This little-known legal risk could force big changes to our dysfunctional health-care system
Lawyers are preparing lawsuits over waste and fraud in health care — invoking Erisa, a law better known for retirement benefits
By Dave Chase and Sean Schantzen
These legal threats could force employers to actively manage health spending the same way they manage other large operational expenses. We’ve already seen companies doing this, reducing their health-benefits spending by 20%-55% with superior benefits packages.
They use a variety of approaches, but most are relatively straightforward and focus on proven benefits-design solutions that make poor care decisions more costly and better care decisions less costly to encourage the right behavior. Most importantly, they don’t focus on shifting costs to employees.
Three high-potential areas involve primary care: actively managing high-cost care to move it to high-quality, low-cost care settings; directly addressing drug costs; and incentivizing wise care decisions.