Spotting Value in Your Benefits Program

NBCH recently participated in the Mediaplanet’s latest “Employee Well-Being” campaign that features industry influencers, organizations and advocates to highlight the importance for employers to prioritize the overall well-being of their employees through the improvement of health care and benefits programs. 

The campaign was distributed in an edition of USA TODAY, and will be available at our upcoming annual conference (Nov. 16-18, Fairmont Dallas).

Chuck Smithers contributed a piece on value-based benefit design : http://bit.ly/1Ow3tkN. And here's a link to all of the other workplace health and wellness articles: http://www.futureofbusinessandtech.com/workplace-wellness.

Employer Considerations In Trends Toward Self-Insurance

A story in USA Today examines the newly emerging trend toward smaller businesses becoming self-insured. Businesses that have made - or are thinking about making - this move say that the decision is about free choice, cost savings, and doing what is right for their employees; others see it as a threat to the Affordable Care Act. As more small employers avoid the act's requirements through self-coverage, small-business marketplaces intended to cover millions of Americans could break down and become unaffordable.

ACA advocates especially worry that firms with fewer than 50 employees will self-insure. Those companies are not required to offer policies under the health law, but many are expected to buy in online marketplaces, SHOPs, scheduled to open in October.  However, self-insurance might be the only way some struggling employers can afford medical coverage.  The article describes these issues and offers considerations for employers when making this decision.

Diabetes Costs Nation $245 Billion Annually

The growing toll of diabetes cost the nation a record high $245 billion in 2012, a 41% increase from $174 billion in 2007, says USA Today. The study Economic Costs of Diabetes in the U.S. in 2012, commissioned by the American Diabetes Association, estimated the health care and work-related costs of diagnosed diabetes. The full study will be published in the April issue of Diabetes Care.

The study estimated that 22.3 million people in the USA were diagnosed with diabetes in 2012. An earlier study by the association estimated that nearly 17.5 million people in the USA were diagnosed with type 1 or type 2 diabetes in 2007. The study found that direct medical costs totaled $176 billion, reflecting hospital and emergency care, office visits and medications. Indirect costs added up to $69 billion, which includes absenteeism, reduced or lost productivity, and unemployment caused by diabetes-related disability.

Will Increased Health Care Price Transparency Actually Improve Care?

A pair of USA Today editorials describe competing arguments on the topic of price transparency. The USA Today Editorial Board argues that providing consumers with price information and encouraging them to use the data by comparison shopping among providers will bring down overall health care system costs. If consumers shop for the best value in health care, the very large variations seen in health care costs will be brought into greater alignment.

An opposing view by Paul Ginsburg, Ph.D., the president of the non-partisan Center for Studying Health System Change, argues that using price transparency to turn consumers into more active purchasers sounds like a good idea, but won't actually bring down overall system costs. Consumers, especially those with employer-sponsored insurance, have no real reason to comparison shop. Modest deductibles and co-payments mean that what the consumer pays does not vary by the provider used. Co-insurance, where patients pay a percentage of the cost, encourages limited price consciousness and only until out-of-pocket maximums are reached.

Because the availability of price information is still very limited, more research is needed to develop relevant measures of value that consumers can use, along with more research on behavioral economics to better understand how to best ensure consumers have a reason to use such information.

USA Today: Costs of many preventive medical exams vary as much as 700%

Check out Kelly Kennedy's story in last week's USA Today illustrating how challenging it is for employers to use average prices given their variability.

Employee incentives drive lower-cost health care

Employers say they hope the efforts, often called "reference pricing," will get patients to act more like consumers — and drive down the cost of some procedures.

"This sends a signal to (medical) providers about what is considered a reasonable and acceptable price," says David Lansky, who is closely watching the California efforts by Safeway and Calpers from his post as CEO of the Pacific Business Group on Health, a San Francisco-based coalition of employers. Read the full article...

FINDING HELP ON PRICING, QUALITY
Consumers looking for cost or quality information on medical care are often stymied. A few insurers provide specific costs for procedures, while others give ranges. There are also a few national websites. Cost data vary from what is actually paid to estimates based on "charges," or the list price before insurers negotiate discounts. Here are some resources:

COSTS
Fair Health, fairhealthconsumer.org
Estimates out-of-network costs for some medical and dental procedures that can be customized by ZIP code.

Healthcare Blue Book,healthcarebluebook.com
Also customizable by ZIP code, the site estimates payments that providers will accept from insurance companies.

QUALITY MEASURES
Hospital Compare,hospitalcompare.hhs.gov
Medicare's Hospital Compare includes a variety of measures to compare specific hospitals.

The Leapfrog Group, leapfroggroup.org
Assesses hospital performance on some selected quality measures.