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Managing Healthcare Benefits Cost Remains Top Priority for HR Professionals

"[W]hile two-thirds of respondents say one of their 2018 goals is to better manage health benefits costs, 49% do not plan to implement any new cost management programs in the next 12 to 18 months. What's more, 54% believe they have done all they can reasonably do to control rising medical costs."

'Prevailing Healthcare Charges System' Rate Schedule Challenged In New Managed Care Litigation

Healthcare Reform Continues to Roil U.S. Managed Markets as the Number of ACOs Nearly Doubles and State Exchanges Create Clear Winners and Losers

"Even though large businesses cannot put their employees into the state exchanges until 2017, millions of small-business employees could go into the exchanges between 2015 and 2017. Meanwhile, several million more individuals who had been uninsured will gain benefits. ACOs fundamentally shift the risk of patient health and costs to providers. They also represent a potential consolidation of power among a more select group of decision-makers -- something that is likely to have a tremendous impact on prescribing habits and medication therapy management."

Predictions for 2026 on Accountability, Transparency and Equity in U.S. Healthcare

"[1] Employers will be held accountable for healthcare costs, driven by transparency, fiduciary pressure, and legislative efforts ... [2] Patients will demand transparency and value, expecting personalized, data-rich experiences with clear prices and quality indicators, influencing healthcare choices. [3] The next phase of the Mental Health Parity Act aims to improve access to mental health services by addressing disparities and including out-of-network services. [4] Doulas will be recognized as essential maternity care providers, leading to organized teams, improved birth outcomes, and increased legitimacy in the healthcare system."

How Employers Are Trying to Tame Healthcare Costs

"Just over half (52%) of the survey respondents indicated that they are considering changing their pharmacy benefit manager. Almost two-thirds (65%) respondents indicated that they are using nontraditional pharmacy procurement to counter high-cost claims.... 38% of the respondents strongly agree that high healthcare costs will result in cost shifting to employees. 55% indicated that PBM conflicts of interest are a 'significant threat' to healthcare affordability for employers."

The State of Employer-Sponsored Healthcare

"[K]ey areas of employer frustration: ... [1] Consolidated medical and pharmacy benefit manager vendor markets means less competition, resulting in higher prices for employers.... [2] Providers are incented to perform more services rather than improving the quality of care ... [3] Most large employers self-insure their health benefits programs, thereby bearing all of the cost escalation risk.... [4] The current prescription drug supply chain model lacks transparency ... [5] Employers perceive that market players (i.e., doctors, hospitals, pharmaceutical companies, insurers, and even brokers) are mostly vested in the status quo, making change slow and difficult."

Employers Concerned About Cost of Waste and Inappropriate Healthcare

"Employers perceive healthcare waste to be a problem, with majority (57%) indicating up to 25% of treatments their employees and dependents receive are wasteful. Most employers don't collect or analyze data to track waste (59%), and those that do rely on their vendors (34%).... Most employers don't report significant success in managing healthcare waste, their efforts have generally only been somewhat effective (e.g. 25% effective for medical imaging, 12% physician referrals)."

U.S. Employers Target Healthcare Costs, Mental Healthcare in 2024

"[M]ore than two-thirds of U.S. employers (69%) are focused on managing healthcare plan costs. This follows a projected cost increase next year of 6.4%, compared with the average 6.0% increase employers are experiencing this year. Almost as many employers (63%) are focused on enhancing mental health and emotional wellbeing programs. Other priorities include employee experience (40%); communication (38%); diversity, equity and inclusion (37%); and employee affordability (34%)."

Employers Reduce Retiree Healthcare Costs by 40% with Medicare Individual Market

"Employers can reduce their healthcare subsidy by an average of 39% while still benefiting retirees.... Most retirees experience cost savings, with a considerable percentage seeing annual savings of $2400 or more.... Employers face less administrative burden in managing healthcare plans in the Medicare Individual Market."

The Value Proposition in Healthcare (PDF)

2 pages. Excerpt: To engage our readers in lively discussion, The American Journal of Managed Care is inaugurating a series of editorials on value in healthcare. This month, Richard T. Clark, CEO of Merck & Co., provides his perspective. We invite you to share your thoughts with us about how value affects your industry, practice, and everyday lives.