美国保险业协会绝密HR分析报告.pptx

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Click to edit Master title style,First level bullet,Second level bullet,Third level bullet,Fourth level bullet,Mercer Human Resource Consulting,*,*,Click to edit Master title style,First level bullet,Second level bullet,Third level bullet,Fourth level bullet,Mercer Human Resource Consulting,*,Rich Bailey FSA,MAAA,FCA,Richmond,VA,Is it Time for Employers to Move Away From the Traditional Ways of Providing Employee Benefits?,November 3,美国保险业协会绝密HR分析报告,第1页,Agenda,The Environment,The Catch-22,Paths Away from Traditional Delivery:Two Camps,Opportunities Along Path 2,The Answer,Additional Topics,2,美国保险业协会绝密HR分析报告,第2页,Agenda,The Environment,Medical Trends,Legislation,Marketplace Changes,Population Demographics,Employer Outlook,The Catch-22,Paths Away from Traditional Delivery:Two Camps,Opportunities Along Path 2,The Answer,Additional Topics,3,美国保险业协会绝密HR分析报告,第3页,Double-Digit Increase for Second Year in a Row,Per employee costs in excess of$5,600 per year,-2.9%,+6.2%,+7.3%,+8.1%,+11.2%,+14.7%,Source:Mercer/Foster Higgins National Survey of Employer-sponsored Health Plans,4,美国保险业协会绝密HR分析报告,第4页,Annual CPI Trend,U.S.health care costs rise,despite continuing economic recession,The gap between CPI-U and medical care component is increasing,5,美国保险业协会绝密HR分析报告,第5页,Comparison of Overall Growth,Cumulative medical care CPI 89%greater than overall CPI since 1967,Data based on January 1 CPI values,6,美国保险业协会绝密HR分析报告,第6页,Employers Cost Increases Out-Pace Other Indicators,Largest increase since 1990(all employers),Includes medical,dental and pharmacy,Source:Mercer/Foster Higgins National Survey of Employer-sponsored Health Plans,Results for Employers with 500 or more lives,6.9%,18.6%,16.7%,17.1%,12.1%,10.1%,8.0%,-1.1%,0.2%,6.1%,7.3%,8.1%,11.2%,14.7%,2.1%,2.5%,-2.00%,0.00%,2.00%,4.00%,6.00%,8.00%,10.00%,12.00%,14.00%,16.00%,18.00%,20.00%,1987,1988,1989,1990,1991,1992,1993,1994,1995,1996,1997,1998,1999,Employers,CPI-Medical,CPI-All Items,7,美国保险业协会绝密HR分析报告,第7页,Aggregate Health Care Spending(1980 ),Government portion of payments increasing;total projected to be over$2 trillion by,Source:CMS,8,美国保险业协会绝密HR分析报告,第8页,Medical Trends,Pop Quiz,How many years will it take gross medical costs to double,assuming no specific employer interventions or national health care?,10 or more,9,8,7,6,5 or fewer,9,美国保险业协会绝密HR分析报告,第9页,Medical Trends,Responses from a group of 25 actuaries who had time to get their calculators,10,美国保险业协会绝密HR分析报告,第10页,Legislation,Medicare Prescription Drugs,If made into law,will have major impact on retiree benefits and strategies,Initial confusion aside,should have positive impact on retiree plans,Expect cost shifting to negatively impact active plans,EEOC Proposed changes in ADEA regulations,Cline vs.General Dynamics,Wells Fargo case,Appears to allow pre-funding(and tax-deductibility)of entire retiree liability,an ILP approach,wont be exactly same number as FAS liability,funding in years 2+would be limited to service cost,IRS weighing its options,11,美国保险业协会绝密HR分析报告,第11页,Proposals to Increase Coverage Among Early Retirees,Few government programs except for financially indigent,COBRA extensions and/or Medicare buy-ins,Prohibitions on post-retirement benefit reductions,Expanded pre-funding for retiree medical,Still few viable products for pre-65 in individual market that overcome access and affordability issues.,12,美国保险业协会绝密HR分析报告,第12页,ADEA Issues,Impact on retiree medical coverage,Age Discrimination in Employment Act(ADEA)prohibits discrimination against persons age 40 or older in terms and conditions of employment,Age-based distinctions in employee benefit plans are permissible