【正文】 4 .8 % 4 .5 % 3 .5 % 2 .8 % 3 .2 % 3 .5 % 3 .9 % 4 .6 % 4 .7 %CP I Ov e r a l l 5 .4 % 4 .2 % 3 .0 % 3 .0 % 2 .6 % 2 .8 % 3 .0 % 2 .3 % 1 .6 % 2 .2 % 3 .3 % 2 .8 % 1 .5 %Ra ti o M C/Ov e r a l l 1 .7 2 .1 2 .5 2 .0 1 .8 1 .6 1 .2 1 .2 2 .0 1 .6 1 .2 1 .6 3 .1S o u r c e : . B u r e a u o f L a b o r S ta ti s ti c s4 Mercer Human Resource Consulting Comparison of Overall Growth Cumulative medical care CPI 89% greater than overall CPI since 1967 Data based on January 1 CPI values C P I v s . C P I M e d i c a l C a r e01002003004001967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2023Y e a rStandardized CostM e d i c a l C a r e C P I O v e r a l l C P I5 Mercer Human Resource Consulting Employers’ Cost Increases OutPace Other Indicators Largest increase since 1990 (all employers) Includes medical, dental and pharmacy Source: 2023 Mercer/Foster Higgins National Survey of Employersponsored Health Plans Results for Employers with 500 or more lives % % % % % % % % % % % % % % % % % % % % % % % % % % % % 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2023 2023 2023 Employers CPIMedical CPIAll Items 6 Mercer Human Resource Consulting Aggregate Health Care Spending (1980 – 2023) Government portion of payments increasing。 changing as appropriate 27 Mercer Human Resource Consulting What is a HPN? High Performance Network: A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria 28 Mercer Human Resource Consulting Rationale for HPNs ? New management approaches are needed in this era of cost acceleration ? Patients and physicians are the key drivers of health care costs – But they have limited or no incentive to care about costs ? The heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians 29 Mercer Human Resource Consulting High Performance Networks Network models ? Limited Network – A subset of an existing provider work prised of high performing providers ? Tiered Network – Employee copay/coinsurance differentials to encourage use of high performing providers ? Physician Partnering – An arrangement with (typically) primary care physicians to enhance efficiency ? Consumer Driven – Deployment of performance information to consumers to improve provider selection 30 Mercer Human Resource Consulting Direct Contracting ? Large employers with significant market presence ? May be able to achieve significant savings by contracting directly with health care providers ? May need group of regional employers to achieve critical mass 31 Mercer Human Resource Consulting Promote Consumer Accountability Help patients be better consumers of health care ? Background – If half of cost is due to lifestyle and half of chronic patients do not follow treatment plan, what can we do? ? Get members’ attention – make them aware of consequences ? Approaches to encourage consumer involvement include – Coordinated health promotion, disease prevention and educational programs – Tying employee cost increase to trend – “Defined contribution” health plans – Consumer directed health care – Reintroduction of coinsurance 32 Mercer Human Resource Consulting Efforts to Improve Quality of Care in Hospitals Leapfrog initiative ? The Leapfrog Group: Background – Formed in response to Institute of Medicine study of errors in health care – Goal: Major gains in patient safety, customer service and health care affordability – Sponsored by Business Roundtable – Employers in Leapfrog Group use purchasing power to encourage health care providers to adopt patient safety standards ? Leapfrog standards include: – Computerized systems in hospitals to improve the accuracy of physicians’ prescriptions and minimize medication errors – Staffing of intensive care units by physicians trained in critical care medicine – Referral of patients requiring certain plex procedures to hospitals offering the best results 33 Mercer Human Resource Consulting Lobbying ? Some employers making presence felt on Capitol Hill ? Many have been active for years and are recognized as important voices ? Some large associations have similar goals and represent large voting populations 34 Mercer Human Resource Consulting Preventive Care and Disease Management Across the Health Care Continuum Programs should be tailored to the needs – Prevention – Screenings – Health Risk Assessment – Targeted Risk Reduction Programs – Risk Modeling – Nurse Advice Line – Web Tools – Consumer Directed Health Plan – Disease Management – Incentive Design – Self Management Training – Case Management – Decision Support – Predictive Modeling Well No Disease At Risk Obesity High Cholesterol Acute Illness/ Discretionary Care Doctor Visits Emergency Visits Chronic Illness Diabetes Coronary Heart Disease Catastrophic Head Injury Cancer 85% members = 15% cost 15% members = 85% cost 35 Mercer Human Resource Consulting Employers Being More Involved Summary ? Typically the larger employers ? “Fighting” to change the way health care delivered to own employees – Goal is to produce better outes…… – And lower cost 36 Mercer Human Resource Consulting Employers Being Less Involved (Camp 2) ? Employers desire to “know their cost” ? Dollarbased plans (often accountbased) ? Reimbursement plans ? Access Only plans ? “Capped Plans”…typically retiree medical ? What these approaches share is an eye toward reducing employer cost at the expense of employees/retirees 37 Mercer Hu