care data for employers and consumers.
A shift to self-insurance among small and mid-size employers .
The rise of high-deductible health plans to avoid “Cadillac Tax” penalties.
Expanded reliance on high-performance networks to save costs by choosing providers who provide statistically better outcomes at lower costs.
More Americans are now covered by high-deductible health plans, and paying more out-of-pocket.
It’s forcing them to want to know more about what they’re spending their money on, and how they can spend it more wisely. Health care providers are responding to pressures to reveal information related to quality of care, treatment outcomes and price. With transparent price performance information, consumers are making informed decisions and choosing providers who offer the highest quality care at the best value. Providers, in turn, will be more motivated than ever to be competitive based on quality, price and service.
Happening now and continuing for the foreseeable future, more companies of every size will switch to self-insurance — paying for individual employee health claims out of cash flow rather than as a monthly fixed premium to a health insurance carrier. Costs are based on actual plan member health care use. This makes self-insurance generally more cost efficient than fully-insured commercial plans.
What’s more, according to research conducted by the National Federation of Independent Businesses, self-insurance is exempt from many of the new federal health insurance taxes under the Affordable Care Act, which will be onerous for the commercial plan market. Also, self-insured companies do not have to offer the government-mandated “essential health benefits,” which enables them to tailor benefits to the needs of a company and the demographics of its workers.