only if:,A specific statutory exception applies,or,Equal benefit/equal cost test is satisfied,Plan must provide equal benefits for older and younger workers,or,Plan must incur equal costs for older and younger workers,Third and Sixth Circuit Courts reach different conclusions,EEOC reviewing ADEA regulations,13,美国保险业协会绝密HR分析报告,第13页,Marketplace ChangesConsolidation of Major Health Care Carriers,Employer options are greatly reduced,carriers have more clout,United Healthcare,HealthSource,Provident,CIGNA,Equicor,Metrahealth,US Healthcare,Aetna,TakeCare,FHP,PacifiCare,HealthSource,CIGNA,Aetna US Healthcare,NYLCare,Prudential HealthCare,FHP,PacifiCare,Provident,Transamerica,Equitable,HCA,Metropolitan,Partners,Aetna,GSDHP,Lincoln National HPs,TakeCare,PacifiCare,Health Plan of America,WellPoint/Blue Cross of California,Hancock,Mass Mutual,Travelers,United Healthcare,Aetna,PacifiCare Health,Systems,WellPoint/Blue,Cross of California,CIGNA,BCBS of Georgia,Multiple BCBS Plans,Fewer,Major BCBS,14,美国保险业协会绝密HR分析报告,第14页,Marketplace Changes,PBM consolidation continues;three major national PBMs remain,CPI,API,CPN,RxNet,Value Rx,Diagnostek,Perform,HCS,HPI,Diagnostek,Value Rx,RxNet,Columbia,Value Rx,Express Scripts,Express Scripts,NPA,DPS,Express Scripts,PAID,MEDCO,Advanced Paradigm,Advance,Medco,Integrated Prescription Solutions(IPS),PCS,Foundation,Merck-Medco,Merck-Medco,Proadvantage,Systemed,Paradigm,Merck-Medco,Medco,Advance PCS,Major Insurers,Major,Insurers,MPS,PCS,Clinical Pharmacy Advantage,15,美国保险业协会绝密HR分析报告,第15页,Population Trends,Aging baby boomers will increase the elderly and near elderly populations,Data Source:U.S.Census Bureau State Population Projections,Baby Boomers Year of Birth 1946 to 1964,Source:U.S.Census Bureau as of January,U.S.Population,Projected Population,Millions,16,美国保险业协会绝密HR分析报告,第16页,Negative Tidal Wave of Available Talent,Pool of“prime workers”will be decreasing,Source:DRI,World at Work Journal,fourth quarter,Percent Change in Population by Age Group,-10,-20%,-10%,0%,10%,20%,30%,40%,50%,60%,5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79,The“Echo boom”ages 15-29,Shrinking Pool of“Prime workers”ages 30-44,Aging“Baby boomers”ages 45-69,17,美国保险业协会绝密HR分析报告,第17页,Impact of Demographics on Health Care Cost,Cost increases with age,0.00,0.50,1.00,1.50,2.00,2.50,3.00,20-24,25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65+,Age,Relative Cost by Age,Male,Female,Average employer cost=1.0,Relative Costs By Age and Gender,18,美国保险业协会绝密HR分析报告,第18页,Health Deterioration,A cause and a consequence,We eat too much-64.5%of adults overweight,Population with diabetes increased over 50%in last decade,*,Overweight is roughly 10 to 30 pounds over an ideal weight.Obesity is roughly 30 pounds over an ideal weight,Source:National Health and Nutrition Examination Survey,45.0%,47.0%,47.0%,56.0%,64.5%,19,美国保险业协会绝密HR分析报告,第19页,Issues Facing Businesses,The perfect storm,Low ambient inflation;high medical inflation,Advances in medical technology likely to lead to higher costs,difficult decisions,Legislative uncertainty,Consolidating medical delivery and financing system,An aging workforce,Increased longevity,Slowing economy,Disappearing over-funded pension plans,Few,if any,obvious and easy alternatives to managing health care costs,20,美国保险业协会绝密HR分析报告,第20页,Employer Outlook,Environmental outlook spurring employer action,Employers acutely aware of trends,Heightened interest in cost saving strategies(active and retiree),Greater emphasis on longer term cost projections and on the“bottom line”,Projection results have induced“fight or flight”responses,21,美国保险业协会绝密HR分析报告,第21页,Retiree Medical Coverage,Employers continue to drop retiree medical