Entries in Surveys & Reports (138)

Thursday
Oct042018

Eighteen Things to Know from the 2018 KFF Employer Benefits Survey

By Clive Riddle, October 4, 2018

 

The Kaiser Family Foundation 2018 Employer Benefit Survey, an annual 200+ page definitive report of the state of employer health benefits since 1999, includes these eighteen things to know that KFF highlights:

 

 

  1.  On average, employees are contributing $5,547 toward the cost of family coverage, with employers paying the rest.
  2. Annual premiums for single coverage increased 3 percent to $6,896 this year, with employees contributing an average of $1,186.
  3. This year’s premium increases are comparable to the rise in employees’ wages (2.6%) and inflation (2.5%) during the same period. 
  4. Since 2008, average family premiums have increased 55 percent, twice as fast as employees’ earnings (26%) and three times as fast as inflation (17%).
  5. Currently 85% of covered employees have a deductible in their plan, up from 81% last year and 59% a decade ago. 
  6. The average single deductible now stands at $1,573 for those employees who have one, similar to last year’s $1,505 average but up sharply from $735 in 2008. 
  7. 26% of covered employees are now in plans with a deductible of at least $2,000, up from 22% last year and 15% five years ago. 
  8. Among covered employees at small firms (fewer than 200 employees), 42 percent face a deductible of at least $2,000.
  9. 57% of employers offer health benefits, the same as five years ago. 
  10. Some employers that offer health benefits provide financial incentives to employees who don’t enroll – either for enrolling in a spouse’s plan (13%) or otherwise opting out (16%).
  11. Overall 10% of all offering firms – and 24% of large ones – expect fewer employees and dependents to enroll because of the elimination of the ACA tax penalty.
  12. 21% of large firms report they collect some information from employees’ mobile apps or wearable devices as part of their wellness or health promotion programs (14% last year.)
  13. Most large offering employers (70%) provide employees with opportunities to complete health risk assessments.
  14. 38% of large offering firms provide incentives for employees to participate in wellness programs.
  15. 29% of firms that offer health benefits offer a high-deductible health plan with a savings option. 
  16. 61% of firms offering HDHPs only this type of plan to at least some of their employees. Overall, 29% of covered employees are enrolled in such plans.
  17. 74% of large firms (200+ employees) cover services provided through telemedicine, up from 63% last year and 27% in 2015. 
  18. 76% of large firms cover services received in retail clinics.

 

 

 

Friday
Sep142018

Post ACA Operating Margins: Health Systems and Health Plans

By Clive Riddle, September 14, 2018

Navigant this week released an eight-page report: Stiffening Headwinds Challenge Health Systems to Grow Smarter, that provides “an analysis of a three-year sample of the financial disclosures of 104 prominent health systems operating 47% of U.S. hospitals,” in which Navigant  “found broad-based and significant deterioration of operating earnings.”

 

Navigant reports that from 2015 to 2017:

  • The average operating margin decline for analyzed systems was 38.7%. Not-for-profit system margins fell 34%, while for-profit margins fell 39%.
  • 65% of systems experienced operating income declines totaling $6.8 billion, with the most significant reductions occurring in the U.S.’s fastest-growing regions: West/Southwest and South Central.
  • At the root of these declines were multiyear reductions in the rate of topline operating revenue growth, which fell from 7% (2015 to 2016) to only 5.5% (2016 to 2017), and a failure to contain expenses in line with revenue deterioration. 

Navigant cites these drivers of earnings deterioration:

  1. Weakening demand for such core hospital services as surgery and inpatient admissions, due in part to rising patient cost exposure from high-deductible health plans;
  2. Deteriorating collection rates for private accounts in non-ACA expansion states;
  3. Steady erosion in Medicare payment rates due to the ACA and the 2012 federal budget sequester; and
  4. Failure of health system value-based insurance contracts to deliver sufficient patient volume to offset steep upfront payer discounts and significant hospital population health investments.

Meanwhile on the other side of the post-ACA equation, Mark Farrah Associates this week “released an analysis brief providing insights into mid-year profitability for commercial and government lines of health insurance business. MFA compared second quarter, year-over-year profitability for the Individual, Employer-Group, Medicare and managed Medicaid segments.”

They found that:

  • At the end of second quarter 2018, the average medical expense ratio for the Individual segment was 70.8%, as compared to 77.2% the previous year.
  • Growth in premiums pushed the average medical expense ratio for the Employer-Group segment down to 80.9% for 2Q18 from 81.8% in 2Q17.
  • For Medicare Advantage, premium growth outpaced increases in medical expenses pushing the medical expense ratio down to 85.3% from 86.1% in 2Q17.
  • 2.9% increase in premiums per member per month pushed the medical expense ratio for Managed Medicaid down to 88.6% from 91.0% in 2Q17.

