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In partnership with Bind, we take a look at the future of employer sponsored health insurance.

Utah Business

In partnership with Bind, we take a look at the future of employer sponsored health insurance.

Is employer-sponsored health insurance dead?

With many unknowns about the future of healthcare policy in this country, some might wonder: Is employer-sponsored health insurance dead? I believe it’s broken, but it’s not dead. To the approximately 60 percent of Utahns who get their health insurance through their employer (the highest percentage of any state), this may be a relief. But there’s much work to be done to make employer-sponsored health insurance (or any health insurance) work like it should in 2020 and beyond.  

Originally, employer-sponsored health insurance was the answer to a perfect storm of post-World War II problems—a clever way to circumvent labor shortages and wage freezes gained a political foothold that hasn’t been dislodged. For both employers and employees, the mid-20th century model has become too costly, confusing, and unnavigable for today’s consumer-driven economy.

It’s time for change 

Healthcare operates by its own rules. There is possibly no other industry so removed from the power of the marketplace and consumer control. Employers and employees have been caught in an unnecessarily adversarial fight about who will pay the exorbitant costs. In many ways, we’ve fundamentally lost sight of the purpose of insurance and the role of consumers in making informed healthcare choices for themselves.    

Employers, this is not your fault. Poor insurance design has forced you to choose between meeting budgets or shifting cost increases to employees. This is not the fault of employees either. They’ve been forced to relinquish control of their own healthcare decisions and in the process have lost the consumer power that, in other industries, lowers costs and drives improvements. 

It’s time to change the design and build health insurance around the common goal of employers and employees: a great benefit that sustainably controls costs and provides choices among high-quality treatments and providers. We need a modern health insurance design that creates an intuitive fit between people’s health insurance and the way they actually use healthcare. 

Give employees tools to make informed choices

When a health plan provides the tools needed to see provider and treatment options for conditions in real time, as well as cost and quality comparisons, people are able to make decisions that are right for their unique circumstances. Advancements in data and AI have made it possible to give consumers tools that give them more awareness and control over how their care decisions impact their health, their pocketbook and the health plan group overall. Informed choice is incredibly powerful. Recent benchmark data shows that people are more likely to choose surgical alternatives and less expensive sites of care, when cost differences that expose value are presented up-front and side-by-side. 

When people are given a navigable health insurance experience that allows for informed choice and cost certainty, employers have a significant opportunity to increase workforce satisfaction and sustainably lower healthcare costs. And, most importantly, people are empowered to take control of their health. 

Bring visibility to quality and value in care decisions

People deserve to be able to shop for healthcare to solve their conditions the same way they shop in other parts of their daily lives. They should be able to see treatment options for the conditions ailing them, as well as a list of providers who are known to effectively and efficiently treat each condition. They should be able to instantly see their options and compare prices from the palm of their hand. All the information needed to make decisions that are right for their unique circumstances should be available online in real-time. 

People also deserve to know that surgical interventions aren’t always the best treatment options—and prices should reflect that. Take knee pain as an example. It makes sense to put more subsidy into physical therapy, chiropractic care and pain injections. And less subsidy into knee arthroscopy (a surgical procedure with high cost variation and questioned rates of efficacy). But if it’s decided that someone should have a knee arthroscopy, their health plan should help them find a provider who has good outcomes at a fair price. 

Eliminate affordability barriers 

Deductibles were originally introduced to employer-sponsored health insurance to create shared member burden—to give employees more “skin in the game.” The hope was that people would select and consume care more thoughtfully if they had to cover all costs out of the gate. But people can’t price shop if they don’t know the prices. And without the money to fund care 100 percent until a deductible is met, many people skip or postpone care. A quarter of Americans skipped necessary medical care in 2018 because they were concerned they couldn’t afford the costs.

When barriers like deductibles, coinsurance, cost uncertainty and narrow networks are eliminated, people have the freedom and flexibility to use their health benefit the way they personally need to. A health benefit that a person can’t use isn’t actually a benefit. 

Consumer-centric health insurance is the future

Regardless of what happens with US healthcare policy over the next four years, cost will continue to be a concern for Americans. And regardless of the payer system that’s in place, nothing will change unless there’s a fundamental shift in the culture of how we view healthcare in this country. We need to focus on achieving health—not just treating sickness. 

