Which elements of the current health policy debate are most relevant to America's large employers? Most people, including members of Congress currently debating the law's future, would probably point to the excise tax on high-cost health plans, the employer mandate, and essential health benefits. Indeed, each of those elements directly affects the many large employers who provide health benefits accounting for half of all Americans' health insurance. With this post, however, we argue that large employers are also have a material interest in two other major issues: (1) value-based payment and delivery reform, and (2) publicly financed coverage.
As Congress and the new Administration consider reforming our health care system, policymakers should take into account the unique perspective and insight on these issues offered by America's large employers.
Value-based payment and delivery system reform
Innovation and continuous improvement are built into the fabric of successful American businesses. In response to rising health care costs, many employers have applied these skills to managing health benefits. The result has been over two decades of innovation to further the value agenda: to get the best value for the money that employers and employees spend on health benefits.
These innovative models have produced important lessons for policymakers. For example:
- Accountable Care Organizations (ACOs) can produce improved health and efficiency — but only if they are held to high standards and full accountability for quality outcomes, patient experience, and total cost of care;
- Bundled payments for episodes of care can lead to better outcomes, fewer complications, and lower costs — but only if there is effective coordination and integration across the care continuum, best achieved by prospective payment and accountability for outcomes and patient experience;
- High-deductible health plans can increase cost-consciousness among consumers and reduce utilization — but only if they are well-designed to avoid creating barriers to needed care that could lead to poor health outcomes for low-income people.
Publicly financed coverage
The advocates for publicly financed coverage, i.e., Medicaid and subsidies for low-income people in the individual market, have generally come from the consumer community as well as hospitals and physician groups. But employers are also affected, albeit indirectly, by increases or decreases in the number of people who have publicly financed coverage.
An increase in the uninsured rate and the associated loss of revenue would drive hospitals and other providers to increase prices for commercially insured patients. The net effect would be a cost shift from government-financed coverage to employer-based coverage, placing additional financial burdens on employers and their employees.
Furthermore, it's critically important for employers to have a healthy workforce. If new employees have not been able to afford coverage previously, they are likely to begin work with deferred health care needs. If that is the case, during their first months on the job, there is likely to be a significant increase in elective surgeries that were postponed when the employee was without health care coverage. Similarly, new employees with chronic medical conditions, such as diabetes, may have significant health problems that were not managed effectively without coverage. Any policy changes that result in increasing the number of uninsured would not only affect the families involved, but will drive up the overall costs for employers as well.
Employers Can Help
Large employers will continue to find ways to innovate to improve quality and curb spending by applying their purchasing power to further the principles of the value agenda. As policymakers address the problems in our current health care system, they should engage large employers with real-world experience in managing health benefits as helpful mission-aligned partners.
from Health Affairs BlogHealth Affairs Blog http://ift.tt/2kQ5pIG
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