Mark Farrah Associates concludes the current outlook is better than the one Navigant finds for health systems: “At the mid-year point, all four health care segments are signifying improved profitability for health insurers over 2017.  The most significant change is once again in the Individual segment showing improvement over 2017, which ended up being a profitable year for the segment overall.  While this analysis of mid-year segment performance sheds light upon profitability trends for 2018, it’s a wait and see proposition until final financial results are revealed in spring of 2019.”

Thursday
Aug232018

Out of Network Services: Not Just Surprise Medical Bills, They Also Erode Care Coordination and Patient Retention

by Clive Riddle, August 23, 2018

Last week, Kaiser Family Foundation released a study of medical bills in large employer plans that found "a significant share of inpatient hospital admissions includes bills from providers not in the health plan’s networks, generally leaving patients subject to higher cost-sharing and potential additional bills from providers." The report stated "almost 18 percent of inpatient admissions result in non-network claims for patients with large employer coverage. Even when enrollees choose in-network facilities, 15 percent of admissions include a bill from an out-of-network provider, such as from a surgeon or an anesthesiologist."

 

The focus of the KFF study of course was surprise medical bills. This week, Kyruus released their 12-page 2018 Referral Trends Report: Positioning for Patient Retention which examines out of network services from a different perspective – when referred by an in-network physician, with the issue focus being on care coordination and patient retention.

The report presents physician survey findings that indicate “one-third of out-of-network referrals would be avoidable with more robust information about in-network colleagues," and "while 77 percent of providers surveyed recognize the importance of keeping patients in-network for care coordination, a notable 79 percent say they refer patients out of network."

The report tells us:

  • Among those who refer out of network, 45 percent say that it’s difficult to determine who is in the network
  • On average, providers that refer out of network send almost 1/4 of patients out-of-network
  • 42 percent of patients leave a provider’s office without a necessary referral appointment booked, despite over 60 percent of providers considering point-of-service scheduling extremely or very important.        
  • Personal networks drive current referral behaviors: 72 percent of providers say they or their staff usually refer to the same provider for a given specialty
  • 40 percent of providers report always knowing whether or not their referral was appropriate for the patient or whether the patient needed to be re-referred, hindering care coordination.       

The report concludes that "providers understand the importance of keeping patients in network to improve care. However, without the right tools to facilitate clinically appropriate and in-network referrals, providers will not necessarily break from familiar patterns."

 

Friday
Aug172018

Healthcare costs – not grandchildren gone wild – the top retiree concern

By Clive Riddle, August 17, 2018

 

What’s the top concern about retirement years voiced by retirees as well as retirement plan sponsors? Its not grandchildren gone wild, keeping up with new technology, staying ahead of future inflation, or even staying in good health. Instead, its paying for that health.

 

Results just released from the 2018 TIAA Plan Sponsor Survey of 1,001 plans sponsors from nonprofit and for-profit organizations found that 91% of plan sponsors believe that healthcare costs are the most significant retirement security issue today. 54% answered very significant and 26% said somewhat significant, while 2% were neutral and – the plan sponsors I’m curious about: 3% said not at all significant.) After health care at 91%, the next highest concern of the top six: Ensuring employees are prepared to retire on a timely basis total 81% saying it was very or somewhat significant.

 

Meanwhile, another new survey tells us even affluent retirees are plenty scared about those retirement costs. A new Nationwide Retirement Institute survey of adults age 50+ with household income exceeding $150k, conducted by the Harris Poll indicates that 73% of affluent, older adults “list out-of-control health care costs as one of their top fears in retirement and 64 percent of future retirees say they are ‘terrified’ of what health care costs may do to their retirement plans.”

