The health care macro-trends employers need to understand

Employer-provided health care is in the midst of the most dynamic change in over two decades, fueled by a convergence of trends that have created new opportunities and also new challenges as organizations craft their health benefit and workforce health strategies.  Their goal is to create high-value, high-performing health programs. However, effectively controlling cost trend while fostering employee health, productivity and satisfaction is far from easy.

Pace, Process and Performance

At the 2016 Conference Board Employee Health Care Conferences in March, we used the theme of Pace, Process, Performance to highlight the challenge.

  • The pace of change is constant and employers need to keep up with it. The key point is to be ready and to keep a measured cadence that allows you to jump on or create opportunities.
  • Process includes many aspects from selecting the right vendors, having an ongoing dialogue with senior management and positioning health care as part of your organization’s employee value proposition.
  • It is through pace and process that we get to performance – using cost, employee health and engagement as key metrics.
For more information on the eight macro-trends, read the full issue of Perspectives.

For more information on the eight macro-trends, read the full issue of Perspectives.

Trying to keep so many balls in the air makes it difficult to attain high performance. And it’s even a greater challenge to sustain that performance over time, especially amid today’s rapidly changing landscape.  To be successful, employers must be prescient and understand the broader issues underlying the changes.  In hockey terms, you would say skate not where the puck is now but where the puck is going to be.

8 Health Care Trends

To that end, we’ve identified and outlined the eight macro-trends that will impact your health care program. They amount to more than just another checklist. They’re the trends that will underlie your health care program and are a must – to understand, monitor and incorporate into your strategic thinking.

1. ACA Legislative Uncertainties

The Affordable Care Act has affected employer strategies for over six years. While the insurance reforms, expansions in access and compliance requirements are largely behind us, two key issues remain:

  • First what will the ultimate definition and calculation of the so-called Cadillac tax (excise tax) be when it triggers or will it be repealed or replaces by some other levy?
  • The second is whether the public exchanges will be successful and whether they will be a viable alternative as a group offering after 2017 when exchanges have the option of extending coverage to larger employers on a group basis.

2. Provider System Redefinition

Will the current trend in provider integration and system consolidation continue? Will it reduce costs? Will access and choice be impeded? Will alternative arrangements like Accountable Care Organizations be viable for employers? How will the transition from discounted fee for service to value based contracting and reimbursement affect the cost, quality and efficiency of care?

3. New Entrants and Disintermediators

Will the long-standing vice grip of the major health plans be loosened or replaced by the many new entrants into the health care marketplace? Will new entrants and long-standing veterans come to co-exist? Will employers ultimately insist on a curated suite of partners that will require the harmonious partnership of many vendors to achieve optimal value and program performance?

4. Health Technology

How will technology change the delivery of care and the way we engage people in health? Will telemedicine simply be the precursor to a broad suite of telehealth applications? Will technology and the smartphone create a physician avatar that dramatically changes the doctor-patient relationship?

5. The Changing Practice of Medicine

As genetic sequencing drops in cost and as physicians are able to move from diagnosis by “signs and symptoms” to understanding each patient’s unique genetic make-up, will precision medicine enable unique treatments that lead to personalized benefit plans, quite literally defined by the employee’s genetic profile?

6. A Realignment of Patient Care and Health Management

Will the shift to more primary care, the medical home and accountable care organizations shift wellness and chronic condition management from health plans and third parties to the physician? Will they co-exist?

7. The Role of Exchanges

The private exchange concept for active workers is already changing the nature of health plans as employers assess expanded choice, subsidy transparency, decision support and an enhanced employee experience? Will the active private exchange become the vehicle of choice?  Will employer provided retiree health benefits for Medicare eligible be wholly replaced by the private retiree health exchange?

8. Change and the Employee Value Proposition

How will the health care experience evolve as the boomers retire, millennials come to the forefront, employee needs change and expectations around the health care consumer experience shifts?

If you monitor these trends closely and incorporate them appropriately into your strategic planning processes, you’ll be better positioned to achieve – and sustain – a high-value, high-performing health care program.

About Randall Abbott

Randall Abbott is a senior strategist emeritus of the Willis Towers Watson Health and Benefits practice. Now retire…
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