coverage,Percentage of Employers,Offering Coverage to Future Retirees,Based on employers of 500 or more lives responding to the,Mercer/Foster Higgins Survey of Employer-Sponsored Health Plans,When coverage is offered,retiree premiums and out-of-pocket costs often increase,22,美国保险业协会绝密HR分析报告,第22页,Agenda,The Environment,The Catch-22,Paths Away from Traditional Delivery:Two Camps,Opportunities Along Path 2,The Answer,Additional Topics,23,美国保险业协会绝密HR分析报告,第23页,The Catch-22,Reducing employer cost typically implies increasing employee/retiree cost,Eventually runs against employers sensibilities regarding fairness,paternalism(if present),and the concept of benefits generally,Example(FAS 106):“Lower my liabilities significantly but dont do anything harsh to our retireesthey wont accept it”,To the extent that retirees represent the bulk of the liability,this is a very difficult proposition,Opportunities exist to change eligibility,design,etc.for future retirees,If we dont take cost out of the,system,either the employer or the employees/retirees will pay the increases,24,美国保险业协会绝密HR分析报告,第24页,Agenda,The Environment,The Catch-22,Paths Away from Traditional Delivery:Two Camps,Opportunities Along Path 2,The Answer,Additional Topics,25,美国保险业协会绝密HR分析报告,第25页,Paths Away from Traditional Delivery:Two Camps,Employers that become more involved in,Changing employee behavior,Changing provider behavior,Changing providers that they work with,Changing the laws,Employers that reduce their involvement by,Increasing employee responsibility,Limiting employer cost,Limiting employer risk,26,美国保险业协会绝密HR分析报告,第26页,Employers Becoming More Involved,Collective Purchasing,High Performance Networks,Direct Contracting,Consumer Accountability,Leap Frog,Lobbying,Disease Management/Preventive Care,What these approaches share is an eye toward reducing cost from the employers system,and in some cases,the entire health care system.,27,美国保险业协会绝密HR分析报告,第27页,Collective Purchasing,Use employer and plan manager clout to negotiate favorable payment arrangements,Background,Traditional network negotiations are volume driven,Approaches to achieve lower costs include,Aggregated purchasing to improve negotiating strength,Coalitions,Formal alliances,Informal alliances,Directing care to most cost-effective source of quality care,Reviewing effectiveness,efficiency and“fit”of current vendor relationships;changing as appropriate,28,美国保险业协会绝密HR分析报告,第28页,What is a HPN?,High Performance Network:,A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria,29,美国保险业协会绝密HR分析报告,第29页,Rationale for HPNs,New management approaches are needed in this era of cost acceleration,Patients and physicians are the key drivers of health care costs,But they have limited or no incentive to care about costs,The heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians,30,美国保险业协会绝密HR分析报告,第30页,High Performance Networks,Network models,Limited Network,A subset of an existing provider network comprised of high performing providers,Tiered Network,Employee copay/coinsurance differentials to encourage use of high performing providers,Physician Partnering,An arrangement with(typically)primary care physicians to enhance efficiency,Consumer Driven,Deployment of performance information to consumers to improve provider selection,31,美国保险业协会绝密HR分析报告,第31页,Direct Contracting,Large employers with significant market presence,May be able to achieve significant savings by contracting directly with health care providers,May need group of regional employers to achieve critical mass,32,美国保险业协会绝密HR分析报告,第32页,Promote Consumer Accountability,Help patients be better consumers of health care,Background,If half of cost is due to lifestyle and half of