Just more than half of 489 large U.S. companies now offer their employees a consumer-directed health plan (CDHP), up from 47 percent in 2008, according to a new survey issued by Watson Wyatt and the National Business Group on Health. Another 8 percent are expected to adopt a CDHP by 2010. Companies with at least half of their employees enrolled in a CDHP have two-year cost increases that are 25 percent lower than non-CDHP health plan sponsors (4.6 percent vs. 6.1 percent). . . . The proportion of children and working-age Americans who went without a prescription drug because of cost concerns jumped to 1 in 7 in 2007, up from 1 in 10 in 2003, according to a national study released by the Center for Studying Health System Change. The 2007 Tracking Survey identified rising prescription drug costs and less generous drug coverage as major contributors. . . .The credit rating organization A.M. Best forecasts a negative outlook for health insurers in 2009. But earnings are not a cause for concern (earnings remain favorable) — it’s the uncertainty of the economic environment. Recession, reform, and competition will affect enrollment and investment income. Declining enrollment, pressure from employers for lower premium rates, and competition in the commercial market will depress profit margins, according to the 2009 special report.
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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.
They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?
A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.
More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.