national survey of employer -sponsored health …...extensive questionnaire covers a full range of...

1

H E A L T H W E A L T H C A R E E R

M E R C E R ’ S

N AT I O N A L S U R V E Y O F

E M P L O Y E R - S P O N S O R E D

H E A LT H P L A N S 2 0 1 7

Robert Valdez

Emery Chen

Attachment.3

2

Oldest

Marking 32 years of measuring health plan trends

Largest

2,481 employers participated in 2017

Statistically valid

Based on a probability sample of private and public employers for reliable results

Employer size groups in presentation

Large: 500+ employees/Jumbo: 20,000+ employees

Most comprehensive

Extensive questionnaire covers a full range of health benefit issues and strategies

Supplemental questions

All survey respondents with 5,000 or more employees were asked to complete a set of

supplemental questions, focused on health benefits strategies that are typically pioneered

or adopted soonest by very large employers. 231 employers with 5,000 or more

employees, including 87 employers with 20,000 or more employees, completed this

AB O U T M E R C E R ’ S N AT I O N A L S U R V E Y O F E M P L O Y E R -

S P O N S O R E D H E ALT H P L AN S

Attachment 3

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Top Stories 1

Plan Cost, Offerings and Enrollment 2

Medical Plan Management 4

Special Coverages and Services 5

Quality and Value 3

C O N T E N T S

Attachment 3

4 Copyright © 2018 Mercer (US) Inc. All rights reserved.

TOP STORIES

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T O P S T O R I E S

• Employers utilizing the greatest number of best practices have significantly

lower trend than those who are using fewer best practices

• Most employers still use a national strategy to select provider networks, but

some are beginning to look for the best options by location and even using

incentives to steer to these options

• Accountable Care Organization (ACO) arrangements are becoming more

prevalent, but reporting on efficacy and performance is limited

• While elimination of out-of-network (OON) benefits is still not very prevalent,

more employers are considering changes to OON reimbursement and

eliminating coverage for certain provider types

• Specialty Rx spend is on the rise and more than half of employers are

considering a specialty Rx vendor (separate from PBM or medical carrier)

• More employers are requiring use of Centers of Excellence (COE) for coverage

• Special coverages and services, like those related to gender reassignment, are

prevalent among jumbo employers (20,000+ employees)

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6

BASICS WELL-BEING QUALITY AND VALUE

• Offer CDHP

• HSA sponsor makes a contribution to

employees’ accounts

• Offer voluntary supplemental

health insurance

• Use/planning to use bundled solution

for health benefits (including private

benefits exchange)

• Transparency tool provided by

specialty vendor

• Mandatory generics or other

Rx strategies

• Steer members to specialty

pharmacy for specialty drugs

• Collective purchasing of Rx benefits

• Offer optional (paid) well-being

programs through plan or vendor

• Company vision/mission statement

supports a healthy workplace

culture

• Offer technology-based well-being

resources (apps, devices,

web-based)

• Use incentives for well-being

programs

• Well-being strategy includes focus

on intrinsic motivation to improve

health

• Spouses and/or children may

participate in programs

• Smoker surcharge

• Have conducted analysis of

employee behavioral health issues

• Provide stress management,

resiliency, or mindfulness

programs

• Offer health advocacy program

• Offer a Surgical Center of

Excellence

• Offer a COE other than for surgical

(oncology, orthopedics, cardiology,

women’s health)

• Primary care on-site clinic

• Telemedicine utilization of 5%

or higher

• Employees have incentives to use:

– Medical homes

– Accountable care organizations

– Other narrow network

• Reference-based pricing

E M P L O Y E R I N N O VAT I O N I S H E L P I N G T O S L O W

C O S T G R O W T H

R E S P O N D E N T S ’ C O S T T R E N D S W E R E A N A LY Z E D B A S E D O N T H E I R

U S E O F 2 4 B E S T P R A C T I C E C O S T - M A N A G E M E N T S T R AT E G I E S

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E M P L O Y E R S U S I N G M O R E B E S T P R AC T I C E S T R AT E G I E S

