What’s Really Going on in Healthcare…

Healthcare Trends Employers Must Know for 2016-17

October 5, 2016

Presented by:

Dominic Franchini, Vice President HORAN

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Setting the Table

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The national average annual premiums for employer-sponsored health insurance is $9,727 and $10,641 per employee in the state of Ohio.

$7,859

$6,350

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

Employer Share

$2,782

$3,378

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

Employee Share

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Data analytics encourages action and leverages predictive models to guide future improvements in benefits strategy.

Plan sponsors have data and metrics to evaluate the performance of their health plan and lower costs by reducing the plan waste and inefficiencies.

Best practice utilization of financial reporting includes strategic focus on cost drivers and targeted disease management programs.

Health Care Trend

For 2016-17

1 Data Analytics

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Emphasis is shifting from fee-for-service to outcome based reimbursement.

Data creates transparency of strengths and weaknesses of various providers.

Consumers have more control than ever in where they get care.

Consumers are being incentivized to seek care at quality providers through narrow networks or lower cost alternatives.

Health Care Trend

For 2016-17

2 Quantity vs. Quality

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Large insurance mergers:

Spike in alternative delivery models:

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Health Care Trend

For 2016-17

3 Industry Consolidation & Alternative Delivery Models

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Population health is a recurring theme for employers and is often improved by implementing a wellness initiative to promote healthy lifestyle, achieve savings and increase productivity.

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Health Care Trend

For 2016-17

4 Population Health Workplace Wellness

Employer provided care • Flu shots • Mammogram/diabetic testing • Nurse on-site • On-site/near-site clinics

Growth in incentives/penalties • Biometrics • Smoking • Primary Care

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Health Care Trend

For 2016-17

5 Technology

Transparency on providers and cost • Engages employees with highly personalized information on cost, quality,

medical conditions and treatments to help employees make the best possible health care decisions.

Telemedicine

• Enables employees to contact a doctor via telephone who can diagnose, treat and write prescriptions over the phone.

Employee Engagement / Cafeteria Plans

• Improve the success of population health management programs and wellness initiatives through innovative engagement and incentive tactics.

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Health Care Trend

For 2016-17

6 Health Care and Pharmacy Cost

2016-17 Medical and Pharmacy Trend Price inflation is the overwhelming driver of cost increases. Hospital services and brand-name medications are leading drivers of plan cost trend increases.

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Prescription Drug Plan Strategies: Implement Specialty Pharmacy network Expand prior authorization Intensify pharmacy management program Expand step therapy Demand competitive PBM proposals with performance-based results and transparency.

Source: Segal Consulting, 2016 Segal Health Plan Cost Trend Survey https://www.segalco.com/media/2139/me-trend-survey-2016.pdf