HELPING YOUR MEMBERS OPTIMIZE THEIR HIGH-DEDUCTIBLE HEALTH PLANS

Transcription

1 BENEFIT DESIGN CONSIDERATIONS HELPING YOUR MEMBERS OPTIMIZE THEIR HIGH-DEDUCTIBLE HEALTH PLANS FOR EMPLOYER HEALTH CARE BENEFITS SPECIALISTS ONLY

2 SHIFTING HEALTH CARE COSTS Health care cost shifting and health literacy challenges may have unintended consequences for both your company and members. 1 Members may be struggling with costs and comprehension Annual deductibles for individual coverage have risen nearly 6 times as fast as wages in just 5 years, between 2011 and * Part of the challenge may stem from members misunderstanding how HDHPs work. Additionally, the average deductible for HSA-qualified HDHPs was 3 : $2295 for individuals $4364 for families Only 7% of individuals could correctly define 4 common insurance terms 5 : Health care premium Health plan deductible Out-of-pocket maximum Coinsurance??? But according to a database of 4 million HSA holders, the mean contribution was only: $833 4 HDHP, high-deductible health plan. *Average general annual deductible is among all covered workers. Workers in a plan without a general annual deductible for in-network services are assigned a value of zero. Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, (April to April). Based on data (dating from 2015) from the Employee Benefit Research Institute. Based on data (dating from 2016) from a UnitedHealthcare Consumer Sentiment Survey of 1011 US adults. MEMBERS IN HDHPs MAY AVOID OR DELAY FILLING PRESCRIPTIONS, VISITING DOCTORS, OR UTILIZING OTHER NECESSARY HEALTH CARE SERVICES. THOSE SUFFERING FROM COMPLEX CHRONIC CONDITIONS MAY BE ESPECIALLY AT RISK. 2

3 SHIFTING HEALTH CARE COSTS Employers are also affected 70 % In a 2015 poll, 70% of emergency physicians reported having seen insured patients who had delayed seeking medical care because of high deductibles and other outof-pocket expenses. 6 More than half of employers (61%) moderately or strongly agreed with the statement that the degree to which we have shifted health care costs has had a negative impact on employee health. 7 * *According to a 2016 survey of 106 jumbo employers representing 3.7 million covered lives. "...employers using HDHPs to help rein in medical costs may experience a bump in short-term savings, but potentially at the risk of higher catastrophic claims in the long-term." -The Guardian Workplace Benefits Study, HOW CAN YOU HELP YOUR MEMBERS AND YOUR COMPANY? 3

4 OPPORTUNITIES TO IMPROVE HDHP BENEFITS FOR YOUR MEMBERSES HDHP DESIGN OPTIONS HDHP with a Health Reimbursement Arrangement (HRA) Allows separate medical and prescription deductibles, to encourage members and their dependents to stay on prescribed medications. Educate members about the potential benefits of this type of plan for those on chronic medications, especially specialty medications HDHP with a lower deductible Can minimize negative impact on members, especially in the beginning of the year when they may not have enough money set aside to cover their deductible. Consider offering wage-based deductibles to support your low-wage workers HSA FUNDING OPTIONS Front-load your company s HSA contributions to help members who may need those funds to cover their deductibles earlier in the year. Consider strategies that allow members to tap into HSAs before the account is fully funded (similar to a Flexible Spending Account) to pay for health care costs. C onsider ways to help members increase their HSA funding For example, wellness incentives, profit-sharing transfers, and reaching biometric targets EXPANDED PREVENTIVE DRUG LIST Talk to your pharmacy benefits manager (PBM) about its preventive drug list and consider adding more medications that can be covered outside the deductible and with typical benefit design mechanisms such as co-pays or coinsurance. If funding is an issue, consider establishing a small co-pay and/or coinsurance for preventive drugs that are currently free to members to build a more inclusive preventive drug list 4

5 OPPORTUNITIES TO SUPPORT MEMBERS WHO CHOOSE HDHPs DECISION-MAKING SUPPORT Provide detailed plan-comparison tools that members can use to compare different plan options and determine the right fit for themselves and their dependents. Many carriers will download prior-year health expenses into the tools ; allow the member to customize and autopopulate data Work with your benefits partners to contact members who have chosen plans with the highest deductibles and who have a history of high health care costs (for example, members on specialty medications) to ensure they have: Understood the plan they have chosen Calculated their potential total out-ofpocket costs Planned to set aside enough money to cover their health care expenses in the beginning of the year before meeting their annual deductibles HELPING MEMBERS OPTIMIZE THEIR HDHP BENEFITS Encourage members to contribute any savings on premium costs (vs other offered health plans) to their HSAs, if available, or other savings accounts Work with your benefits partners to explore options. Encourage members to save at least enough to cover their deductibles Provide websites, apps, and high-touch support to help all members shop for health care services and products including doctors, prescriptions, and laboratory tests. Clearly communicate which preventive care services and medications are fully covered by the plan and encourage them to take advantage of these services. For example, annual check-ups, vaccinations, and screenings 5

6 OPTIMIZE HDHPs FOR YOUR MEMBERS AND YOUR COMPANY Provide additional educational support for your members To help educate your members and their dependents about HDHPs during and after open enrollment, consider distributing the Optimizing Your High-Deductible Health Plan brochure to them. This user-friendly brochure explains HDHPs, defines relevant terms, and suggests ways your members can optimize their plans. An electronic version of the brochure enables you to add your company s logo. HELP PREVENT UNINTENDED CONSEQUENCES BY TAKING ACTION NOW ON HDHP BENEFIT DESIGN AND MEMBER SUPPORT. References: 1. Guardian Life Insurance Company of America. The Guardian workplace benefits study, 4th annual: a crack in the foundation. guardiananytime.com/gafd/wps/wcm/connect/bf8933e5-142d-42f9-b3d0-fa5eb2e43ad6/employee-benefits-study-crack-in-the-foundation. pdf?mod=ajperes&cvid=lpbwko-. Published Accessed August 24, The Henry J Kaiser Family Foundation. Employer health benefit survey 2016 release slides. Accessed August 29, The Henry J Kaiser Family Foundation. Employer health benefits 2016 annual survey. Accessed August 29, Fronstin P. Health savings account balances, contributions, distributions, and other vital statistics, 2015: estimates from the EBRI HSA Database. EBRI Issue Brief. 2016;427: Nov16.HSAs.pdf. Published November 29, Accessed August 16, UnitedHealthcare. Consumer sentiment survey: 2016 results executive summary. Sentiment%20Survey.pdf. Accessed August 24, American College of Emergency Physicians. ACEP health insurance poll research results. org/ insurance-industry-drives-patients-to-sacrifice-necessary-medical-care. Published Accessed August 24, Benfield Arthur J Gallagher & Co. Employer market healthcare reform & private exchanges. Report presented at: AbbVie; November 2, 2016; Chicago, IL AbbVie Inc. North Chicago, IL October 2017