It's an established fact: High health care costs are hurting employers and employees. For years, employers tried to curb their spend by implementing consumer-driven strategies, often with the opposite consequences. "As we evolve as companies to really wrap resources around our employees, we're realizing that our focus on consumerism or what was consumerism, didn't really pan out the way we hoped it would," Brian Marcotte, president and CEO of the National Business Group on Health, said in a recent webinar. " As much as we would like consumers to be sophisticated purchasers of health care, the system is too fragmented." Instead, more employers and their benefits partners are trying a new strategy, or rather, series of strategies, changing the way health care is provided and paid for. "There's a confluence of energy around looking at alternative ways to pay for health care," said Suzanne Delbanco of Catalyst for Payment Reform, a non-profit offering thought-leadership for health care reform strategies and host of the webinar, "Are Disruptive Health Care Purchasing Strategies Becoming the New Normal?" Related: Creative plan design: Overcoming the obstacles During the webinar, HR and benefits professionals shared their experiences using a variety of strategies to rein in health care costs, including alternative TPAs, group purchasing, bundled payments, direct contracting and semi-direct contracting (click through the slideshow above to learn more about how companies instituted these strategies). In listening to each strategy, a few key takeaways emerged. One, what works (or doesn't) in one area may or may not work for someone else. State regulations can play a role, as well as the availability of startup services. The health care market and number of providers may also limit an employers' bargaining power. "Health care is local," said Marcotte. "It's a market-by-market battle." In addition, health care providers may not be prepared to deal with employers looking to test out alternative strategies--but that shouldn't be a deterrent. "Our experience indicated that the marketplace wasn't as far along as we'd hoped in terms of offering some of the things were were looking at," said Vicki Mair, benefits manager for the St. Vrain Valley School District. "But the companies we talked with voiced a willingness to partner with the districts to advance some of these more innovative approaches. I'm hopeful that we've begun to see some shift in the marketplace." "Part of this is sharing the perspective of stakeholders," Marcotte added. "If you ask, providers aren't getting the data. The health plans say providers aren't ready yet. You hear all of this noise, but if you get them all in the room, you can figure out what's really going on. You start to wrestle some of those issues." In fact, said Marcotte, NBGH research shows that employers interest in direct contracting and Centers of Excellence doubled over a two-year period. As demand for alternative solutions heats up, health care entities will have to be more willing to adapt--or be driven out. "There's this tension between employer and benefits and the employee experience," said Jodi Hubler, managing director of health care investment firm Lemhi Ventures. "Combine that with the significant opportunity for new options. You've attracted a significant number of entrepreneurs." Bind is one that Hubler is particularly interested (and invested) in. Others are mentioned throughout the strategy case studies--ZeroCard, Carrum, Imagine Health. "The most promising models are those that are offering an opportunity to integrate," Hubler said. "It's not enough for me to have to wonder if it's covered, log into another vendor, look up what the price might be… but it's the ability to be relevant and have price transparency." Health care entities aren't the only one who have shown reluctance to adapt to new models. Risk-averse employers will also need some convincing. "We have a group we've brought together to try to figure this out," Marcotte said. "How do you advance this more quickly? We do a terrible job of articulating the value proposition. We don't do a great job of articulating to the employer the business case, and how the consumer experience will be different. They have to sell the change to their C-suite and their employees." Read more: |

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