tidewaterreview.com

Join us at 11 a.m. CT (12 p.m. ET/9 a.m. MT) on Thursday, Dec. 16, to chat about employer health care costs with Chicago Tribune's healthcare reporter Bruce Japsen and Sara Taylor, Health & Welfare Product Development Leader at Aon Hewitt, global benefits consulting firm.

Health care costs continue to rise and employers will have new ways of dealing with them in 2011, whether companies face new challenges from federal reform laws to grappling with medical inflation that will result in costs being pushed onto workers in new and different ways.

Health Chat: Employer health care costs

(12/16/2010)

  

Close

10:56

bruce:  Health care costs continue to rise and have for years. So to mitigate these increases, employers have had to ask employees to shoulder more of the premium burden. In 2011, employers again are using new strategies. Sarah Taylor what is Aon Hewitt doing to help these companies. Thursday December 16, 2010 10:56 bruce

10:58

Sara Taylor:  Aon Hewitt is assisting employers in many ways - evaluating health care plan designs, negotiating rates with health plans, communicating changes to employees, and promoting employee consumerism of health care. Thursday December 16, 2010 10:58 Sara Taylor

11:01

[Comment From Glenn GGlenn G: ]  What is being done to help small employers. We only have 7 people on our plan. Last year we received a 22% increase and this year we received a 38% increase Thursday December 16, 2010 11:01 Glenn G

11:02

bruce:  Glenn, first let me tell you that you might be eligible for a tax credit that kicked in this year under the new health reform law. So please go to healthcare.gov and see. It could be a significant write-off of your premiums. Thursday December 16, 2010 11:02 bruce

11:03

Sara Taylor:  Glenn - Additionally, another option is to shop around and look for a better rate with another carrier. We also see many small employers introducing high deductible health plans with or without an Health Savings Account (HSA) to keep premiums low. Thursday December 16, 2010 11:03 Sara Taylor

11:03

[Comment From JoeJoe: ]  Is it time for healthcare providers to work with employers to provide prevention care in the workplace setting rather than focus on curing when the costs arehighe Thursday December 16, 2010 11:03 Joe

11:05

bruce:  Joe. Indeed, more providers of medical care are trying to work with employers on prevention. And they have to because the health care law requires state-regulated health plans to spend 80 to 85 percent of their premium dollars on medical care. So insurance companies will be bundling more payments to doctors and hospitals and they will have to provide care more efficiently. ie: wellness is a way for them to do that. Thursday December 16, 2010 11:05 bruce

11:05

[Comment From MarkMark: ]  What does Aon Hewitt think of Wellness programs that reward on outcomes Thursday December 16, 2010 11:05 Mark

11:07

Sara Taylor:  Wellness programs are a mixed bag. Research suggests that postive rewards have an effect - but s hort-term effect. Over time the benefits decline. Also, depending on the outcomes you are measuring there are legal consdirations (e.g, privacy). Must most important for any wellness program is to measure the results of that program - something tjhat has been difficult for many to do. Thursday December 16, 2010 11:07 Sara Taylor

11:08

[Comment From FredFred: ]  In the small group market in CT insurance carriers don't offer wellness programs that would help reduce cost. Small group rates are fixed Thursday December 16, 2010 11:08 Fred

11:09

Sara Taylor:  Fred - I'm not an expert on the CT market. But you should expect to see some changes as a result of health care reform. Preventative care and wellness are key components of the law. Thursday December 16, 2010 11:09 Sara Taylor

11:10

bruce:  Sarah. every year I get calls from readers right after January 1 at the Tribune from consumers who complain their drug and doctor's office visit co-pays are rising. Are employers making new moves in this regard. Thursday December 16, 2010 11:10 bruce

11:11

Sara Taylor:  Employers are always changing the co-pays, co-insurance. That's one of the primary ways they shift costs to the employees. Unfortunately many employes do not look at or enroll in their benefits during the fall enrollmetn season so they're surprised by the changes on January. Thursday December 16, 2010 11:11 Sara Taylor

11:12

[Comment From FredFred: ]  Sara, yes they are but I don't see those components helping to keep the cost down. Thursday December 16, 2010 11:12 Fred

11:14

bruce:  Fred, Bruce here. You are correct. Certainly in the first year of health reform the law is not keeping costs down. But the hope is that when millions of Americans have access to preventive services, they will take advantage and remain healthy and therefore costs will slow over time. And that is a hope, certainly. Time will tell. Thursday December 16, 2010 11:14 bruce

11:14

[Comment From JoeJoe: ]  Vendors have been promoting health risk assessments. Are they of value Thursday December 16, 2010 11:14 Joe

11:14

Sara Taylor:  Joe - It depends on what you're going to do with the results of the health risk assessment. If you look at it and say "interesting" - there really is no value. But if you use that information to target wellness programs, follow-up with individuals, and measure results you can get benefit from the assessments. Thursday December 16, 2010 11:14 Sara Taylor

11:14

[Comment From SarahSarah: ]  What do you think of P4P on the provider side? Will this get implemented? Thursday December 16, 2010 11:14 Sarah

