WTW+2022年医疗保健最佳实践调查.pdf

1Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey12022 Best Practices in Healthcare Survey Highlights of key Introduction 03Identifying opportunities to control costs and make healthcare affordable 05Enhancing employee mental health and DEI initiatives 09Shaping the employee experience for health and wellbeing benefits 11Take action to manage competing priorities 14About the survey 15TABLE OF CONTENTS2Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey2Figure 1.Rising medical trend10.3%14.7%13.0%11.3%9.2%8.3%6.4%5.3%6.8%6.8%5.5%5.5%4.2%4.9%4.0%4.4%4.0%4.0%3.7%1.5%5.0%5.0%6.0%9.0%8.0%8.0%8.0%8.0%6.8%6.0%6.0%5.0%6.0%5.0%5.0%4.1%2.6%5.6%5.1%6.2%20012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023*Healthcare Trend After Plan Changes(Total Plan Costs)Healthcare Trend Before Plan ChangesCPI-UWage growthExpected;*ProjectedNote:Percentages of healthcare trend are median numbers.Sample:Companies with at least 1,000 employees.Source:WTW 2022 Best Practices in Healthcare Survey;Bureau of Labor Statistics,CPI-U,CES.3Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey3Employers are bracing for a higher-cost environment as rampant inflation and market forces fuel a projected rise in healthcare costs of 6%for 2023(Figure 1).This is a one-percentage-point hike over the 5%increase expected in 2022 and higher than 2022s wage growth of 5.3%.IntroductionU.S.employers balance controlling healthcare costs with boosting affordability and enhancing mental health programsFindings from our 2022 Best Practices in Healthcare Survey suggest we are entering a period of sustained cost increases.Seven in 10 employers anticipate moderate to significant increases in healthcare costs over the next three years.Budgeting can become challenging in these circumstances.Over half of respondents(54%)expect their costs will be over budget in 2022.Fewer than a fifth(15%)expect their costs to be at budget.Diversity,equity and inclusion(DEI)Add/Enhance benefits that reflect services important to unique populations and provide fair opportunity to attain the highest level of health and wellbeing that meet employees needsWhat are your organizations top health and wellbeing priorities over the next three years?(Select at most the top five options)Mental health and emotional wellbeing Enhance mental health and emotional wellbeing programs and solutionsEmployee affordabilityAchieve health program costs that are affordable for employees,especially lower-wage employeesCompany costsManage companys healthcare plan costs67%67%52%42%Figure 2.Employers key priorities over next three years4Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey4Competing priorities:Cost management,affordability,enhanced benefitsIn this higher-cost environment,over two-thirds of employers(67%)plan to prioritize managing their organizations healthcare plan costs over the next three years(Figure 2).But,at the same time,employers understand that to attract,engage and retain talent in todays tight labor market,it is important to offer benefits that are affordable and competitive.Accordingly,employers rank employee affordability as a key priority,especially as it applies to lower-wage workers.Additionally,many employers are looking to strengthen their employee health and wellbeing programs.Given the toll the pandemic has taken on employees emotional health,employers ranked enhancing mental health and emotional wellbeing programs as their top priority along with managing costs.Employers also recognize the urgency of meeting the needs of a diverse workforce,addressing the many social factors that influence health and treating all workers in an equitable and inclusive manner.With this in mind,over half of survey respondents(52%)indicate they plan to prioritize adding or enhancing diversity,equity and inclusion(DEI)in health and wellbeing benefits.Managing these competing priorities requires planning ahead to identify high-impact opportunities to mitigate costs,improve affordability,and strengthen health and wellbeing programs.41%3%8%Action taken/Tactic used in 2022Planning for 2023Considering for 2024Figure 3.Employers use a defined contribution strategy to control costs5Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey5To address cost management challenges,more than half of employers(52%)will implement programs or switch to vendors that will reduce total costs.But only one in four(24%)will shift costs to employees through higher premium contributions.With limited budgets,many employers have increased their budgets to reflect anticipated increased medical costs.Of the four-fifths of organizations that have a three-year budget plan,more than four in 10(41%)have adjusted their plans,while almost half(47%)are discussing changes.Employers are also taking a variety of other actions to rein in healthcare costs:Implementing a defined contribution strategy.Four in 10 employers(41%)indicate they are using a defined contribution strategy with a fixed dollar amount provided to all employees that differs by plan tier(Figure 3).By 2024,over half(52%)could be using such an approach.Identifying opportunities to control costs and make healthcare affordable Spousal surcharges are becoming more common.In 2022,about three in 10 employers (31%)imposed a surcharge on employees with spouses who have access to their own employer-sponsored health insurance,up from 26%in 2021.By 2024,this figure could reach 40%.Managing medical plans costs.Employers are pursuing a range of measures to improve their management of medical plan costs.Concierge navigation.Two in 10 employers(21%)offer plan concierge navigation even if it required changing from a full-service health plan to a third-party administrator.This approach appears to be gaining in popularity,as another 25%are planning or considering offering concierge navigation by 2024.Travel benefits.Over half of employers(55%)provide domestic travel benefits for medical services,while another 11%are planning or considering doing so in the next two years.Fraud,waste and abuse.A quarter of respondents(27%)added or enhanced programs to combat fraud,waste and abuse.Another 22%are looking to do so by 2024.Out-of-pocket costs.Nearly a quarter of employers(23%)implemented higher out-of-pocket costs for use of less efficient services or site of service,such as use of non-preferred labs,use of high-cost facilities for imaging or failure to use mandated centers of excellence.Another 19%are planning or considering doing so in the next two years.Figure 4.Contribution bandingNote:*Planning,Considering.Sample:Companies with at least 1,000 employees.Source:WTW 2017,2019,2021 and 2022 Best Practices in Healthcare