employer strategies to improve health and healthcare value · arthur j. gallagher & co. |...
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Employer Strategies to Improve Health and Healthcare ValueSUMMARY OF KEY FINDINGS© October 2015
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Thank You!
You are receiving this summary because you participated in our survey on Employer Strategies to Improve Health and Healthcare Value. Employers are believed to be a key stakeholder and influencer on population health and the healthcare market. Your input helps us capture the employer mindset and your priorities, and understand the initiatives you’re pursuing to improve the health of your employees and your surrounding communities.
We hope you find this report valuable. Don’t hesitate to contact us with your questions and comments.
Thank You, The Benfield-Gallagher Team
2015 Benfield, a division of Gallagher Benefit Services, Inc. All Rights Reserved.
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Contents
› Research Objectives› Research Participants› Key Research Topics
o Approaches to Managing Employee Healtho Employer Perspectives and Strategies: Healthcare Value (HCV)o Employer Perspectives and Strategies: Community Health (CH)
› Research Conclusions
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Research Objectives
› Assess the status and trends related to employers’ health management strategies› Understand employer awareness of/participation in national and regional/local
initiatives focused on improving health and healthcare value› Gauge employer interest in:
o Learning more about initiatives, strategies, tactics and tools to help drive market-level healthcare value improvement
o Becoming trained to drive collaborative action at the market levelo Identifying peers who are interested and involved in market-level healthcare value
improvement initiatives
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Employer Research Panel205 COMPLETED SURVEYS 11 INTERVIEWS
Jumbo Employers
(5,000+ Employees)
Mid-size Employers
(500 - 4,999)
Employer Participant SizeNumber of U.S. Employees
60%
40%
3%4%5%
8%10%10%10%11%
13%26%
Technology
Mining/Construction/Wholesale
State/Local Government
Education
Transportation/Communications/Utility
Retail
Finance
Healthcare
Service
Manufacturing
Industries Represented
20%
34%27%
7%7%
4%
Organizational Role of Respondents
VP/SVP HR/Benefits
HR/Benefits Director
HR/BenefitsManagerHR/BenefitsAnalysts/SpecialistCorporate MedicalDirectorOther
n=205 Employers
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APPROACHES TO MANAGING EMPLOYEE HEALTH
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Health Plan Funding
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91%
9%
Approach to Funding for Active Employee Health Plans
Self-insureFully-insure
n=205
Most (91%) employer respondents self-insure their health plans
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Health Management Philosophy
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7% 15%
78%
Provide financial protection forunforeseen costs, catastrophic
illness or accidents
Provide benefits for preventionand support employees trying to
manage health conditions
Proactively manage benefitsand programs to improve
employee health and productivity
Philosophy for Managing Employee Health
A majority of employers hold a core philosophy of proactively managing employee benefits, with the goal of improving health and productivity
n=205
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National vs. Regional Health Management Strategies
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n=205
42%
29% 29%
We focus exclusively on strategies thatcan be implemented for all our
employees nationally
We prefer national solutions but willpursue regional/local strategies when
needed
We focus substantially on identifying andpursuing regional/local strategies
Employer's Preference for National vs. Regional/Local Management Strategies
Most employers prefer national strategies, but a majority are engaged in regional/local strategies either occasionally or primarily
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3%
2%
4%
3%
7%
7%
8%
8%
9%
15%
1%
4%
2%
1%
1%4%
3%
3%
4%
4%
5%
7%
7%
8%
8%
9%
19%
Active participant Active leadership
Employer Involvement on the National Stage
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NBGH - National Business Group on Health (n=157)
WELCOA - The Wellness Council of America (n=153)
NBCH - National Business Coalition on Health (n=123)
HERO - Health Enhancement Research Organization (n=65)
Leapfrog Group (n=137)
Catalyst for Payment Reform (n=35)
Choosing Wisely (n=46)
IOM - Institute of Medicine (n=88)
HC13 - Health Care Incentives Improvement Institute (n=63)
Healthcare Transformation Task Force (n=24)
Consumer Purchaser Alliance (n=25)
Employer’s Level of Involvement with Organizations/Initiatives
Employers have limited involvement in national health organizations and initiatives
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Adoption of Innovative Approaches
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n=20523%
47%
31%
We wait until innovations have beenpopularized and proven before
adopting them
We typically don't want to be the firstmover, but we monitor innovative
approaches and are relatively quick toadopt those that make sense for us
We consider ourselves innovators with ahistory of inventing newer and better
solutions to health, healthcare cost andquality challenges
Employer’s Approach to Innovations in Managing Employee Health and Healthcare Value
About a third of employers view themselves to be innovators, while nearly half consider themselves fast followers in adopting innovative health management approaches
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EMPLOYER PERSPECTIVES AND STRATEGIES: HEALTHCARE VALUE (HCV)
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Improving Value in Health Management
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55%
57%
77%
84%
85%Improve health and well-being (n=200)
Increase informed/wise use of healthcare services by employees (n=199)
Provide better care management for employees with the highest health needs/costs (n=177)
Drive employees toward CDHP plan options (n=134)
Increase utilization of Centers of Excellence for complex and costly treatments and procedures (n=151)
Most Critical Objectives for Improving Value in Health Management Strategy (percentage selecting as one of top five among objectives currently in place or planned)
Some HCV-related initiatives are among the most critical to employers in terms of improving value, while others are lower priority
Few employers rank use of narrow networks, patient-centered medical homes or ACOs as a top-5 most critical objective for improving value.
