| Health & Medical Innovation | Employee Benefits
In 2021, the average health insurance cost for employers was $16,253 annually, or 73% of the premium, to cover a family and $6,440, or 83% of the premium for an individual. These premiums for families and individuals have increased 22% over the last five years and 47% during the previous 10 years. [Kaiser Family Foundation; 2021]
Compared with high-income peer countries, the United States has a 46 to 50 percent higher disease burden rate for 20- to 40-year-old workers, and a 17 to 33 percent higher disease burden rate for those over 40 years old. [Innovating employee health: Time to break the mold?; McKinsey; Sept 2021]
Self-insured employer plans usually cover employees and their spouse/partners and dependents. Employers depend on their medical carriers and their administrative services to provide access to good medical care, pay an appropriate (and pre-specified) amount and respond to covered members as customers.
At the heart of employer health plans are employees on whom companies depend for business success. The relationship between health and productivity is strong, but complex. Direct costs of health-related absence and disability can be dwarfed by "presenteeism." The focus on wellness and wellbeing is shifting to employee engagement and performance.
Employer-provided health coverage is important for recruiting, but even more important for retention. A recent AHIP survey shows that: 56 percent of U.S. adults with employer-sponsored health benefits said that whether or not they like their health coverage is a key factor in deciding to stay at their current job. 46 percent said health insurance was either the deciding factor or a positive influence in choosing their current job. The role that healthcare innovation can play to support this is considerable.
Rule of thumb: Larger employers tend to work with larger consultant organizations who charge by the hour and bring sophisticated resources and broad subject matter expertise. Smaller employers tend to work with brokers who earn commission from placing medical insurance business- but often include value-added services to those client relationships. Knowing the players and understanding the working dynamics (and how they may vary) is invaluable to successful growth in the self-insured employer marketplace.
Health care purchasing coalitions, executive roundtables, industry membership organizations are among those influencers who help employer decision-makers navigate the complex landscape. These influencers offer powerful potential for healthcare innovators looking to shape and showcase their solutions.
210 pages of charts and graphs is actually quite easy to produce.
Identifying the handful of key findings that have an actionable solution is harder. This requires seasoned familiarity with the data set, as well as an up to date understanding of available marketplace solutions.
Whether your firm has an enterprise solution for your employer clients' clinical claims data analytics, or you rely on carriers or third-parties vendors- it is ultimately up to you to provide recognized value as a trusted advisor.
At RON LEOPOLD CONSULTING we help brokers with the clinically rich data they need to interpret and help them bring relevant, marketplace-ready innovative solutions to their employer clients.
Self-insured employers need a clinically-savvy advocate on their side. Whether you are meeting with your health plans, or determining the progress of key point solutions, the data you face can almost always benefit from a seasoned clinician familiar with claims data reporting.
At RON LEOPOLD CONSULTING we help employers extract value from their carrier reports and measure the progress of your Point Solutions.
210 pages of charts and graphs......but what is this telling you? Employers and their trusted advisors increasingly require a clinically-trained data expert to find genuine meaning and actionable recommendations from their claims data.
Your CFO is watching cost trends. Looking at cost stratification is as important as risk stratification. Percentage of "zero dollar" members may represent inadequate access to care. Higher than benchmark spend on very expensive claims may provide insights to more aggressive medical and pharmacy cost solutions.
Every major condition has a story. The solutions for different diseases and conditions vary greatly, and often require specialized clinical resources. Members with cancer, diabetes, back injuries or high risk maternity each require approaches that leverage expertise in their respective areas.
3% of your claimants drive 56.5% of your dollars. In other words, for 10,000 members, 300 people are driving well over half of your expenditure. How much of that is specialty pharmacy? Which members are potential stop-loss risks? What targeted strategies should you consider?
Underutilization of primary care, preventive services and behavioral health may eventually drive greater costs than overutilization of emergency departments and medical specialists.
The long game, for employers, is mitigating higher risk. The value of health risk solutions, such as wellness and lifestyle programs, are seen in the migration of members from higher risk strata, to lower risk strata. These programs can mitigate member population risk migration and offset further costs.
Measuring quality of care requires an ability to measure gaps in care for members. Overutilization, or misuse of key diagnostics and treatments can also assist in identifying foci of lower quality care.