Employee Benefit Trends and Strategies

Transcription

1 Employee Benefit Trends and Strategies Leo Tokar Executive Vice President L O C K T O N C O M P A N I E S

2 Topics Lockton Employer Survey Market Trends What are Employers Doing? 2

3 Lockton Employer Survey Highlights

4 Rate Increases Health Insurance Plan Cost Percentage Rate Increase Before Plan Design Changes 16% 14% 12% 10% 8% 15.0% 12.0% 13.5% 12.9% 13.7% 11.8% 14.4% 9.4% 7.4% 10.9% 8.0% 8.0% 7.6% 6% 4% 2% 0%

5 Rate Increases by Size Employer Size Range Initial Renewal Avg Final Renewal Avg Avg Change Strategy Assessment Initial Renewa Avg % 7.0% 10.8% Well developed 4.9% % 6.9% 3.8% Partly developed 7.0% % 3.1% 1.5% Just starting 8.5% % 3.8% 1.9% Don't have one 12.1% % 3.6% 1.4% Composite 7.6% % 4.7% 1.9% Composite 7.6% 4.7% 2.9% 5

6 Lockton Employer Survey Themes Increases higher than national trends After changes, the net result was in line with national trends Cost management is top concern Traditional cost shifting tactics as well as targeted strategies to attack cost drivers Other concerns Compliance/administrative burden Employee dissatisfaction with benefits/ability to use benefits to recruit & retain Employers want benefit offering to be at or above market ACA not impacting decision to offer benefits Labor market is very competitive Benefits importance growing as tool to attract and retain Increasing employee involvement in benefits and accountability for cost management (e.g., consumerism, wellness) ACA administrative requirements put considerable pressure on employers 6

7 Health Plan Funding HEALTH PLAN FUNDING RESULTS 70% 60% 50% 51% 57% 61% 57% 54% 55% 54% 58% 46% 47% 49% 47% 48% 40% 30% 39% 29% 26% 34% 33% 35% 32% 32% 39% 41% 40% 39% 36% 20% 10% 0% 17% 14% 13% 14% 15% 14% 12% 12% 10% 8% 10% 11% 1% Fully Insured Self Funded Combination of Fully Insured & Self Funded 7

8 Cost Management Strategies Cost Shift Tactic Response Ratio Increase employee premium contributions for family coverage 55% Increase employee premium contributions for single coverage 51% Absorb the increase 15% Increase deductibles 13% Increase the amount employees pay for prescription drug coverage 13% Increase employee maximum out-of-pocket expense 11% Tobacco Surcharge 11% Other areas: Telemedicine Consumerism tools (e.g. cost transparency, decision support, advocacy) Narrow network (smaller number of providers) Various pharmacy management tactics Bundle ancillary coverage(s) (e.g. dental, vision, life, disability, etc.) with medical 8

9 Impact of Strategic Planning al wal g Final Renewal Avg Avg Change Strategy Assessment Initial Renewal Avg Final Renewal Avg Avg Change % 7.0% 10.8% Well developed 4.9% 2.8% 2.1% % 6.9% 3.8% Partly developed 7.0% 4.7% 2.3% 3.1% 1.5% Just starting 8.5% 5.5% 3.0% 3.8% 1.9% Don't have one 12.1% 6.8% 5.3% 3.6% 1.4% Composite 7.6% 4.7% 2.9% 4.7% 1.9% 9

10 Market Trends and Employer Strategies

11 Significant Market Trends Network Strategy: Beyond PPOs Pharmacy/Specialty Spend Data and Measurement Large Claims Workforce Health Medical Trend Strategic Decision + Areas Engagement and Consumerism Compliance: Not just ACA Benefit Restoration Private Exchanges Retirement Planning 11

12 Current Planning Environment Health Reform 2.0 Fewer rules/regulations but different game? More employer latitude Cost as central focus Specialty pharmacy Large claims Network management Data/analytics Technology will continue to disrupt healthcare delivery Single-chain to multi-chain Amazon, Google and Uber for healthcare Leverage data Sick-care to well-care Mobile, accessible, personalized Strategic planning or not? 8 key program components 12

13 Medical Trend Continues to Outpace CPI Medical/Rx Trend is Outpacing CPI by 2-3X Top Cost Drivers of Rising Healthcare Costs 12.0% 10.0% CO Specialty pharmacy High cost claimants Specific diseases or conditions 8.0% 6.0% US CO 7.0% 6.0% 6.0% 6.0% Overall medical inflation Hospitalization (inpatient care) 4.0% US 5.0% 5.0% 5.0% 5.0% Outpatient procedures Traditional pharmancy 2.0% 0.0% Projected National Before Plan Design Changes National After Plan Design Changes Colorado-Before Changes Colorado-After Changes ACA compliance Geographic variation in cost/utilization Outpatiient care Other* 0% 20% 40% 60% 80% 100% Highest Driver 2nd-Highest Driver 3rd-Highest Driver *Other includes pharmacy, maternity, chronic diseases, and an aging workforce Source: National Business Group on Health 2017 Large Employer Health Plan Design Survey 13