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Performance-Based Payment Models
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35%
47%
52%
54%
55%
Healthcare Provider Contracts with Shared Savings or Pay-for-Performance Provisions (have or will have provisions for payment adjustments by 2018)
Accountable Care Organizations (n=73)
Narrow networks based on differentiated quality/value (n=93)
Centers of Excellence for complex and costly treatments and procedures (n=96)
Care management services for employees with multiple complex chronic conditions (n=120)
Provision of healthcare services at worksite clinics (n=79)
Current/planned shared savings or pay-for-performance payment models are most common in arrangements with ACOs, narrow networks and COEs
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Driving Use of New Payment Models
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n=25
40%
48%
12%
We are responding to newpayment models being made
available by our carrier(s)
We are encouraging ourcarriers to develop andimplement new models
We are demanding our carriersoffer new payment models as acondition of our doing business
with them
Employers’ Actions Regarding New Payment Models (among employers currently “driving transition away from fee-for-
service models”)
A majority of the employers focused on new payment models are playing an active role in driving them; About 60% are either encouraging or demanding their carriers/TPAs to develop and implement new payment models
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Employer Engagement with Healthcare Providers
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n=205
40%
18%21% 20%
We have not engagedin such discussions.
We have haddiscussions aboutchallenges only.
We have hadsubstantive
discussions aboutchallenges and
solutions.
We are currentlyworking with healthcareproviders on solutions.
Engagement in Discussions with Healthcare Providers About Local Healthcare Cost and Quality Issues
A majority of employers are engaging directly with healthcare providers; about 40% have had substantive discussions about solutions, and half of those are currently working with providers on solutions
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Employer Contracting with Healthcare Providers
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9%
12%
25%
31%
36%
26%
33%
22%
7%
23%
Currently in place (2015) Expected to contract (by 2018)
Services for Which Employer Contracts with Healthcare Provider (directly or through an alternative intermediary—not through their carrier/TPA)
n=205
Care management services for employees with multiple complex chronic conditions
Provision of healthcare services at worksite clinics
Centers of Excellence for complex and costly treatments and procedures
Narrow networks based on differentiated quality/value
Accountable Care Organizations
Employers increasingly expect to contract with providers for selected services: care management services is the most common choice currently, but many expect significant expansion of contracting for narrow networks and ACOs by 2018
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Employer Involvement in Local HCV Initiatives
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17%
18%
24%
28%
29%
33%Promote healthcare literacy and smart healthcare consumerism in the region
Develop consistent and transparent reporting of COST measures from healthcare providers
Develop consistent and transparent reporting of QUALITY measures from healthcare providers
Drive adoption of payment approaches that pay for value rather than volume
Assure healthcare information can be shared among providers in the region
Drive broad adoption of electronic healthcare information technology
Involvement in Initiatives in Any Key Workforce Location: Active Participant or Leader
n=205
At best, only 1/3 of employers are active participants or leaders (in at least one location) for any one type of HCV initiative
Not shown: Don’t know, No engagement, Supportive responses
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EMPLOYER PERSPECTIVES AND STRATEGIES: COMMUNITY HEALTH (CH)
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Employer Approach to Engaging in CH Initiatives
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n=190
57%
22%17% 4%
Participation in communityhealth and well-beinginitiatives is left to the
discretion of leadershipin each major location,
no explicit concerns
We actively select andengage in communityhealth and well-being
improvement initiatives incommunities where we
believe there is a concern
There is an expectation forbusiness leaders in major
locations that theirorganization will participate
in community health andwell-being initiatives
Other*
Employer's Approach Toward Involvement in Community Health and Well-Being Improvement Initiatives
(among those supportive/active in at least one health issue)
*Other includes: Actively involved in local community in partnership with the Department of Health, both local/county and state level, Involvement is left up to the employees, None, We do not promote leadership involvement in community health and well being initiatives, We have dedicated units for community programs