R E P O R T L O W E R T R E N D S

Actual increase in total health plan cost

5.4% 5.5%

2.9%

1.4%

Employers with 5,000+ employees Employers with 20,000+ employees

Employers using the fewest best practices Employers using the most best practices

Attachment 3

8 Copyright © 2018 Mercer (US) Inc. All rights reserved.

PLAN COST,

OFFERINGS AND

ENROLLMENT

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9

8.3% 9.1%

9.8%

8.2% 7.4%

8.0%

7.1% 6.3% 6.3% 6.5%

5.5%

6.9% 6.1%

4.1%

2.1%

3.9% 3.8%

2.4% 2.6%

4.2%

-0.7%

2.2%

1.0% 2.5%

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018*

Annual change in health benefit cost per employee – expected trend before plan changes

Actual trend – after plan changes

Overall inflation Workers' earnings

E M P L O Y E R S H O L D H E ALT H B E N E F I T C O S T G R O W T H

B E L O W 4 % F O R A F I F T H C O N S E C U T I V E Y E AR

Change in total health benefit cost per employee compared to CPI, workers’ earnings,

among all employers

* Projected

Source: Mercer’s National Survey of Employer-Sponsored Health Plans; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to

April) 1993-2017; Bureau of Labor Statistics, Seasonally Adjusted Weekly Earnings from the Current Employment Statistics Survey (April to April) 1993-2017.

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T O TA L A N N U A L H E A LT H C A R E C O S T P E R

C O V E R E D E M P L O Y E E

P E B B ’ S C O S T S A R E A B O V E B E N C H M A R K S

$17,976

$13,868 $12,880

$12,288 $11,697

$18,676

$13,132 $13,459 $12,615

$11,715

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

$20,000

PEBB Government 500+ Oregon 500+ National 500+ National 20,000+

*Total health benefit cost includes medical, dental, Rx, vision and hearing benefits

*Oregon PEBB includes Providence Statewide, Delta Dental of Oregon, and VSP

2016: Active Employees

2017: Active Employees

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G R O W T H I N C D H P E N R O L L M E N T S L O W S I N 2 0 1 7

Percentage of covered employees enrolled in each plan type, among large employers

1

1

1

1

<1

66%

68%

69%

65%

65%

64%

61%

56%

53%

52%

26%

23%

20%

21%

20%

18%

16%

16%

14%

14%

7%

8%

10%

13%

15%

18%

23%

28%

33%

34%

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Traditional indemnity plan PPO/POS* HMO CDHP

*Includes traditional indemnity plans beginning in 2013.

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12

H S A - E L I G I B L E C D H P S C O S T M U C H L E S S T H A N O T H E R

P L A N S , I N C L U D I N G P P O S W I T H H I G H D E D U C T I B L E S

AV E R A G E M E D I C A L P L A N C O S T P E R E M P L O Y E E , A M O N G

L A R G E E M P L O Y E R S

$12,611 $12,513

$10,019

$10,747

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

PPO HMO HSA-eligible CDHP PPO with deductible of$1,000 or more

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B E Y O N D C O N S U M E R I S M : E M P L O Y E R S R AT E T H E

S T R AT E G I E S C O N S I D E R E D C R I T I C AL F O R I M P R O V I N G

C O S T AN D Q U AL I T Y I N T H E F U T U R E

% employers rating as important / very important

5,000+

employees

10,000 or

more

employees

20,000 or

more

employees

Focused action to manage cost for specialty

pharmacy 82% 87% 83%

Monitoring and managing high-cost claimants 79% 79% 76%

Focused strategy for creating a culture of health 69% 70% 71%

“Point solutions”—high tech or high touch

support for physical/mental/financial health

issues

48% 49% 51%

ACO or other high-performance network

strategies 46% 50% 53%

Offering employees more plan or benefit options

with decision support tools 44% 46% 50%

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QUALITY AND VALUE

Attachment 3

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I N P U R S U I T O F T H E B E S T C AR E