11:17

bruce:  Sarah - Pay for performance is already happening. UnitedHealth Group and other insurers like Blue Cross plans are already negotiating this into their plans. Essentially, they say they are moving from payment that has been based on costs of services provided to outcomes. In Illinois Blue Cross' case, doctors and hospitals are supposed to share in any savings achieved by these programs. Such contracts from insurers will be more comment by the time broader health coverage is available under reform in 2014. Thursday December 16, 2010 11:17 bruce

11:17

[Comment From CorinneCorinne: ]  With respect to changes in the delivery of healthcare is anyone perhaps setting up 24 hour clinics staffed by nurse practitioners with an MD consult available by Web cam. 24 hours clinics would reduce costs for expensive visits to E.R's which are currently being used as doctor offices and give people a choice for a less expensive visit for minor issues. Thursday December 16, 2010 11:17 Corinne

11:17

Sara Taylor:  Corinne - There are some medical groups that are providing medical evaluations on-line, Skype, and other methods. They are being proposed as an option to reduce costs and provide 24 hour coverage. I think this is an area to watch to see if the benefits truly happen. I think some items - like the poison ivy I had a couple of years ago - could be diagnosed via webcam. But other conditions may need more indepth evaluation by a medical professional. Let's see what happens. Thursday December 16, 2010 11:17 Sara Taylor

11:18

[Comment From AamerAamer: ]  when will there be guidelines for how physicians should conduct medicare's new annual wellness visits (i.e., what is included in them, what has to be reported, etc)? Thursday December 16, 2010 11:18 Aamer

11:20

bruce:  Aamer. I recently inquired to Centers for Medicare & Medicaid about this and they are working with doctor groups on this. Some clarity is expected in 2011. Thursday December 16, 2010 11:20 bruce

11:20

[Comment From SarahSarah: ]  Will telemedicine/e-health be covered by insurance in the near future? Thursday December 16, 2010 11:20 Sarah

11:21

Sara Taylor:  Sarah - Not sure. The telemed organizations I've looked at thus far (and I've not researched all of them) were not a part of a health plans network. But that may have changed. And if the plan covers out of network expenses, those should be reimburseable. Thursday December 16, 2010 11:21 Sara Taylor

11:23

bruce:  Sarah. So far, what is the biggest concern Aon Hewitt employer clients as to the implementation of health reform in the next year Thursday December 16, 2010 11:23 bruce

11:26

Sara Taylor:  First and foremost employers are concerned with controling health care costs. In many ways health care reform complicates the employer environment. There are additional regulations employers must comply with - and those regulations cost employers money. Right now employers are still evaluting their strategy for the next few years. Thursday December 16, 2010 11:26 Sara Taylor

11:26

[Comment From JoeJoe: ]  Have on site clinics or doctor days at the company proven to be of value Thursday December 16, 2010 11:26 Joe

11:28

bruce:  Joe, Bruce Japsen of the Tribune here. We have written a lot about retail clinics and on-site doctor clincs. Indeed, Walgreens might have some more specific data on that but they have shown to reduce sick days and increase access. Often time, it is a piece of mind issue for the employee. If they are sick and have a minor condition, it keeps them from the emergency room. The Convenient Care Association might have some data for you if you are interested. They have worked with Walgreens, Target and CVS on site clinics and data Thursday December 16, 2010 11:28 bruce

11:28

[Comment From AamerAamer: ]  Thanks Bruce, so does that mean it's probably better to wait until CMS comes out with something definitive before we reach out to our medicare patients about coming in for their annual visit? I was hoping to write a blog and send it out to our patients so they can start making their appointments starting in January. I found this article while doing research, what do you guys think about what it says: (it's from codepedia): http://www.codapedia.com/article.cfm?id=508 ( to Sarah's comment about telemend btw, Aetna has a telemed program with Relay Health, some of Aetna's plans have that option and a co-pay associated with it,etc)> Thursday December 16, 2010 11:28 Aamer

11:28

Sara Taylor:  Aamet - Yes. Just sit tight until you get the guidance from CMS. Thursday December 16, 2010 11:28 Sara Taylor

11:29

Sara Taylor:  Joe - Employers I've worked with have had very positive results with on-site clinics - particulary strong employee feedback. Thursday December 16, 2010 11:29 Sara Taylor

11:30

Now that health reform is law, do you think it will lower your personal costs and provide better benefits? Yes  ( 42% ) No  ( 50% ) Undecided  ( 8% ) Thursday December 16, 2010 11:30

11:32

[Comment From CorinneCorinne: ]  To decrease employer costs we need to decrease the costs of Medicaid. Folks on Medicaid in Il. pay absolutley nothing for visits to E.R's, physicians and have no incentive to alter their number of visits or where they obtain healthcare. Does the Federal govt. have any plan to be more responsive to the billing fraud that occurs?? Thursday December 16, 2010 11:32 Corinne

11:34

bruce:  Corinne - Bruce of the Chicago Tribune here. Indeed, there are more and more investigations into health billing fraud. In addition, health insurance companies are providing more information to federal and statte authorities when they see doctors submitting claims that they believe are outliers. For example, a cardiologist that implants more stents than most of his colleagues might first get a letter from the insurance company asking him why this is. If his stenting is off the charts, the insurer might ask the government to take a look. Thursday December 16, 2010 11:34 bruce