Nearly 60% of employers leave the decision to engage in CH up to local management, while about 40% either actively select initiatives or set expectations for participation
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Importance of CH to Employers
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n=205
17%
37%
46%
Not important Moderately important Important
Importance of Health and Well-Being of the Overall Population Relative to Employer's Goals and Interests
Most employers (over 80%) believe community health is at least moderately important relative to the health of their employee population
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Employer Involvement in CH Initiatives
3%
1%
5%
9%
9%
11%
14%
16%
15%
17%
2%
4%
6%
5%
6%
8%
9%
14%
17%
20%
Other*
Teen pregnancy
Homelessness
Hunger
Health disparities
Disabilities
Behavioral health
Cancer
Obesity
Chronic illness
Recreation and fitness
Active participant Active leadership
n=205
Employer Involvement in Community Health Initiatives
*Other includes: Employee wellness, National Obesity Initiative, healthy campus initiative, student wellnessNot shown: Don’t know, No engagement, Supportive responses
A moderate share of employers (19% to 37%) are active participants or leaders for the most popular types of initiatives
1%
22
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26%
31%
46%
74%
Reasons Employers are Interested in Investing in Efforts to Improve Community Health and Well-being
(among those supportive/active in at least one health issue)
Employer Reasons for Engaging in CH
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n=190
We want the culture in which our employees live to be a healthy one
We consider it part of our corporate social responsibility
A healthier community is more competitive economically
We want to improve the health of our local labor pool
Active employers engage in CH initiatives to promote a healthy environment for their employees. Corporate social responsibility is another important driver of participation, and some interviewees also identified the positive impact on corporate branding that attracts desirable employees
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Barriers to Employer Engagement
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n=205
13%
16%
17%
32%
39%
60%
67%
Challenges to Participating in National or Market-Level Initiatives(employers were asked to select up to 3 factors)
We do not have organizational capacity or resources to engage in market-level healthcare initiatives
We do not have organizational capacity or resources to engage in national healthcare initiatives
We are not a large enough purchaser to impact the market(s) where we operate
It is too difficult to achieve meaningful progress when multiple stakeholders are involved
We find it difficult to identify initiatives that we want to support
We do not have enough expertise in healthcare to contribute effectively
We don't think benefits from such initiatives are worth the effort
Most employers believe that the main barrier to engagement in HCV and CH is organizational capacity or resources—not a lack of expertise or importance. Many employers (especially mid-size) also believe that they are not large enough to exert market influence
24
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RESEARCH CONCLUSIONS
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Research Conclusions
› There is a reasonably strong foundation of employer interest and engagement in HCV and CH
› More than 2 out of 5 employers are already active in either HCV initiatives (44%) or CH initiatives (41%)—and most of these are active in both kinds of initiatives
› Most employers have a preference for national initiatives, but many are willing to engage in regional/local markets where they have a substantial presence
› Most employers believe that it is moderately-to-very important for employers to engage in HCV initiatives and CH initiatives
› Employers are increasingly adopting health management approaches that align with HCV, including value-based purchasing strategies and direct engagement with healthcare providers
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Research Conclusions (cont.)
› Employers tend to engage in regional/local CH initiatives that address health conditions impacting their employee populations
› Most employers are not aware of national employer health initiatives beyond a few large membership organizations, and active participation is limited to a small share of employers
› Employers face barriers to market-level engagement—chiefly the perception that they lack the organizational capacity/resources—but employers with strong, “disruptive” leaders have overcome these barriers
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Thank You!
We value your insights and hope that you will continue to support our research efforts! Again, do not hesitate to contact us with your questions and comments.
Contact us:Jack NightingaleVice President(703) [email protected]
Sarah DaleyResearch Director(314) 968-0011 x [email protected]
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