chronic patients do not follow treatment plan,what can we do?,Get members attention make them aware of consequences,Approaches to encourage consumer involvement include,Coordinated health promotion,disease prevention and educational programs,Tying employee cost increase to trend,“Defined contribution”health plans,Consumer directed health care,Re-introduction of coinsurance,33,美国保险业协会绝密HR分析报告,第33页,Efforts to Improve Quality of Care in Hospitals,Leapfrog initiative,The Leapfrog Group:Background,Formed in response to Institute of Medicine study of errors in health care,Goal:Major gains in patient safety,customer service and health care affordability,Sponsored by Business Roundtable,Employers in Leapfrog Group use purchasing power to encourage health care providers to adopt patient safety standards,Leapfrog standards include:,Computerized systems in hospitals to improve the accuracy of physicians prescriptions and minimize medication errors,Staffing of intensive care units by physicians trained in critical care medicine,Referral of patients requiring certain complex procedures to hospitals offering the best results,34,美国保险业协会绝密HR分析报告,第34页,Lobbying,Some employers making presence felt on Capitol Hill,Many have been active for years and are recognized as important voices,Some large associations have similar goals and represent large voting populations,35,美国保险业协会绝密HR分析报告,第35页,Preventive Care and Disease Management,Across theHealth Care Continuum,Programs should be tailored to the needs,Prevention,Screenings,Health Risk Assessment,Targeted Risk Reduction Programs,Risk Modeling,Nurse Advice Line,Web Tools,Consumer DirectedHealth Plan,DiseaseManagement,Incentive Design,Self ManagementTraining,Case Management,Decision Support,Predictive Modeling,Well,No Disease,At Risk,Obesity,High Cholesterol,Acute Illness/Discretionary Care,Doctor Visits,Emergency Visits,Chronic Illness,Diabetes,Coronary Heart Disease,Catastrophic,Head Injury,Cancer,85%members=15%cost,15%members=85%cost,36,美国保险业协会绝密HR分析报告,第36页,Employers Becoming More Involved,Summary,Typically the larger employers,“Fighting”to change the way health care delivered to own employees,Goal is to produce better outcomes,And lower cost,37,美国保险业协会绝密HR分析报告,第37页,Employers Becoming Less Involved(Camp 2),Employers desire to“know their cost”,Dollar-based plans(often account-based),Reimbursement plans,Access Only plans,“Capped Plans”typically retiree medical,What these approaches share is an eye toward reducing employer cost at the expense of employees/retirees,38,美国保险业协会绝密HR分析报告,第38页,Account-Based Approaches,Defines employers commitment as a defined dollar contribution instead of a defined medical benefit,Commitment can be monthly,annual,aggregate,Commitment can be based on retiree-only or recognize dependents,Amounts available for health care only;employer contributions are tax-free to the retiree and deductible for employer under Sections 105,106 and 162 of IRC,Can be funded or unfunded,For Medicare-eligible,Medicare+Choice,Medigap and traditional Medicare available;HIPAA may eventually make this a viable option for pre-Medicare retirees,39,美国保险业协会绝密HR分析报告,第39页,Account-Based Approaches,Examples,Monthly/annual promise,Retirees receive monthly(or annual)credits of a specified dollar amount(e.g.,$100/monthly;$5/month/year of service for 20 years of service),Fixed or increases annually;“flat”or tied to service;amount not used can be carried over or not,Aggregate(“lump sum”)promise,Employer promise is one-time credit(e.g.,$30,000;$1,000 per year of service for 30 years of service);accounts earn interest(e.g.,at T-bill rate)or not;no employer pre-funding required,Payment options,“Draw-down”on funds(retiree uses f