Change starts at the financing level—with health insurance. Health insurance that is focused on conditions, treatment and health. Health insurance that is aimed at improving and maintaining health. Health insurance that makes more effective, efficient providers and treatments cost less. Health insurance that understands and reflects consumer value. 

Employers, the health insurance industry hasn’t served you well. But we now have an opportunity to design better—an opportunity to stop pitting you against your budgets and employees. 

We have the power to fix employer-sponsored health insurance. It starts with a consumer-centric mindset.

Jodi Hubler president of Bind, believes innovation and certainty are the keys to health benefits design. A veteran health care industry executive, investor, and former CHRO, she has a unique perspective on what makes good business, good policy, and high-quality employee benefit programs.

Comments (7)

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    David Murphy, PHR

    I would agree with the fundamental approach shared in the article. I think there needs to be more transparency in the costs and the consumer needs to be better informed. We have the technology to share this information and make it available on an App. I have spoken to several Doctors who would be happy to share their pricing information. The biggest hurdle I see to making health care consumer driven is the insurance companies. Over the years the insurance companies have found more ways to hide costs, not pay claims, make the paperwork as complicated as possible and just plain frustrate the doctors and the consumers. Ask a doctor how many people he now has to employ just to code and file a claim. In the old days you could actually see an entire bill from like the hospital. During this time my wife gave birth to two children. We were sent the bill and told to review it for errors. At that time our insurance company would pay us 10% of the savings we found in the errors. We earned several hundred dollars due to all the billing errors. They no longer let you do that. I was in the emergency room the other day and was put through so many tests, CT Scans, xrays, etc. to confirm what the doctor already suspected in his initial diagnosis. Many of the treatment cost thousands of dollars and i knew it. But, I wasn’t going to say no because I just wanted the pain to stop. I began to feel they were running all these tests for two reasons and neither of them had to do with me. Reason 1 was to increase revenues for the at profit Hospital and 2 was to cover themselves from a potential malpractice suit. I am a strong proponent of consumer driven healthcare but there are a lot of things that need to be fixed if the system is going to work.

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    James McDougal

    This sounds similar to Arches, which, if I recall, was a casualty of the ACA funding fighting. I was a big fan of the concept and will be keeping an eye on this one.

    reply
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    Rick Lindquist (LegUp Health)

    It’s not dead, but it’s dying. And the new democrat-controlled congress is going to accelerate it’s death.

    reply
    • Avatar

      Rick Lindquist (LegUp Health)

      its*

      reply
  • Avatar

    John Montague

    I enjoyed reading this article and the comments. Full disclosure, I’m very biased on this topic because I’m both a passionate Bind member — and a Bind employee.

    In today’s challenging economic environment, Bind’s innovative health plan helps companies reduce costs while also delivering a better benefit to their employees. As one of the 100,000+ happy Bind members, I can’t imagine going back to the “old way” of health insurance.

    If anyone is interested to further discuss this topic and learn more about Bind, then I welcome you to send me an email at: john.montague@yourbind.com

    reply
  • Avatar

    Timothy Funk

    As one who has had six operations and multiple procedures on both knees and shoulders I agree completely with Jodi Hubler. Most of my medical intervention was pretty obvious, I needed the surgery I got. But the one shoulder not operated on is,or actually was, plenty sore and really troublesome. Do I need surgery or is something more procedural and less complicated like PT and pain injections more feasible, less invasive and just as reasonable? So far you bet it is. I have trusted every doctor I have dealt with but plenty of experience has taught me finally to listen and learn. I am a bit smarter than I was six operations (and rigorous rehabs) ago. Yes, I have had decent health insurance but I had to learn over a long period of time how to ask and challenge my providers. Early on if I had had the kind of qualified care and guidance described in the article I might well have avoided at least two of the surgeries I have received plus the one I am avoiding on my shoulder.

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  • Avatar

    Kwin Peterson

    Our surgical center posts transparent, fixed prices on our website—no confusion, no arbitration, and market forces at work. Transparency is coming and with it a lot more certainty and clarity for the employers who pay for so much of healthcare.

    reply

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