The four chief UM techniques cited in the report as potentially causing substantial problems for employees are prior authorization, step therapy, non-medical switching and copay accumulators. (Photo: Shutterstock)
Employers trying to achieve a balance between the health care coverage their employees need and efforts to control costs are increasingly putting pressure on employees, who are paying higher prices for less coverage and more obstacles. And that can be penny wise and pound foolish.
A report from nonprofit Aimed Alliance, "Costly Considerations: An Analysis of Employer Priorities When Selecting Health Benefits," which sought input from both human resource professionals and executives who are involved in employee health benefits, finds that while HR professionals prioritize the quality of care provided by health plans, in the end they choose plans that shift high costs to employees, limit access, or both—despite being aware of such plans' negative impact on employees.
According to the report, more than 75 percent of HR professionals whose plans include utilization management techniques say they're aware of insured employees reporting negative life impacts because of inability to afford health care services or treatment. In addition, nearly 55 percent of HR professionals whose plans include UM techniques say employees have ended up taking extended medical leave because they couldn't afford or get treatment through their health plan.
The four chief UM techniques cited in the report as potentially causing substantial problems for employees are prior authorization, step therapy, non-medical switching and copay accumulators. They not only make it difficult for employees to experience uninterrupted care but also perhaps to receive care at all.
Prior authorization can delay care or prevent its access altogether, while step therapy requires workers to "try and fail on alternative medications" before they're allowed to receive the care that their practitioners have prescribed.
Non-medical switching can eliminate treatments on which employees are stable, which can make them relapse or experience progression of their health problem, and copay accumulators can make medication financially inaccessible by preventing manufacturer coupons from counting towards a patient's deductible or out-of-pocket limit—thus putting it beyond reach.
And considering that some employers choose to provide health plans that both increase cost-sharing and reduce access, employees can end up having to seek even more treatment, driving up costs, and be less productive at work or even end up quitting because of health concerns—thus increasing employer costs for turnover and lower productivity.
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
