mercer为美国保险业协会做的绝密hr分析报告.ppt

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1、mercer为美国保险业为美国保险业协会做的绝密协会做的绝密hr分析分析报告报告1AgendanThe EnvironmentnThe Catch-22nPaths Away from Traditional Delivery: Two CampsnOpportunities Along Path 2nThe AnswernAdditional Topics2AgendanThe EnvironmentMedical TrendsLegislationMarketplace ChangesPopulation DemographicsEmployer OutlooknThe Catch-22n

2、Paths Away from Traditional Delivery: Two CampsnOpportunities Along Path 2nThe AnswernAdditional Topics3Double-Digit Increase for Second Year in a RowPer employee costs in excess of $5,600 per year-2.9%+6.2%+7.3%+8.1%+11.2%+14.7%Source: 2002 Mercer/Foster Higgins National Survey of Employer-sponsore

3、d Health Plans4Annual CPI Trend U.S. health care costs rise, despite continuing economic recessionThe gap between CPI-U and medical care component is increasing1990199119921993199419951996199719981999200020012002CPI-Medical Care9.0%8.7%7.4%5.9%4.8%4.5%3.5%2.8%3.2%3.5%3.9%4.6%4.7%CPI Overall5.4%4.2%3

4、.0%3.0%2.6%2.8%3.0%2.3%1.6%2.2%3.3%2.8%1.5%Ratio MC/Overall1.72.12.52.01.81.61.21.22.01.61.21.63.1Source: U.S. Bureau of Labor Statistics5Comparison of Overall Growth Cumulative medical care CPI 89% greater than overall CPI since 1967Data based on January 1 CPI valuesCPI vs. CPI Medical Care01002003

5、00400196719691971197319751977197919811983198519871989199119931995199719992001YearStandardized CostMedical Care CPIOverall CPI6Employers Cost Increases Out-Pace Other Indicators Largest increase since 1990 (all employers)Includes medical, dental and pharmacySource: 2002 Mercer/Foster Higgins National

6、 Survey of Employer-sponsored Health PlansResults for Employers with 500 or more lives6.9%18.6%16.7%17.1%12.1%10.1%8.0%-1.1%0.2%6.1%7.3%8.1%11.2%14.7%2.1%2.5%-2.00%0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%16.00%18.00%20.00%1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

7、2002EmployersCPI-MedicalCPI-All Items7Aggregate Health Care Spending (1980 2010) Government portion of payments increasing; total projected to be over $2 trillion by 2009Source: CMS8Medical TrendsnPop QuiznHow many years will it take gross medical costs to double, assuming no specific employer inter

8、ventions or national health care?10 or more98765 or fewer9Medical TrendsResponses from a group of 25 actuaries who had time to get their calculators10LegislationnMedicare Prescription DrugsIf made into law, will have major impact on retiree benefits and strategiesInitial confusion aside, should have

9、 positive impact on retiree plansExpect cost shifting to negatively impact active plansnEEOC Proposed changes in ADEA regulationsCline vs. General DynamicsnWells Fargo caseAppears to allow pre-funding (and tax-deductibility) of entire retiree liabilityoan ILP approachowont be exactly same number as

10、FAS liabilityofunding in years 2+ would be limited to service costIRS weighing its options11Proposals to Increase Coverage Among Early RetireesFew government programs except for financially indigentnCOBRA extensions and/or Medicare buy-insnProhibitions on post-retirement benefit reductionsnExpanded

11、pre-funding for retiree medicalStill few viable products for pre-65 in individual market that overcome access and affordability issues.12ADEA IssuesImpact on retiree medical coveragenAge Discrimination in Employment Act (ADEA) prohibits discrimination against persons age 40 or older in terms and con

12、ditions of employmentnAge-based distinctions in employee benefit plans are permissible only if:A specific statutory exception applies, orEqual benefit/equal cost test is satisfiedoPlan must provide equal benefits for older and younger workers, oroPlan must incur equal costs for older and younger wor

13、kersnThird and Sixth Circuit Courts reach different conclusionsnEEOC reviewing ADEA regulations13Marketplace ChangesConsolidation of Major Health Care Carriers Employer options are greatly reduced, carriers have more cloutUnited HealthcareHealthSourceProvidentCIGNAEquicorMetrahealthUS HealthcareAetn

14、aTakeCareFHPPacifiCareHealthSourceCIGNAAetna US HealthcareNYLCarePrudential HealthCareFHPPacifiCareProvidentTransamericaEquitableHCAMetropolitanPartnersAetnaGSDHPLincoln National HPsTakeCarePacifiCareHealth Plan of AmericaWellPoint/Blue Cross of CaliforniaHancockMass MutualTravelersUnited Healthcare

15、AetnaPacifiCare Health SystemsWellPoint/BlueCross of CaliforniaCIGNABCBS of GeorgiaMultiple BCBS PlansFewerMajor BCBS14Marketplace Changes PBM consolidation continues; three major national PBMs remainCPIAPICPNRxNetValue RxDiagnostekPerformHCSHPIDiagnostekValue RxRxNetColumbiaValue RxExpress ScriptsE

