Employers Are Becoming More Active in Healthcare Claims Management

“Employers are cutting out insurers completely and contracting directly with providers and/or creating near-site or on-site health clinics for primary care……………….More traditional cost management techniques are simply running out of gas. Employees, who have borne half of recent-year cost increases, simply can’t afford anymore,”

Employers Are Becoming More Active in Healthcare Claims Management

by Craig Hasday on November 1, 2018 Leave a Comment

When Amazon, JPMorgan and Berkshire Hathaway announced their healthcare partnership, it was a part of a wave of employers taking a more active role in medical cost management. No longer content to leave claims management to the health insurance companies, last week, Morgan Stanley announced that they have hired a high-level executive responsible for healthcare management and data analytics. And many employers are cutting out insurers completely and contracting directly with providers and/or creating near-site or on-site health clinics for primary care.

More traditional cost management techniques are simply running out of gas. Employees, who have borne half of recent-year cost increases, simply can’t afford anymore – and with the tightening of the job market, benefit plan design and costs have once again become a talent acquisition and retention pivot point. The trend of shifting to high-deductible plans has slowed and many employers are considering plan improvements instead of takeaways.

So, employers are not going to be passive in trying to control this expanding expense. As a benefit advisor, one of the challenges has been helping employers navigate the flood of add-on products and services which attach to traditional health insurance. As data analytics become more available and more sophisticated, it is easier to drill down into cost drivers and focus on what matters.

Here are a couple of suggestions for middle-market employers – and they are all about engagement:

  1. Look to telemedicine to reduce the cost of emergency care and improve mental health. It has been estimated that by 2023, emergency room visits will be reduced by 20 million because of new artificial-intelligence-driven techniques to manage chronically ill patients. And although the stigma surrounding mental health is lessening, accessing quality, affordable mental health care is an issue which can be impacted with telemedicine. But telemedicine only works with engagement. Employers should embrace this care setting and do a better job educating employees on how to access care. But delaying enrollment until care is actually needed is a recipe for failure and that’s why telemedicine utilization rates rival those of Employee Assistance Programs (EAPs).
  2. Make the most out of wellness with condition management. General wellness programs are great for employee morale, but limited wellness resources should be directed towards conditions that can be impacted, such as metabolic syndrome.
  3. Cost transparency tools are getting better. It’s getting very easy for employees to shop for lower-cost drugs or lab/X-ray procedures. With your advisor, identify the best tool for your population and align incentives for employees to use these tools.

Employers have been reluctant to invest in employee engagement programs; that reluctance is lessening.

 

Comments are closed.