14 Increasing Pharmacy Spend PHARMACY TREND Projected at 7.3% in % for traditional drugs 16.8% for specialty drugs IMPACT OF SPECIALTY DRUGS 33.7% of Rx cost in % of drugs in current R&D pipeline are specialty Projected to make up 40-50% of Rx cost by 2020 GENERIC DRUGS Generic dispensing rates at 81.7% in 2016 nearing a plateau 2017 projected achievable generic dispensing rate: 87 88% Highly utilized brand names now available in generic form Generic strategies need to shift focus from GDR to lower-cost generic mix MARKET FORCES PHARMACY Pharmacy benefit manager (PBM) and retail chains forming exclusive connections Focus has been on 90-day retail dispensing for maintenance medications Prime Therapeutics and Walgreens Optum Rx and CVS OPIOID INFLUENCES Employer and PBM groups focusing on opioid epidemic One out of every three (32%) opioid prescriptions is abused Abusers cost employers nearly twice as much in healthcare expenses Best practice is to require strict management through prior authorization, step therapies, and quantity limits Sources: National Business Group on Health 2017 Large Employers Health Plan Design Survey; Express Scripts Drug Trend Report, March 2016; Kantar Media, April 2016; Institute for Healthcare Informatics, 2015; Lockton Infolock Analysis for 12 Months Ending 6/30/

15 Large Claims The Severity and Frequency of Catastrophic Claims Continues To Increase Specialty Rx Costs Are Skyrocketing An Increasing Frequency of Large Claims Incurred at Outof-Network Providers (OONP) Are Paid at Retail 99% Claims over $1M from % Total Health Spend by 2020 Excessive Billing Practices $ Most common: Premature infant Live born complications Cancer 1.7% of claimants accounted for a disproportionate 18.5% of stop-loss reimbursements. Pharmacy claims billed via medical plan are more expensive than if billed through the specialty pharmacy vendor. Patients receiving high-cost infusion treatments at a provider facility could obtain the same drugs via specialty pharmacy for significant savings. High-cost compound drug claims can include non-fda-approved ingredients, driving costs up. Services such as nerve conductive monitoring, detox laboratories, autism treatment, psychiatric visits, outpatient surgeons, cancer treatment centers, and dialysis, are delivered at an increasing rate at OONP. These services can be discounted through partner resources, if not reduced through plan document language. Source: 2016 Sun Life Top Ten Catastrophic Claims Report 15

16 Spending Variation 100% 97% 90% 80% 76% 82% 70% 66% 60% 50% 50% 40% 30% 20% 10% 0% 23% of total health spending Top 1% of health spenders... Top 5% Top 10% Top 15% Top 20% Top 50% Lower 50% 3% Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services 16

17 Cost Management Options Simplified Employer absorbs cost Employee absorbs cost Buy better Make trade-offs 17

18 Key Program Components PBM best practices Network/Care Delivery Optimization Know your population (data / analytics) Chronic condition engagement Culture of wellness Intensified focus on communication Navigation/advocacy/concierge HDHPs / HSAs the new norm 18

19 Network Management/Care Delivery High- Performance Networks Telehealth Centers of Excellence Reference- Based Pricing ACOs & PCMH Carriers creating narrow network options Often featuring the new provider ACOs/PCMHs 26% of large employer groups are offering plans or plan options with a high-performance network Almost universal adoption of telehealth services 90% of large employer groups offer telehealth Utilization currently at 1-3% Expanded services such as mental health and substance abuse may help to increase utilization and employer savings Steerage toward COEs increasing 16% of employers incent the use of centers of excellence through valuebased benefit design Reference-based pricing ( no network plans ) experimentation Reimbursement levels set at percent of Medicare Many employers restructuring outof-network benefits to reflect a percentage of Medicare, rather than traditional U&C Providers developing accountable care organizations (ACOs) and patientcentered medical home (PCMH) models in most major markets 3% of large employers are directly contracting with ACOs 21% are promoting ACO arrangements available through the health plan Source: National Business Group on Health 2017 Large Employer Health Plan Design Survey 19

20 Data and Analytics Know your population Assess how the population accesses and uses healthcare services Identify the care gaps that when closed could lead to fewer emergency room visits and inpatient admissions STEP 5 Measure and adjust as needed STEP 7 STEP 3 STEP 6 STEP 1 STEP 4 STEP 2 Determine what s driving trend Identify population segments by illness, risk, utilization, and unit cost impactability. Design a comprehensive plan involving: population-level and individual-level health management solutions, care management, and benefit redesign/ steerage. 20

21 8 Key Program Components 1. PBM best practices Contract management (pricing and terms) Specialty pharmacy management (coupons, clinical management) Clinical management (exclusions at launch; prior auth; step therapy; formulary management) 2. Network/Care Delivery Optimization Ensure plan design drives consumers to the right networks (broad-based, narrow, ACOs, COEs, bundled carve-outs) Ensure members can access the most effective treatment level/provider 3. Know Your Population (data and analytics) Identify drivers of cost trend through population segmentation 4. Chronic health conditions engagement The 5% of members who drive 50% of the claim spend need long-term, continuous support/coaching 5. Culture of wellness physical, emotional and financial Keep the lower 50% healthy 6. Intensified focus on communication & education - ongoing, targeted, and millenial-friendly 7. Navigation/advocacy/concierge/care coordination/expert opinion assistance The healthcare delivery system (outside of Kaiser) is a maze. EEs need a coordination hub to bring it all together. 8. HDHPs / HSAs the new norm be there or get there New administration favors them Most employers offer them (and the trend is continuing up) Supports retirement preparedness 21

22 APPENDIX Lockton Employer Survey Background

23 Industries Represented 23

24 Employer Size Represented Number of Benefit-Eligible Number of Responses Employees 5, % 1,000 4,999 21% % % % <101 8% 24

25 Locations Represented 25

26 Presented by Leo Tokar Executive Vice President Our Mission To be the worldwide value and service leader in insurance brokerage, risk management, employee benefits, and retirement services Our Goal To be the best place to do business and to work RISK MANAGEMENT EMPLOYEE BENEFITS RETIREMENT SERVICES lockton.com 2016 Lockton, Inc. All rights reserved. 26