- Posted by Chris Elvidge
- On January 16, 2017
On January 20, 2017, president-elect Trump will officially assume the position of President of the United States. The POTUS has many questions that need to be immediately addressed once he assumes office about how health care, more specifically the fate of the Affordable Care Act. Every press conference and sound bite indicates repeal but how and when exactly is anyone’s guess.
Regardless of what happens in Congress, or what President Trump or House Speaker Paul Ryan proposes, there will be constants in the health care industry. Our employer-based health care system appears to still be well intact and not going away. There are four health care trends that don’t appear to be changing any time soon. With the right strategies, we can all stay ahead of the curve in trying to manage costs and quality in these turbulent times no matter what occurs in Washington, D.C. over the next four years.
- High deductible health plans and cost sharing are here to stay. If anything, the new leadership’s plans focus even greater on the development and investment into HSA’s (Health Savings Accounts). Most employers have already been getting employees used to cost sharing and HDHP’s, and this trend is expected to continue and even accelerate. However, it is important to provide employees access to information and cost of procedures in order to make the most informed and cost effective medical decisions. We want them to spend their money (and yours) wisely and go to high quality providers to get the care they need (and not care they don’t need). To accomplish this, employers must continue to turn to strategies like partnerships with organizations that offer consumer education and navigation.
- Transparency will be huge (no pun intended). It has been a cornerstone of Trump’s health care policy platform from the beginning. And yet, we know from studies that very few employees who are offered price transparency tools actually use them. That is because price information alone is too complex and confusing. Clients need to pair transparency tools with other tools or coaches who serve as a medical ally and help with consumer navigation.
- A small percent of employees will always account for most of your spending. This mathematical fact isn’t going away, no matter who is in the Oval Office. So employers need a strategy to address the fact that 1.2% of employees typically account for over 30% of employer health care spending (Source: American Health Policy Institute). The strategy here is pairing with a carrier or Third Party Administrator that has case management intervention with your employees that have high cost conditions. This would include programs like surgical decision support, second opinion services, and shared-decision making that can help ensure these employees choose better providers, and high-quality treatment options that are appropriate. Otherwise you may end up spending a fortune on a surgery for an employee who really only needs physical therapy. Decision support tools create dynamic variation in cost and quality. And when you are certain that employees need that surgery, a strategy like reference based pricing can help ensure they see a high quality, yet affordable, provider.
- Managing the cost and quality of care. This concept was missed and never addressed in the formation of the Affordable Care Act. The balance of quality of care and value must take a heavier weight in this health care discussion. Part of the ACA may be repealed, but Republicans and Democrats alike agree on “MACRA,” which changes the way Medicare pays doctors by tying reimbursement to quality. What this means is that the commercial insurance sector will continue to follow suit, and we will continue to hear about “paying for value, not volume in health care.” Many carriers have added quality subset networks to incentivize patients to seek more affordable, higher quality providers. Employers can piggy back on this concept by encouraging employees to have access to these ‘Centers of Excellence’ where the quality of care is better and providers are paid based on value.
It certainly is a time of great change, but as the old saying goes, the more things change, the more they stay the same. Health care costs will continue to rise, and quality will continue to vary from provider to provider. As always, our challenge is to get employees more engaged in the process to steer them toward the care that is highest quality and most efficient. We want them to be consumers, but they can’t do that on their own. They need the right benefit design, but also the right support and related programs and to help them understand and get there.