16、xpress ScriptsNPADPSExpress ScriptsPAIDMEDCOAdvanced ParadigmAdvanceMedcoIntegrated Prescription Solutions (IPS)PCSFoundationMerck-MedcoMerck-MedcoProadvantageSystemedParadigmMerck-MedcoMedcoAdvance PCSMajor InsurersMajorInsurersMPSPCSClinical Pharmacy Advantage15Population TrendsAging baby boomers

17、will increase the elderly and near elderly populationsData Source: U.S. Census Bureau State Population ProjectionsBaby Boomers Year of Birth 1946 to 1964Source: U.S. Census Bureau as of January 20003,0008,00013,00018,00023,00028,00020 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465 -

18、6970 - 7475 - 7980 - 8485+Age GroupNumber (000s)2000 US PopulationBaby BoomersU.S. Population, 2000Projected Population010203040506070802000201020202030Ages 55 to 64Ages 65 or OlderMillions16Negative Tidal Wave of Available Talent Pool of “prime workers” will be decreasing Source: DRI, World at Work

19、 Journal, fourth quarter 2001Percent Change in Population by Age Group, 2000-10-20%-10%0%10%20%30%40%50%60%5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79The “Echo boom”ages 15-29Shrinking Pool of“Prime workers”ages 30-44Aging “Baby boomers”ages 45-6917Impact

20、of Demographics on Health Care Cost Cost increases with age0.000.501.001.502.002.503.0020-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-6465+AgeRelative Cost by AgeMaleFemaleAverage employer cost = 1.0Relative Costs By Age and Gender18Health Deterioration A cause and a consequence nWe eat too much

21、 - 64.5% of adults overweightnPopulation with diabetes increased over 50% in last decade*Overweight is roughly 10 to 30 pounds over an ideal weight. Obesity is roughly 30 pounds over an ideal weightSource: National Health and Nutrition Examination Survey45.0%47.0%47.0%56.0%64.5%19Issues Facing Busin

22、esses The perfect storm nLow ambient inflation; high medical inflationnAdvances in medical technology likely to lead to higher costs, difficult decisionsnLegislative uncertaintynConsolidating medical delivery and financing systemnAn aging workforcenIncreased longevitynSlowing economynDisappearing ov

23、er-funded pension plansnFew, if any, obvious and easy alternatives to managing health care costs20Employer OutlooknEnvironmental outlook spurring employer actionEmployers acutely aware of trendsnHeightened interest in cost saving strategies (active and retiree)nGreater emphasis on longer term cost p

24、rojections and on the “bottom line”nProjection results have induced “fight or flight” responses21Retiree Medical Coverage Employers continue to drop retiree medical coveragePercentage of EmployersOffering Coverage to Future RetireesBased on employers of 500 or more lives responding to the2001 Mercer

25、/Foster Higgins Survey of Employer-Sponsored Health PlansnWhen coverage is offered, retiree premiums and out-of-pocket costs often increase22AgendanThe EnvironmentnThe Catch-22nPaths Away from Traditional Delivery: Two CampsnOpportunities Along Path 2nThe AnswernAdditional Topics23The Catch-22nReduc

26、ing employer cost typically implies increasing employee/retiree costnEventually runs against employers sensibilities regarding fairness, paternalism (if present), and the concept of benefits generallynExample (FAS 106): “Lower my liabilities significantly but dont do anything harsh to our retireesth

27、ey wont accept it”To the extent that retirees represent the bulk of the liability, this is a very difficult propositionOpportunities exist to change eligibility, design , etc. for future retireesnIf we dont take cost out of the system, either the employer or the employees/retirees will pay the incre

28、ases24AgendanThe EnvironmentnThe Catch-22nPaths Away from Traditional Delivery: Two CampsnOpportunities Along Path 2nThe AnswernAdditional Topics25Paths Away from Traditional Delivery: Two CampsnEmployers that become more involved inChanging employee behaviorChanging provider behaviorChanging provid

29、ers that they work withChanging the lawsnEmployers that reduce their involvement byIncreasing employee responsibilityLimiting employer costLimiting employer risk26Employers Becoming More InvolvednCollective PurchasingnHigh Performance NetworksnDirect ContractingnConsumer AccountabilitynLeap FrognLob

30、byingnDisease Management/Preventive CarenWhat these approaches share is an eye toward reducing cost from the employers system, and in some cases, the entire health care system.27Collective PurchasingUse employer and plan manager clout to negotiate favorable payment arrangementsnBackgroundTraditional

31、 network negotiations are volume drivennApproaches to achieve lower costs includeAggregated purchasing to improve negotiating strengthoCoalitionsoFormal alliancesoInformal alliancesDirecting care to most cost-effective source of quality careReviewing effectiveness, efficiency and “fit” of current ve

