The Future Of Employer-Sponsored Insurance

A recent post at Health Evolution  discussed four ways innovation can inspire employers to be more creative about their benefit strategies while garnering better results for their workforce. The findings in the article are especially relevant for self-insured employers because of the significant budget they allocate to workforce healthcare in order to retain employees by providing competitive benefits.

Let’s look at each claim and then explore how advanced primary care can help.  

1. The Biden administration signals incremental progress

The current administration is likely to focus on rebuilding the Affordable Care Act (ACA), which was partially dismantled during the previous four years. Expanding Medicare benefits by lowering the eligibility age is the most likely outcome to improve employer-sponsored insurance — although this advancement is unlikely to pass Congress unless legislation offers more choices to employers.

Elizabeth Mitchell, CEO of Pacific Business Group on Health, underscores the importance of options. “Whether it’s a public option, Medicare for All or Medicare Advantage for All, we still need to deal with payment reform because the incentives are wrong,” Mitchell says in the Health Evolution post.

2. The dominoes continue to fall

The pandemic has underscored the enormous risk large employers like Walmart, Disney, and Amazon face as they navigate self-insured healthcare costs that exceed 700 to 800 percent the cost of Medicare, which Mitchell adds is “really not a good look.”

On the member side of things, workforces are seeing their benefits thinned year-over-year as employers try to control costs and employer plans leave 170 million Americans vulnerable to losing their insurance if they lose their jobs. 

Mitchell anticipates a widespread solution in a model where the health system — not employers — incurs the risks of care cost and quality. 

3. Rethinking costs and quality

Marketplace transparency is always beneficial, but it’s not a cure-all for what ails the healthcare system. While greater visibility is good for a competitive marketplace, it doesn’t always drive meaningful improvements in the numbers of patients who use the information to comparison shop for their care services.

The answer lies in what the Health Evolution post calls an “intelligent benefit design that steers people toward providers based on cost and quality;” a benefit package that creates additional space for the treatment of behavioral health in a primary care setting.

It’s a model that results in significant savings for employers and more attentive engagement between providers and patients, which ultimately drives improved health outcomes and increased member satisfaction.

4. When more is more 

Mitchell recommends large employers with self-insured healthcare plans consider a fresh combination: direct contracting mixed with a more expansive suite of care options. It’s a recipe that greatly reduces costs for employers while transferring risk back to the payer. 

“There’s also a significant need for more prospective, population-based payment for primary care,” Mitchell adds. “You need to have both and that’s where our members are headed.”  

Solving employer headaches with advanced primary care

Let’s take a look at how advanced primary care addresses the needs and pressure points we’ve explored above. 

Advanced primary care is a value-based model that controls the total cost of care by centralizing services within the primary care setting. Vera’s advanced primary care model is built on self-efficacy, so patients can take ownership of their own long-term health outcomes. 

Advanced primary care builds on the foundation of true primary care and adds:

1. Robust informatics: Rich-claims data and informatics provide actionable insight, better utilization, and diminished care gaps.

2. Active care coordination: Providers direct patients to value-based specialists only when appropriate, which cuts down on employer costs, reduces hassle, and drives improved health outcomes. 

3. Clinically-integrated health coaches: Clinically integrated health coaches use the Transtheoretical Model to help patients take ownership of their health goals and change their behavior to improve lifestyles.

4. Empathetic listening: Health services go beyond prescriptive medicine to promote self efficacy, build provider-patient relationships, and enhance understanding of a person’s whole health. 

Advanced primary care unlocks numerous proven advantages by:

• Flattening the curve of skyrocketing healthcare costs for the entire population
• Lowering the cost of traditional healthcare plans by reducing utilization by giving workforces access to a fixed-cost primary care benefit
• Driving improved health outcomes and member satisfaction through strong relationships between providers and patients — with a focus on whole person care (including behavioral health)
• Offering a more expansive suite of services

It’s clear that continuing down the road of standalone employee-sponsored insurance plans will only result in escalating costs and reduced benefits for employees. But when employers place advanced primary care at the center of their benefit strategy, they will cap runaway healthcare spending while increasing the satisfaction and health of their employees. 

Learn more about advanced primary care by downloading our free eBook.