 

Here’s more of Nationwide’s survey findings:

  •  72% wish they better understood Medicare coverage
  •  42% admit they would give away all their money to their children so they could be eligible for Medicaid-funded long-term care.
  •  53% do not know that Medicare Part B is not free even if you have worked and paid Social Security taxes for at least 10 years
  •  23% do not know you cannot enroll in Medicare at any time
  •  29% do not know Medicare does not cost the same for everyone
  •  62% do not know that future changes will impact the ability to sign up for Medigap/Medicare supplement   plans
  •  53% are unsure or can't estimate what their annual health care will be
  •  65% are unsure what their long-term care costs will be
  •  27% of even these affluent, older adults say they couldn't cover more than $1,000 in unplanned expenses:   44% couldn't cover more than $4,000 and 60%couldn't cover more than $5,000 of unplanned expenses
  •  50 % have access to a Health Savings Account (HSA) through their employer, with 30% participating in or   contributing to the HSA

 

 

Friday
Jul202018

Consumers and Digital Technology: What’s the Deal With Healthcare?

by Clive Riddle, July 20, 2018 

The Deloitte Center for Health Solutions has just released some preliminary findings from their 2018 Survey of U.S. Health Care Consumers, which will be published in August, on the heels of their recently released Deloitte 2018 Survey of U.S. Physicians. Deloitte shares that “consumers and physicians typically agree that virtual health care holds great promise for transforming care delivery. Yet many physicians remain reluctant to embrace the technologies, worried about reimbursement, privacy and other issues.”

Thus Deloitte found consumers are well ahead of providers on the technology acceptance curve, and many providers are dragging their feet in meeting rising consumer demand in this arena. Dr. Ken Abrams, managing director, Deloitte Consulting tells us "Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board."

The Deloitte surveys found:

  • 64% of consumers and 66% physicians “cite improved patient access as the top benefit of virtual care.”
  • “About half of physicians surveyed agree that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52% agree) and staying connected with patients and their caregivers (45%  agree)
  • “While 57% of consumers favor video-based visits, only 14% of physicians surveyed have the capability today, and just 18% of the remainder plan to add this capability.”
  • “Clinicians worry about medical errors (36%) and data security and privacy (33%) associated with virtual care.”
  • “Email/patient portal consultations are the most prevalent virtual care technology used by responding physicians (38%), followed by physician-to-physician consultations (17%) and virtual/video visits (14%).”

Moving beyond just virtual care, and examining the healthcare digital experience as a whole, the global brand and marketing consultancy Prophet has just released a two part report: Making the Shift, Part I Healthcare’s Transformation to Consumer-Centricity (25 pages) and Part II  A Culture Change Playbook for Healthcare Transformation (also 25 pages.) They found that “ healthcare providers, payers and pharma companies are not making significant strides toward consumer centricity despite increasing demands and competition for healthcare dollars.”

Jeff Gourdji, a partner at Prophet, tells us  “consumers want to be treated as powerful participants in their own health.  Increasingly healthcare organizations’ own bottom lines require meeting consumers halfway or more. So, it is increasingly in everyone’s best interests to make sure consumers are empowered, engaged, equipped and enabled so they become what we call the ‘e-consumer.’”

Prophet paints the picture at the start of their report like this: “With the rise of digital technology, consumers have unprecedented power. Consumers expect business categories like retail and consumer goods to provide individual experiences across both the physical and digital worlds. While other businesses are shifting their focus toward delivering meaningful and valuable consumer experiences, healthcare has largely stayed the same. And, until recently, it hasn’t had the imperative to change. However, pressures from governments and employers to lower costs and pressures from consumers to meet ever rising expectations means that driving consumer engagement and redefining how healthcare organizations interact with people is no longer a luxury, but a necessity. While healthcare organizations are feeling pressure to upgrade their consumer experience, with a focus on how to engage and empower consumers, the path to accomplishing this is unclear.”

Immediately below this intro, the next section header asks “What’s the Deal with Healthcare?” They share survey results that “81 percent of consumers are dissatisfied with their healthcare experiences, and the happiest are those who interact with the system the least.”

Some of Prophet's other survey findings include:       

  • “Fewer than 10% of all healthcare organizations say they are “most willing” to partner with digital companies     
  • Only 21% of respondents believe that ‘practical and important innovation is coming from digital startups’ compared to over 50% of respondents who believe this innovation is coming from providers and medical device companies         
  • "Only about a quarter (27%) of surveyed companies measure relationship metrics like Net Promoter Score despite evidence that consumer metrics are critical to driving a commitment to consumer centricity.”
  • "Only 15% of respondents reported a willingness to consider adding leadership from outside the industry, even when those leaders would be supported by a healthcare-savvy team.

Prophet goes on to share on elaborate on “five shifts that organizations must prioritize to reshape into more consumer-centric businesses:

  1. Moving from tactical fixes to a holistic experience strategy
  2. Moving from fragmented care to connected ecosystems
  3. Moving from population-centric to person-centered
  4. Moving from incremental improvements to extensive innovation
  5. Moving from insights as a department to a culture of consumer obsession