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【正文】 cor 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 Geia Multiple BCBS Plans Fewer Major BCBS 13 Mercer Human Resource Consulting 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 MerckMedco MerckMedco Proadvantage Systemed Paradigm MerckMedco Medco Advance PCS Major Insurers Major Insurers MPS PCS Clinical Pharmacy Advantage 14 Mercer Human Resource Consulting Population Trends Aging baby boomers will increase the elderly and near elderly populations Data Source: . Census Bureau State Population Projections Baby Boomers Year of Birth 1946 to 1964 Source: . Census Bureau as of January 2023 3 , 0 0 08 , 0 0 01 3 , 0 0 01 8 , 0 0 02 3 , 0 0 02 8 , 0 0 020 2425 2930 3435 3940 4445 4950 5455 5960 6465 6970 7475 7980 8485+A g e G r o u pNumber (000s)2 0 0 0 U S P o p u l a t i o nB a b y B o o m e r s. Population, 2023 Projected Population 010203040506070802 0 0 0 2 0 1 0 2023 2030A g e s 5 5 t o 6 4A g e s 6 5 o r O l d e rMillions 15 Mercer Human Resource Consulting Negative Tidal Wave of Available Talent Pool of “prime workers” will be decreasing Source: DRI, World at Work Journal, fourth quarter 2023 Percent Change in Population by Age Group, 202310 20% 10% 0% 10% 20% 30% 40% 50% 60% 59 1014 1519 2024 2529 3034 3539 4044 4549 5054 5559 6064 6569 7074 7579 The “Echo boom” ages 1529 Shrinking Pool of “Prime workers” ages 3044 Aging “Baby boomers” ages 4569 16 Mercer Human Resource Consulting Impact of Demographics on Health Care Cost Cost increases with age 2024 2529 3034 3539 4044 4549 5054 5559 6064 65+ Age Relative Cost by Age Male Female Average employer cost = Relative Costs By Age and Gender 17 Mercer Human Resource Consulting Health Deterioration A cause and a consequence 1 3 . 0 %1 5 . 0 %2 3 . 0 %3 1 . 0 %1 4 . 5 %3 2 . 0 %3 2 . 5 % 3 2 . 0 %3 3 . 5 %3 3 . 0 %0 . 0 %1 0 . 0 %2 0 . 0 %3 0 . 0 %4 0 . 0 %5 0 . 0 %6 0 . 0 %7 0 . 0 %1 9 6 0 1 9 6 2 1 9 7 1 1 9 7 4 1 9 7 6 1 9 8 0 1 9 8 8 1 9 9 4 1 9 9 9 2 0 0 0% o f a d u l t s a g e s 2 0 7 4w h o a r e o v e r w e i g h t o ro b e s e * h a s c l i m b e d o v e rt h e y e a r s% w h o a r e o b e s e a l s o h a si n c r e a s e d? We eat too much % 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 % % % % % 18 Mercer Human Resource Consulting 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 overfunded pension plans ? Few, if any, obvious and easy alternatives to managing health care costs 19 Mercer Human Resource Consulting 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 20 Mercer Human Resource Consulting Retiree Medical Coverage Employers continue to drop retiree medical coverage 29%40%46%43%41%38%36%35%31%23%35%40%31%33%30%40%28%24%051015202530354045501993 1994 1995 1996 1997 1998 1999 2023 2023P r e M e d i c a r eM e d i c a r e E l i g i b l ePercentage of Employers Offering Coverage to Future Retirees Based on employers of 500 or more lives responding to the 2023 Mercer/Foster Higgins Survey of EmployerSponsored Health Plans ? When coverage is offered, retiree premiums and outofpocket costs often increase 21 Mercer Human Resource Consulting Agenda ? The Environment ? The Catch22 ? Paths Away from Traditional Delivery: Two Camps ? Opportunities Along Path 2 ? The Answer ? Additional Topics 22 Mercer Human Resource Consulting The Catch22 ? Reducing employer cost typically implies increasing employee/retiree cost ? Eventually runs against employer’s sensibilities regarding fairness, paternalism (if present), and the concept of benefits generally ? Example (FAS 106): “Lower my liabilities significantly but don’t do anything harsh to our retirees…they won’t accept it” – To the extent that retirees represent
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