• Expert medical

opinion

• High-cost claimant

management

• Specialty Rx

solutions

• Health Advocacy

COST

QUALITY

EXPERIENCE • Value based care

• Centers of

Excellence

• Narrow networks

COST

QUALITY

EXPERIENCE

• Care silos

• Limited quality

oversight

• No focus on patient

experience

COST

QUALITY

EXPERIENCE

C U R R E N T S TAT E

Attachment 3

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W H Y E X P E R T M E D I C AL O P I N I O N ?

Statistics based on Grand Rounds’ research

84% adherence

to treatment plan

2x increase in

health literacy

30-40% lower mortality

20-25% fewer

complications

Attachment 3

17

E X P E R T M E D I C AL O P I N I O N

A M O N G E M P L O Y E R S W I T H 5 , 0 0 0 O R M O R E E M P L O Y E E S

13%

23%

64%

Offer expert

medical opinion

services M O S T I M P O R T A N T

O B J E C T I V E S F O R

O F F E R I N G E M O s

Assist patients who have

complex conditions 92%

Steer patients to

high-quality providers 85%

Lower medical plan cost 84%

Expand access to care 68%

Considering

offering

Do not

offer

Results from supplemental survey of employers with 5,000 or more employees

Attachment 3

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H I G H - C O S T C L AI M S S U R V E I L L AN C E

N O T A L L H C C S U N AV O I D A B L E

C l i n i ca l assessmen t

C l i n i ca l r ounds

C la ims paymen t aud i t

F ocused c l i n i ca l aud i t

RESULT S MAY WARRANT ADDI T I O NAL SO LUT I O NS

MANAG E

C l i n i c a l S u rv e i l l anc e

Ea r l y Warn ing

Repo r t

La rge C la im P a id

Repo r t La rge C la im Paymen t P rocess

I mp rovemen t

MO NI TO R MI T I G AT E

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19

AN N U A L S P E C I ALT Y R X S P E N D N E AR LY

D O U B L E D I N J U S T 4 Y E AR S

G R O W T H F R O M $ 8 2 B T O $ 1 5 0 B F R O M 2 0 1 1 T O 2 0 1 5 ; 4 1 % O F T H E

W O R L D ’ S R X S P E N D I N U S B Y 2 0 2 0

$24.1 $28.1 $39.1

$13.1 $18.3

$30.2

$18.8

$7.8

$11.9

$17.7

$10.1

$12.2

$16.2

$24.8

$24.9

$28.9

$0.0

$20.0

$40.0

$60.0

$80.0

$100.0

$120.0

$140.0

$160.0

2011 2013 2015

Oncology Autoimmune Viral Hepatitis Multiple Sclerosis HIV Antivirals Other Specialty

Source: IMS Health

To

tal

$ S

pen

t in

Billi

on

s

Attachment 3

20

20%

17%

12%

61%

47%

13%

12%

31%

500+ employees

20,000+ employees

Offer lower cost-sharing if employees use the specialty pharmacy

Some/all specialty drugs excluded from retail pharmacy/medical benefit

M O R E T H AN H AL F O F E M P L O Y E R S AR E S T E E R I N G

E M P L O Y E E S T O S P E C I ALT Y P H AR M A C I E S

Encourage use of specialty pharmacies some other way

Do not attempt to steer members to any channel for specialty medications

Attachment 3

21

23%

62%

15%

28%

60%

12%

Offer throughspecialty vendor

outside the healthplan

Offer through healthplan only

Employees do nothave access to

transparency tools

5,000 or moreemployees

20,000 or moreemployees

M O S T E M P L O Y E R S C O N T I N U E T O O F F E R

C AR R I E R - B A S E D T O O L S F O R C O M PAR I N G

H E ALT H P R O V I D E R P R I C E AN D / O R Q U AL I T Y

Employers

with 5,000+

employees

Employers

with 20,000+

employees

Average

utilization rate of

transparency

tools

21% 30%

Offer incentives

to use 11% 13%

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES / NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS

Attachment 3

22

D I G I TAL N AV I G AT I O N & H E ALT H AD V O C A C Y

W H AT AR E T H E Y ?