11:37

bruce:  Sara - Are their particular benefits under health reform that employers and their workers really like. I often get positive feedback about the law that requires plans to cover children up to age 26. Is that the most popular? Are there others? Thursday December 16, 2010 11:37 bruce

11:39

Sara Taylor:  Employees are very excited about covering dependents up to age 26. Aon Hewitt's customer service centers were flooded with calls from employees wanting to cover their dependents as soon as the law was enacted. I would say employers are mixed on the dependent provision - some believe it's the right thing to do, others are concerned about the cost. Employers are probably most interested in the exchanges coming a couple of years from now. Thursday December 16, 2010 11:39 Sara Taylor

11:40

[Comment From CorinneCorinne: ]  Just a comment and not wanting to sound like a pessimist but it sure sounds like business as usual with a whole lot more money being thrown in the pot. There a changes but is there real improvement??? More people insured with more money in the pot is not improvement to me. Thursday December 16, 2010 11:40 Corinne

11:42

bruce:  Corinne. That will be the big question states and the federal government face given the nation's economic situation. State budgets are constrained so government will have to work more with less. As exchanges are set up in these states to provide benefits, it will be interesting to see just how rich the benefits are that are provided. That will come in 2014 Thursday December 16, 2010 11:42 bruce

11:43

Sara Taylor:  Corine - That's the million dollar question. Time will tell. Access to care for millions of uninsured Americans has benefits. But will those benefits outweigh the cost? Not sure. I think many people would like to see additional efforts to actually reduce costs, not just provide access. Thursday December 16, 2010 11:43 Sara Taylor

11:45

[Comment From CorinneCorinne: ]  Absolutely agree with you. Then there is the drug industry and the legal industry. They must be in heaven. Thursday December 16, 2010 11:45 Corinne

11:45

[Comment From SarahSarah: ]  I agree that most of what we're seeing now is access, but there are several pilot programs within the law that are looking for cost savings. Which of these has the most potential in your minds? Tort reform, evidence-based medicine protocols, etc.? Thursday December 16, 2010 11:45 Sarah

11:47

bruce:  Corinne. I just wrote a story on the health care industry and its continued support for health reform law. All of the major lobbies do NOT want to repeal this. A key reason is this: they are going to get more than 30 million paying customers once health reform is fully implemented in the next three years. AMA, American Hospital Association, America's Health Insurance Plans and the Pharmaceutical Research and Manufacturers of America are all in support of reform and do not want a repeal. They may want small changes, but in no way want this repealed. Thursday December 16, 2010 11:47 bruce

11:47

Sara Taylor:  Sarah - Evidence based medicine has the most legs. It's proven to work - data shows better results for patients and reduced costs. Tort reform and other items help, but quantifying impact is a little more diffcult. Still lots of work to be done to find ways to reduce costs. Thursday December 16, 2010 11:47 Sara Taylor

11:47

[Comment From CorinneCorinne: ]  We need both tort reform and evidence-based medicine protocols. Thursday December 16, 2010 11:47 Corinne

11:49

bruce:  Sara - Is Aon Hewitt getting a lot of questions about Flexible Savings Accounts and the requirement under the health law that people have to get prescriptions from doctors to use over-the-counter meds? Or at least have them paid for out of their FSA accounts. Thursday December 16, 2010 11:49 bruce

11:51

Sara Taylor:  Yes, we're getting lots of questions about the over-the-counter provision. Right now most employees are trying to understand the impact so they can figure out how much money to contribute to their FSA for 2011. But just as you commented earlier about people complaining in January about changes to co-pays, etc., we're anticipating lots of complaints from people submitting claims early next year from people who didn't realize there was a change to the over-the counter- provision. Thursday December 16, 2010 11:51 Sara Taylor

11:54

bruce:  To Corrine and others who asked about the importance of ferreting out health care fraud. Just one minute ago, US attorney General Eric Holder issued a press statement about that very topic. They have pumped tens of millions of dollars into a new initiative called "Heat" that in effect leads to more health care fraud arrests and investigations across the country Thursday December 16, 2010 11:54 bruce

11:54

[Comment From CorinneCorinne: ]  Have there been changes with respect to dental and vision plans being dropped, revised and costs increased? Thursday December 16, 2010 11:54 Corinne

11:55

Sara Taylor:  Corine - Most dental and vision plans are generally 100% paid by the employee, so employers are less concered about those costs. Employers generally spend 80%+ of their benefits budget on medical, so that's what they focus on. Thursday December 16, 2010 11:55 Sara Taylor

11:57

bruce:  Thanks to all of the readers and our guest Sara Taylor of Aon Hewitt who joined us today on our live Health Chat. We will be doing more of these after the first of the year. Please go online to www.healthkey.com for further information. Also see my archived series on health reform at www.chicagotribune.com/health Thanks again Bruce Japsen Thursday December 16, 2010 11:57 bruce

11:57