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2025-01-04 21:38本頁(yè)面
【正文】 fixed employer mitment ? Risk transferred to employees/retirees ? In some versions (caps), no immediate impact felt by participants – Communication is critical ? Employers concerned about participant response 43 Mercer Human Resource Consulting The Two Camps Summarized Fight or Flight ? The largest employers seem willing to try to change the world ? Mid sized and smaller employers seem to want to “get out” of the responsibility ? Neither reflects the traditional way of providing benefits Focus on employers reducing involvement, using a generic defined dollar (defined contribution) approach 44 Mercer Human Resource Consulting Agenda ? The Environment ? The Catch22 ? Paths Away from Traditional Delivery: Two Camps ? Opportunities Along Path 2 ? The Answer ? Additional Topics 45 Mercer Human Resource Consulting Where can we apply “Defined Contribution” approaches most easily? ? Active employees/early retirees – Employers will still need to “sponsor” a plan – Can set employee contributions to meet desired cost share and allow employees to buy back into a selfinsured plan – Easiest calculation if underlying plan is fully insured ? Medicare Eligible Retirees – Employers may actually be able to get all the way out – Even if pany sponsors no Medicare eligible retiree plan, options available in market for retirees to choose from – Some with little or no underwriting (removes access problem) but eligibility/timing important 46 Mercer Human Resource Consulting DC Health Plans in the Spectrum of Employer Contributions % of Cost Employer pays X% (., 80%) of cost of health plans。 increases subject to employer discretion ? Not a taxadvantaged approach 40 Mercer Human Resource Consulting Access Only Plans ? Employer “sponsors” pany health plans (stays “in the business”) ? By doing so, retains group underwriting, pricing and risk profile ? Employer contemplates no subsidy ? Full cost and annual increases absorbed by employees/retirees ? Fully insured plans – Works best – Costs known in advance – Premiums fixed in advance ? Selfinsured plans – Requires more management – Costs not known in advance – But premiums must be fixed in advance – Caution regarding active/retiree subsidy – May impact other accounting (FAS 106) 41 Mercer Human Resource Consulting Capped Plans ? “Employer cost will be capped at 2 times the 1993 cost” ? Implication is that employer share bees a fixed dollar mitment at some point in the future ? Typical action taken in early to mid 1990s for retiree programs in response to FAS 106。 no employer prefunding required – Payment options ? “Drawdown” on funds (retiree uses funds to pay portion of retiree medical cost。 $1,000 per year of service for 30 years of service)。 “flat” or tied to service。 HIPAA may eventually make this a viable option for preMedicare retirees 38 Mercer Human Resource Consulting AccountBased Approaches Examples ? Monthly/annual promise – Retirees receive monthly (or annual) credits of a specified dollar amount (., $100/monthly。 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
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