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Hospitals are Applying Stricter Rules on Health Benefits

Posted Tuesday, August 15, 2017 8:59 am

A growing number of hospitals are enforcing stricter rules around their health benefits as they cope with increasing health care costs and an evolving health care landscape, according to a new survey by Cammack Health, a business of Aon. The annual Benefits Survey of more than 196 hospitals across 86 participating health systems in the Eastern region of the U.S., found that the average annual health care expense per employee was $15,541, compared to $11,102 in 2010.

As costs continue to increase, so are hospitals’ appetites for requiring more from their employees in managing their own health care and plan choices:

  • 45 percent of hospitals surveyed either levy a surcharge or do not cover spouses who have access to coverage by their own employer.
  • More than three-quarters of plans (79 percent) maintain a higher cost sharing requirement for using urgent care facilities. While still priced to steer employees away from the emergency room, these copays are beginning to outpace primary care copays to help influence choice for place of service to encourage physician/member relationships.
  • 40 percent maintain separate cost sharing for specialty drug tiers, and 12 percent set coinsurance for non-formulary medications at 100 percent of the discounted price.
  • 48 percent price incentives to encourage employees to use their internal pharmacies.

“Hospitals want to continue to offer a comprehensive benefits package, but face financial pressure to achieve a meaningfully different cost outcome. As a result, their health strategies have evolved to introduce more cost-sharing to employees,” said Mary Clark, a senior vice president in Aon’s Health business. “However, they also recognize that focusing only on cost-sharing is not a sustainable long-term strategy. To remain competitive, they are adopting more innovative strategies that encourage accountability and deliver high-quality health outcomes.”

Adopting new strategies to mitigate cost. According to Cammack Health’s survey, more than two-thirds (67 percent) participate in a value-based contract with a payer. More than half (53 percent) have at least discussed the concept of partnering to manage health plan members at non-hospital employers. Such partnerships include accountable care organizations (41 percent), clinically integrated networks (32 percent), and physician hospital organizations (27 percent).

Eighty-three percent use a domestic tier to steer employees towards services within their health system. To encourage employees to use these services, hospitals use the following strategies:

  • No coinsurance (54 percent) or deductible (56 percent);
  • Free inpatient care (41 percent) and outpatient care (37 percent); and
  • No copay for primary care physician (24 percent).

"These trends align with the overall business objectives of the health care delivery system as health care transforms from volume to value,” added Clark. “Self-insured, employer-sponsored health plans are key risk populations for systems because they have more control over the data, design and incentives. By retaining care within their own networks and facilities, they have increased their ability to facilitate utilization, cost and quality outcomes.”

Source: Wolters Kluwer

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