The Health Section

Employer benefit choices shaping health care

Today’s employers are wielding their influence to help shape the health care system of tomorrow. In fact, today’s employers are not just paying the bills. Employer benefit choices are helping to drive the transformation of health care, from a fee-based system to a value-based system that emphasizes the outcome, not the activity, of providing health care.

Why are employers getting involved in health care?

As the decision makers on which plans and networks are offered to their employees, employers are influencing health coverage choices for half of the country’s population – 155 million Americans.

The health care system’s historic approach has been a fee-for-service model. Physicians, facilities and other providers are paid by activity (tests, appointments) and use (facilities, supplies, equipment). Missing from this model is a strong  connection between the service provided and the patient’s outcome. The old system asks “What services were provided?” The new approach, value-based medicine, asks “Did the patient’s condition improve or get better?”

Private insurers and the federal government are well on their way to a collective goal of moving toward value-based models with the aim of both decreasing overall costs to employers and employees while also improving the experience for consumers. The Department of Health and Human Services is making plans to move 50 percent of traditional Medicare payments to value-based models such as accountable care organizations and bundled payments by 2018, while others in the Health Care Transformation Task Force, including Aetna, Blue Cross Blue Shield of Massachusetts and Blue Shield of California, have pledged to have 75 percent of their payments in these arrangements by 2020.

Employer benefit choices are creating better options for their employees

Employers are beginning to offer solutions built around paying doctors, hospitals and others according to patients’ outcomes. Some solutions are focused networks leveraging a relationship with one primary health care system, or a joint-venture between a health care system and insurer. Others follow a center of excellence model, where  a highly specialized provider locally, nationally or internationally is promoted for specific treatments like organ transplants, CABGs, spinal fusions, joint replacement and other high cost and highly variable cost procedures.

Members can get their care from a single doctor and hospital network that uses data, communication, quality improvement processes, and techniques to drive better care. Results clearly show that health outcomes and costs are more effective in these types of care arrangements. Now, even plans that are not built on value-based agreements may include many doctors and hospitals that have separately agree to be paid based on the value they provide.

More employers are also choosing high-deductible plans. These plans offer lower monthly premiums in exchange for higher deductibles. These high-deductible plans can be paired with Health SavingsAccounts to help employees cover their deductibles in a medical crisis. The number of people in high-deductible plan is trending upward every year, with nearly one in four people in employer-based plans making that selection.

It is not immediately obvious to a consumer that a plan with a deductible of several thousand dollars and a network that doesn’t include every hospital in the area is actually a good deal. Yet, high deductible plans create an incentive for people to shop around for cost-effective care based on their particular health needs.

Consumers still need a lot of education to understand how to manage their expenses when they choose a high-deductible plan, in order to get a lower monthly premium. They cannot escape the burden of rising health care costs, but they can consider their options and how to most effectively use their benefits.

This is where companies like bswift come in. bswift’s technology enables better enrollment choices.

With education, employees can make the right choice for their needs

Employers have an incentive to help their employees understand their options so they can choose the one that works for them and their families. Benefits technology solutions such as bswift let employers send their employees to a website to shop for benefits provided by the employer.

bswift uses interactive and personalized shopping and decision support tools, to educate employees about the options their employer is offering. When employees understand what they are buying, they can make more appropriate choices for their situation.

Once they have chosen a health plan, online tools let consumers compare price and quality before deciding where to get care.  Moving away from activity-driven fee-for-service medical care is in everyone’s interests. To really leverage value-based care, smart employers are using technology to give their employees the tools and incentives they need to become active participants in their own health.