Catalyst for Payment Reform

What does the next wave of benefit design look like?

What does the next wave of benefit design look like?


Employers are getting increasingly creative when it comes to health care coverage. Whether that means covering benefits on the cutting edge of medical care or figuring out ways to make coverage custom for individual employees, purchasers are thinking out of the box with benefit design to retain employees and address underlying barriers to higher value health care. Here are three ways leading employers are reshaping health care coverage for their populations.

Addressing Social Determinants of Health in Benefit Strategies

Our concept of health is ever evolving and expanding. Increasingly there is a recognition that physical health is both a part and a product of overall wellbeing. Factors like economics, and the social, physical, and environment we live in can have a tangible impact on health. For instance, poor adults are almost five times as likely to report being in fair or poor health as adults with family incomes at or above 400 percent of the federal poverty level. This awareness is also affecting how employers design their benefits strategies, leading them to design offerings focused more on stress, financial wellbeing, and behavior change, among other factors. Yet, given the vast literature on the impact of social determinants of health, should employers be expanding their health and benefit strategies to look beyond the office?

Tune in on October 16 as Jim Knutson from Aircraft Gear Corporation and Guy D’Andrea from Discern Health discussed how they are thinking through SDOH.

A New Approach to Managing Pharmacy Benefits

Employers’ struggles with pharmaceutical pricing is nothing new. Exorbitantly increasing prices for specialty and now even generic drugs has made coverage for medications a top of mind issue for purchasers. And employees are attuned to high drug prices as well.  Specialty medications represent 35 to 40 percent or more of pharmacy-related costs for employers, and just last year, prescription drug costs were projected to rise 11.6 percent for active employees. Access to affordable medications has a significant impact on employee health and employers’ bottom lines and sustainability of offering coverage for drug benefits. But how can purchasers combat skyrocketing drug prices short of regulatory reform?

On October 30, listen in as John Stenerson from Self-Insured Schools of California (SISC) and Thomas Cordeiro from Integrity Pharmaceutical Advisors L.L.C. talk about their new approach to formulary management.

Rethinking Benefit Design for Employees with Lower Incomes

Sharing out-of-pocket health care costs with employees (i.e., cost sharing) is one lever employers use to drive higher value, but not all cost sharing models are created equal. Evidence is increasingly piling up that cost sharing models, such as high deductible health plans (HDHPs), do not incentivize thoughtful utilization of care, but rather lead consumers to cut care utilization across the board with no distinction between necessary and unnecessary care. Certain groups of employees, such as workers with lower incomes, are more susceptible to these unintended incentives than others. Consider the fact that that average Americans do not even have $400 in savings to cover an emergency—how can they be expected to cover a $1,300 deductible out-of-pocket?  It is easy to see why this cost sharing model would be a strong deterrence for these employees to seek care at all.

On November 8, hear how Sara Rothstein from 32BJ Health Fund and Jeff Levin-Scherz from Willis Towers Watson are tackling this issue.

If you’re interested in the full webinar series, click here!

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