Survey.24%25%23%20172019202131%202236%2023*46%2024Structure employee contributions based on employee pay levels or job grades6Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey6 Addressing employee affordability.To make healthcare benefits more affordable,employers are taking the following steps:Structuring employee contributions for targeted groups or by job class.More than a quarter of employers(28%)structured payroll contributions to reduce costs for targeted groups,such as low-wage employees,or by job class.Another 13%are planning or considering doing so in the next two years.Employers are increasingly structuring employee contributions based on pay or job class to reduce employee costs(Figure 4).While roughly three in 10(31%)take this approach today,this figure could jump to 46%in two years.Increasing healthcare plan budget.Two in 10 employers(20%)added dollars to their healthcare plan without reallocating funds from other benefits or pay.Another 30%expect to do so by 2024.Offering a low-deductible plan.Approximately three out of 10 employers(32%)offered a plan with low member cost sharing(e.g.,no more than a$500 deductible for a single preferred provider organization plan)in 2022;another 7%are planning or considering doing so in the next two years.Providing voluntary benefits.Over a third of respondents(35%)added or enhanced voluntary benefits(e.g.,critical illness,group accident,pet insurance,ID theft coverage)and vendor solutions.Another 27%are planning or considering doing so by 2024.Evaluating employee contributions by income.While only 13%of employers currently examine employee health payroll contributions as a percentage of total compensation(or income)as a basis for plan/benefit design decisions,this figure is expected to climb to 32%in the next two years.35%of employers added or enhanced voluntary benefits and vendor solutions in case of a catastrophic event.55%of employees provide domestic travel benefits for medical services.Figure 5.Navigation servicesFigure 6.Clinical areas employers are targeting to improve member health35%3%9%29%5%17%In place in 2021 or 2022Planning for 2023Considering for 2024Offer an expert medical opinion programOffer access to concierge services with integrated care management programs51%17%13%45%10%15%Mental/Behavioral health Metabolic syndrome/Diabetes37%17%19%Maternity/Infertility29%11%23%Cancer/Oncology28%13%14%Transgender support(including navigation support)35%10%19%Obesity and weight management30%18%21%MusculoskeletalAction taken/Tactic used in 2022Planning for 2023Considering for 20247Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey7Rethinking network and provider strategiesEmployers are using various network and provider strategies to rethink how and where healthcare is delivered in order to improve access to cost-efficient care.Among the most common of these strategies is the use of centers of excellence within health plans.About half of employers(47%)offer centers of excellence,while another 22%are planning or considering doing so in the next two years.Slightly more than half(51%)also offer onsite/worksite health promotion activities,with another 16%looking to do so by 2024.Additionally,employers are offering navigation services,including expert medical opinion and concierge services with integrated care management programs(Figure 5).Targeting clinical areas to improve member health and reduce costsCompanies are focusing on key clinical conditions to improve health outcomes and bring down costs(Figure 6).As was the case in 2021,employers reported focusing on mental/behavioral health as the leading clinical condition to prioritize followed by metabolic syndrome/diabetes.Maternity/fertility has moved up in importance from number six in 2021 to number three,as employers strive to meet the needs of diverse employees,including individuals having children later in life and LGBT+employees.Looking ahead to 2024,cancer/oncology ranks highest as a clinical area of focus.Employers also ranked obesity and weight management as a key clinical condition.Effective weight management initiatives can help improve health outcomes and employee productivity and reduce healthcare costs.Transgender support continues to be an area of increasing focus.This includes providing navigation services to help improve access and coordination of care in a cost-effective manner.Other common strategies include using direct-to-consumer Rx delivery or discount programs for select drugs and offering a narrow network of higher-quality and/or lower-cost providers.Figure 7.Employers act to control the costs of specialty drugs50%14%12%35%3%5%In place in 2021 or 2022Planning for 2023Considering for 2024Evaluate and address specialty drug costs and utilization that are paid through the medical benefitDo not apply third-party coupons/copay assistance toward deductible or out-of-pocket maximum33%11%10%Offer programs to maximize specialty copay assistance/optimization 25%6%15%Implement coverage changes to influence site of care for specialty pharmacy(e.g.,moving from outpatient hospital setting to lower-cost settings)8Table of contentsIntroductionIdentifying opportunities to control costs and make healthcare affordableEnhancing employee mental health and DEI initiativesShaping the employee experience for health and wellbeing benefitsTake action to manage competing prioritiesAbout the survey8Managing pharmacy plan costsTo manage pharmacy costs over the next two years,employers will focus on specialty drugs and deploy a range of actions in other target areas.Half of employers(50%)already evaluate and address specialty drug costs and utilization paid through the medical benefit,and roughly another quarter(26%)are planning or considering doing so by 2024(Figure 7).Over the next two years,employers are also looking to offer programs that maximize copay assistance for specialty drugs and to implement coverage changes to influence site of care for specialty pharmacy,such as moving from an outpatient hospital setting to lower-cost settings.Regarding biosimilar drug strategy,26%of employers currently offer members lower cost sharing for the use of biosimilars compared with name brand biologic medications,and another 20%are planning or considering taking this action in the next two years.Roughly a third of employers(34%)are waiting to decide on plan design strategy for biosimilar promotion until additional financial details are shared by vendors.Other key actions to control pharmacy plan costs include offering programs to maximize specialty copay assistance and issuing a formal RFP for pharmacy benefit management(PBM).9Table of contentsIntroductionIdentifying opportunities to control costs and make