Are employers the sleeping giants of the healthcare system?
When we think about the audience for communications or certain strategies for programming, we talk a lot about the healthcare system “stakeholders”: patients, advocates, doctors, insurers, PBMs and policymakers. Employers, however, don’t often get a specific callout.
But a new 5-part series from Harvard Business Review has us thinking about the impact employers have on the care patients get, and the missed opportunity of seeing employers as core customers. A quick look at the landscape:
- Massive responsibility: Employers insure 49% of Americans. Compare that to public government programs like Medicare and Medicaid, which cover 35%.
- Bills to pay: From 2007 to 2016, employer healthcare spending per enrollee increased by 44%, rising to an annual total of $700 billion in 2017.
- 99 problems but variation ain’t one: A huge variation in costs across providers and geographic regions (remember our recap on hospital costs?) makes it difficult for employers to forecast budget and ensure consistent, high-quality care for their employees.
So it should come as no surprise that employers are considering innovative solutions to cut costs and provide better benefits.
Companies like Lowe’s, McKesson, GE and Boeing are trying their hand at new programming. Two leading programming strategies, according to HBR include:
- Centers of excellence (COE) – “employers tap into a purchaser coalition that helps them identify best-in-class providers and create bundled-care contracts for a defined episode of care.”
- Accountable care organization (ACO) – While people typically think of ACOs in relation to Medicare, more employers are aligning with them “to craft coverage that may pay a set amount per associate for a given period and that usually links reimbursement to the provider’s performance on quality and cost metrics.”
Another approach – pioneered by Comcast – is to contract with a “portfolio” of companies to provide a diverse set of benefits to employees.
When building these programs and identifying potential partners, most employers consider some core criteria: the potential for evidence-based care, patient-centered teams, existing data that reflects the quality of care and of course, the potential for low, “bundled” prices.
What does that look like in action? Going to Walmart for your spine surgery.
When built well, these programs benefit not only the employers, but theoretically providers and patients as well. Walmart, which provides coverage to over 1 million workers and their families, has both COE and ACO initiatives, and has seen impressive outcomes across a number of disease states. For example:
Spinal surgery: By providing early, expert care, Walmart has saved costs on hospital readmission and follow-up needs for spinal patient post-surgical care.
Joint replacement: Employees that were treated at COEs are back on the job faster.
Bariatric surgery: They saved money on long-term costs.
In a competitive job market, in which employees are demonstrating an ever-growing appetite for employer transparency and action on core values, “good” healthcare benefits aren’t just a nice-to-have. Employers must take a step back and evaluate what makes sense for their employees and their budget, and ask “could we be doing more to provide efficient, high-quality care for our employees at the best possible price?”
Meanwhile, drug makers must consider employers a core customer group, and watch how they are evolving their benefits and cost controls, and responding to new rebate reform proposals. And the next time you and your team are discussing access solutions, consider the potential role employers could play in innovative contracting or the value of some direct to employer communications.
Who wrote this? The managing editors of TWTW are Dana Davis, who really wants someone to throw her a CVS-themed birthday party, and Randi Kahn, who is more of a Duane Reade kind of girl.
Syneos Health Communications' Reputation & Risk Management Practice is a team of healthcare communications consultants, policy-shapers and crisis response specialists. We provide unique solutions to the evolving communications challenges in today’s healthcare industry, using evidence-based approaches to help our clients successfully navigate the most sensitive of situations.
Got thoughts? Contact Dana
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