Digital Navigation and Health Advocacy employer healthcare solutions emerged to support

employees by helping them navigate today’s complex health care market and engaging

them in their health care decisions :

APPROACH Technology first – “Do it yourself” Telephonic first – “Hold my hand”

MODALITY

Primarily mobile app or web portal that

directs User to employer-sponsored

programs/solutions

Primarily via telephone; supported by

web portal and/or mobile app

OBJECTIVES

• Aggregate health benefits

programs/services

• Recommend appropriate solutions

• Own/resolve User issues

• Guide Users / drive engagement into

right programs at right time

DIGITAL

NAVIGATION (DN)

HEALTH

ADVOCACY (HA)

Attachment 3

23

v

O B J E C T I V E S F O R I M P L E M E N T I N G A H E ALT H

AD V O C A C Y P R O G R AM , W H E N O F F E R E D

30% with 20,000+ employees offer a Health Advocacy program

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES

60% 64%

46% 43%

32% 36%

29% 35%

Assist memberswith claims

issues

Direct membersto services

Improvetraditional healthplan customer

service

Provide betterintegration with

third-partyprograms

Very important Important

57%

Majority of employers agree

that the health advocacy

program has met objectives

Attachment 3

24

10% 6%

12% 10% 8%

16%

Accountable CareOrganization

Patient-CenteredMedical Home

Another narrowprovider network

Employers with 5,000 or more employees Employers with 20,000 or more employees

M O S T H E ALT H P L AN S I N C L U D E VAL U E - B A S E D

P R O V I D E R N E T W O R K S , B U T R E L AT I V E LY F E W

E M P L O Y E R S O F F E R E M P L O Y E E S I N C E N T I V E S T O U S E

T H E M

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES / NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS

P E R C E N T O F

P L A N M E M B E R S

A T T R I B U T E D

T O A N A C O

Employers with 5,000+

employees 24%

Employers with 20,000+

employees 31%

Employers may want more performance data before offering

incentives. While 18% of respondents* report some cost

savings achieved with the ACO, most (70%) say they can’t

measure.

Attachment 3

25

4% 12% 4%

85%

9% 18%

9%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Lower premium contributionin the medical home

Lower cost-sharing at pointof service (deductible,coinsurance, copays)

Other We don't actively encouragemembers to seek care from

the PCMH

Employers with 5,000+ employees Employers with 20,000+ employees

M E T H O D S U S E D T O E N C O U R AG E E M P L O Y E E S T O

S E L E C T T H E P C M H

Among employers that offer a PCMH

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES

Attachment 3

26

CONSIDERING

FOR 2016 OR 2016

35%

28%

16% 16%

2%

12%

51%

45%

35%

20% 20%

5%

15%

40%

Cost targets Qualitytargets

Utilizationtargets

Patientsatisfaction

targets

Other N/A - Noperformance

payments

Don't know

Employers with 5,000+ employees

Employers with 20,000+ employees

M AN Y E M P L O Y E R S U N AWA R E O F TAR G E T S U S E D

F O R D E T E R M I N I N G P E R F O R M AN C E PAY M E N T S

Among employers that offer ACOs

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES

Attachment 3

27

63% 59% 58% 57%

46%

0%

10%

20%

30%

40%

50%

60%

70%

Surgical (other thantransplants)

Orthopedics Cardiology Oncology Women'sHealth

(Infertility/pregnancy)

E M P L O Y E R S H AV E E M B R AC E D C E N T E R S O F

E X C E L L E N C E F O R A R AN G E O F T R E AT M E N T S

E M P L O Y E R S W I T H 2 0 , 0 0 0 O R M O R E E M P L O Y E E S

HOW EMPLOYERS STEER EMPLOYEES TO A COE: PAID TRAVEL. LOWER COST-

SHARING. CASH BONUS. 32% MAKE IT MANDATORY FOR COVERAGE.