32、ndor relationships; changing as appropriate28What is a HPN? High Performance Network: A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria29Rationale for HPNs nNew management approaches are needed in this era of cost accelerati

33、onnPatients and physicians are the key drivers of health care costsBut they have limited or no incentive to care about costsnThe heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians30High Performance Networks Network modelsnLimited

34、NetworkA subset of an existing provider network comprised of high performing providersnTiered NetworkEmployee copay/coinsurance differentials to encourage use of high performing providersnPhysician PartneringAn arrangement with (typically) primary care physicians to enhance efficiencynConsumer Drive

35、nDeployment of performance information to consumers to improve provider selection31Direct Contracting nLarge employers with significant market presencenMay be able to achieve significant savings by contracting directly with health care providersnMay need group of regional employers to achieve critic

36、al mass32Promote Consumer AccountabilityHelp patients be better consumers of health carenBackgroundIf half of cost is due to lifestyle and half of chronic patients do not follow treatment plan, what can we do?oGet members attention make them aware of consequencesnApproaches to encourage consumer inv

37、olvement includeCoordinated health promotion, disease prevention and educational programsTying employee cost increase to trend“Defined contribution” health plansConsumer directed health careRe-introduction of coinsurance33Efforts to Improve Quality of Care in Hospitals Leapfrog initiative nThe Leapf

38、rog Group: BackgroundFormed in response to Institute of Medicine study of errors in health careGoal: Major gains in patient safety, customer service and health care affordabilitySponsored by Business RoundtableEmployers in Leapfrog Group use purchasing power to encourage health care providers to ado

39、pt patient safety standardsnLeapfrog standards include:Computerized systems in hospitals to improve the accuracy of physicians prescriptions and minimize medication errorsStaffing of intensive care units by physicians trained in critical care medicineReferral of patients requiring certain complex pr

40、ocedures to hospitals offering the best results34Lobbying nSome employers making presence felt on Capitol HillnMany have been active for years and are recognized as important voicesnSome large associations have similar goals and represent large voting populations35Preventive Care and Disease Managem

41、ent Across theHealth Care Continuum Programs should be tailored to the needsPreventionScreeningsHealth Risk AssessmentTargeted Risk Reduction ProgramsRisk ModelingNurse Advice LineWeb ToolsConsumer DirectedHealth PlanDiseaseManagementIncentive DesignSelf ManagementTrainingCase ManagementDecision Sup

42、portPredictive ModelingWellNo DiseaseAt RiskObesityHigh CholesterolAcute Illness/Discretionary CareDoctor VisitsEmergency VisitsChronic Illness DiabetesCoronary Heart DiseaseCatastrophicHead InjuryCancer85% members = 15% cost15% members = 85% cost36Employers Becoming More Involved SummarynTypically

43、the larger employersn“Fighting” to change the way health care delivered to own employeesGoal is to produce better outcomesAnd lower cost37Employers Becoming Less Involved (Camp 2)nEmployers desire to “know their cost”nDollar-based plans (often account-based)nReimbursement plansnAccess Only plansn“Ca

44、pped Plans”typically retiree medicalnWhat these approaches share is an eye toward reducing employer cost at the expense of employees/retirees38Account-Based ApproachesnDefines employers commitment as a defined dollar contribution instead of a defined medical benefitnCommitment can be monthly, annual

45、, aggregatenCommitment can be based on retiree-only or recognize dependentsnAmounts available for health care only; employer contributions are tax-free to the retiree and deductible for employer under Sections 105, 106 and 162 of IRCnCan be funded or unfundednFor Medicare-eligible, Medicare+Choice,

46、Medigap and traditional Medicare available; HIPAA may eventually make this a viable option for pre-Medicare retirees39Account-Based ApproachesExamplesnMonthly/annual promiseRetirees receive monthly (or annual) credits of a specified dollar amount (e.g., $100/monthly; $5/month/year of service for 20

47、years of service)Fixed or increases annually; “flat” or tied to service; amount not used can be carried over or notnAggregate (“lump sum”) promiseEmployer promise is one-time credit (e.g., $30,000; $1,000 per year of service for 30 years of service); accounts earn interest (e.g., at T-bill rate) or

48、not; no employer pre-funding requiredPayment optionso“Draw-down” on funds (retiree uses funds to pay portion of retiree medical cost; ends when fund exhausted), or “lump sum” is converted to an annuity (multiple options)40Reimbursement Plans nEmployer often requires submission of receipts for health

49、 care expendituresPremiumsOut-of-Pocket costsnTypically defined with a maximum reimbursable limit (e.g. $75/month)nMost common is reimbursement (or pre-payment) of Medicare Part B premium for Medicare eligible retireesCurrent cost $58.70 per month with moderate year-to-year trendsEmployer motivated

50、to ensure Part B in effect for Medicare-eligible retireesPart D reimbursement may become popularnEmployer achievingEscape from plan sponsorship (for whichever segment of his population the plan applies to)Fixed costs; increases subject to employer discretionnNot a tax-advantaged approach41Access Onl