It's certainly not news to any employer that the upward trajectory of health costs has been steady and relentless. On a per-capita basis, health spending has increased over 31-fold in the last four decades, from $355 per person in 1970 to $11,172 in 2018.
Even with the introduction of HMOs, PPOs and value-based contracts over the years, the cost of employer-sponsored insurance plans also continues to rise.
This hits employers and employees equally hard. In the past 20 years:
· The average individual insurance premium has increased from $2,196 to $7,168, representing a 226% increase.
· The average family premium has increased from $5,791 to $20,576, representing a 255% increase.
In addition, the average worker contribution for family coverage has increased 25% over the last five years, and 71% over the last 10 years. In 2019, the average deductible amount for single coverage is $1,655 which has increased 36% over the last five years, and 100% over the last 10 years.
As a result:
· There has been a significant transfer of wealth from employers/employees into the healthcare system.
· Take-home wages have stagnated for the past 20+ years.
· Healthcare costs are a significant contributor to bankruptcy, even among insured workers.
· Hyperinflating healthcare costs have significantly reduced retirement savings.
· Employer spending on capital expenditures has dramatically reduced.
Staring up a mountain of facts and statistics like these, what can employers do to help keep insurance costs contained -- without sacrificing the quality of care?
With the cost containment strategies of the EBS solution, employers in a variety of industries have been able to control or reduce healthcare spend by 20 to 40% over time.
Our High-Performing Health Plans High-Performing Health Plans eliminate waste and redundancy, streamline processes, reduce costs, improve quality and create better experiences for the plan's members.
With the cost containment strategies of the EBS solution, employers in a variety of industries have been able to control or reduce healthcare spend by 20 to 40% over time.
Our High-Performing Health Plans High-Performing Health Plans eliminate waste and redundancy, streamline processes, reduce costs, improve quality and create better experiences for the plan?s members.
Medical Cost Containment Strategies
Direct Primary Care - Savings: 10-20%
Highly accessible primary care significantly reduces urgent/emergency room visits, duplicative tests, and hospitalizations. Members have same day-appointments and unlimited time with their primary care physicians.
Quality Provider Navigation - Savings: 10-20%
Members can feel confident in their sub-specialty provider choice with proven improved outcomes and reduced costs. Most plans offer incentives like reduced cost-sharing for those who choose high-quality providers.
Alternative Reimbursement - Savings: 20-30%
Reference-based Pricing (RBP) is a powerful tool that allows the plan sponsor to set its reimbursement schedule using multiples of Medicare.
Direct Contracting - Savings: 10-20%
Common for routine procedures, imaging, healthcare commodities or densities of populations with nearby healthcare systems, direct contracting leverages mutually beneficial relationships to offer reduced costs, steerage and lessened administrative burdens.
Medical Management - Savings: 5-10%
Sound medical management ensures evidence-based guidelines for pre-certification, utilization management, case management and disease management.
Disease-Specific Program - Savings: 5-10%
These programs are designed to target specific diseases like cancer, MSK (musculoskeletal conditions), diabetes, etc., and provide high-quality specialized care.
Pharmacy Cost Containment Strategies
Fiduciary Pass-Through PBMs - Savings: 10-20%
This service provides the oversight to control the many layers of costs of Pharmacy Benefit Managers (PBMs) Contracts specify that the PBM will only receive an administrative fee, and is obligated to provide the most cost-effective medications as well as a pass-through of all rebates.
International Prescription Sourcing Program - Savings: 5-10%
This program provides expert assistance in streamlining the process of obtaining and containing the costs of medications from Canada, the United Kingdom and Australia.
Variable Copay Program - Savings: 5-10%
This program reduces cost on eligible brand name and specialty medications by utilizing manufacturer-provided coupons.
Manufacturer Assistance Program - Savings: 75%
This program assists qualifying members (based on household income) in obtaining high cost specialty medications directly from the prescription manufacturer at no cost to the member.
Pharmacy Direct Contracting - Savings: 10-15%
This service assists patients in contracting directly with pharmacies for medications related to hip replacement, hernia repairs, sinuplasty and multiple imaging.
As employee benefits brokers, our core competency is to provide you access to medical, dental, vision, life, disability, and other insurance products. We help you navigate employee benefits through automated technologies that streamline and automate the process, such as integrated payroll, enrollment platforms, benefits administration, and Human Resource Information Systems. We keep you out of the penalty zone by advising you and providing solutions to meet your ERISA and Affordable Care Act (ACA) requirements, including reporting and distributing notices. We protect your bottom line by providing financially-focused and strategic planning, cost containment strategies, and risk management. We back all of this up with incredible customer service that is with you every step of the way. We are Employee Benefit Services. We are easier, better, smarter.