Attachment 3

28

MEDICAL PLAN

MANAGEMENT

Attachment 3

29

M AN A G I N G O O N S P E N D : E M P L O Y E R S AR E B E G I N N I N G

T O C O N S I D E R C H AN G E S T O R E I M B U R S E M E N T O R

E L I M I N AT I N G C O V E R AG E F O R C E R TAI N P R O V I D E R S

15%

7% 4%

19% 26%

9%

Changingreimbursementmethodology

Excluding certaintypes of providers /

facilities

Eliminating OONcoverage (except

emergencies /network

deficiencies)

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES

20%

7% 4%

20%

42%

9%

Changingreimbursementmethodology

Excluding certaintypes of providers /

facilities

Eliminating OONcoverage (except

emergencies /network

deficiencies)

Have taken this step

Considering

Employers with 5,000+ employees Employers with 20,000+ employees

Attachment 3

30

R E F E R E N C E - B AS E D P R I C I N G

8% 7%

5%

13%

15% 16%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

5,000 or more employees 10,000 or more employees 20,000 or more employees

Currently use Considering using

Attachment 3

31

SPECIAL COVERAGES

AND SERVICES

Attachment 3

32

11%

28%

43%

47%

58%

55%

66%

11%

23%

23%

42%

43%

54%

59%

All large employers

20,000 or moreemployees

Modified physical work environment to promote physical activity

Healthy food choices in cafeteria, company meetings or events

No smoking anywhere on work campus

Offer onsite fitness facility

S T E P S TAK E N T O B U I L D A “ C U LT U R E O F H E ALT H ”

Large employers

Have policies to promote healthy work/life balance

Company vision/mission statement supports a healthy workplace culture

None of the above

Attachment 3

33

E M P L O Y E E S H AV E AC C E S S T O S U P P O R T F O R

B E H AV I O R A L H E ALT H

5,000 or more

employees

10,000 or more

employees

20,000 or more

employees

Stress management 77% 77% 80%

Resiliency 38% 37% 35%

Mindfulness 40% 38% 38%

Tele-therapy 40% 43% 50%

Texting/online coaching with mental health

experts 29% 24% 24%

Family support services for children with

disabilities 36% 33% 34%

No programs offered 16% 14% 12%

Attachment 3

34

C O V E R G E N D E R R E AS S I G N M E N T S U R G E RY, B Y

E M P L O Y E R S I Z E

31%

44%

52%

62%

4% 7% 7% 7%

0%

10%

20%

30%

40%

50%

60%

70%

500-4,999 employees 5,000-9,999 10,000-19,999 20,000 or more

Currently cover

Considering covering

MERCER NATIONAL SURVEY OF EMPLOYER-SPONSORED HEALTH PLANS

Attachment 3

35

S E R V I C E S C O V E R E D I N AD D I T I O N T O G E N D E R

R E AS S I G N M E N T S U R G E RY

Among employers that cover gender reassignment surgery

18%

20%

51%

64%

82%

19%

19%

47%

67%

80%

Employers with 5,000+ employees

Employers with 20,000+ employees

Non-surgical gender reassignment treatment (hormone therapy)

Behavioral health services / counseling

Puberty suppression

None of the above, reassignment surgery only

Reconstructive procedures

MERCER NATIONAL SURVEY SUPPLEMENT FOR EMPLOYERS WITH 5,000 OR MORE EMPLOYEES

Attachment 3

36

Attachment 3