The World Healthcare Congress in DC earlier this month was a phenomenal event, and I’ve shared a few key takeaways below. Employers are still facing significant challenges in finding their employees the right care, at the right price, at the right place; however, virtually all of these challenges have been and are being addressed by new, innovative vendors embracing proven strategies. Simply put, healthcare from the employer perspective has been fixed.

  1. The self-funded ASO model is fading as more and more employers are looking to Independent TPAs for transparency, flexibility, cost-control, and service.
  2. Surgical Centers of Excellence are becoming increasingly popular and will become the norm in 5 – 7 years.
  3. When properly implemented, employers are seeing tremendous savings with Reference Based Pricing. PPO plans reimburse at 300% – 1,000% of Medicare, while RBP vendors are successfully negotiating to 150% on 99% of claims.
  4. As deductibles have risen, hospitals are getting stuck with large AR balances that patients simply cannot afford. Thus, hospitals are more open than ever to engage in direct contracting with employers.
  5. Employers have given up on the rebate games of the big PBMs and are moving to transparent, fee-only PBMs. Along with increased transparency, employers are saving 15 – 20% per year on Rx spend with this model.
  6. Captives aren’t for everyone but are increasingly easy to setup. A number of employers are now covering their entire enterprise risk with a single captive.
  7. Unnecessary care is still a huge problem and drain on the healthcare ecosystem. In a recent survey, doctors admitted that 21% of all care is unnecessary. For example, C-sections are performed at 300% the rate as they were in the 1990s.
  8. Employees are asking for Financial Wellness programs, and vendors are stepping up with user friendly, engaging solutions.
  9. Behavioral Health is still being overlooked by many employers, and utilization of EAPs is concerningly low. New platforms that focus on meeting employees at their comfort level are finally reversing this trend.  

-Geoff Rowson