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Employers aim to move workers to consumer-directed health plans


By Virgil Dickson
Posted: August 13, 2014 - 5:45 pm ET
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In the face of rising healthcare costs, large employers will increasingly shift employees to consumer-directed health plans, impose surcharges for spousal coverage and adopt strict medication management programs for specialty drugs, according to a survey from the National Business Group on Health.

Even with these and other strategies, such as cost-sharing and wellness programs, companies expect to see their health benefit expenses grow 5% next year. Without them, though, they'd face a 7% rise.

In addition to helping them control costs, U.S. companies are angling to avoid the so-called Cadillac tax in the Patient Protection and Affordable Care Act. Beginning in 2018, the Internal Revenue Service will impose a 40% excise tax on health insurance benefits that exceed $10,200 for an individual and $27,500 for a family.

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Employers are putting the most focus on consumer-directed health plans, which come with high deductibles and are usually tied to a health savings account.

Almost one-third of the companies that responded to the survey plan to offer a consumer-directed plan as their only benefit plan option in 2015, compared with 22% in 2014.

Another 29% of those surveyed said they are planning to impose surcharges for covering spouses if they can obtain coverage through their own employer, and 3% said they intend to exclude spouses outright if they have other coverage options.

The charges, averaging $100 a month, may lead some spouses to drop out of a plan, but many will pay to keep the coverage. “If you're facing paying a surcharge versus potentially going to a network that's potentially more restrictive, you may just choose to pay the fee,” said Glen Mays, professor of health services and systems research at the University of Kentucky in Lexington.

Most of companies that responded to the survey cited specialty pharmaceutical drugs, such as Sovaldi and other new hepatitis C drugs that hit the market this year, among their top three reasons they are seeing their healthcare costs grow.

The vast majority of companies say they plan to rely on high-touch case management to help keep these expenditures down.

“This could mean having a qualified clinician that specializes in the particular disease state, walking them through what they need and ensuring compliance,” said Karen Marlo, vice president of the National Business Group on Health.

Self-insured employers, meanwhile, are getting aggressive with drug manufactures on price, said Steve Kelly CEO of ELAP Services LLC, a healthcare cost management and employee advocacy services firm. For instance they may insist on paying Medicare rates or the average price paid by wholesalers plus a premium. Paying the full retail price is largely out of the question, Kelly said.

Follow Virgil Dickson on Twitter: @MHvdickson


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