WASHINGTON – In 2013 and going forward, employers are likely to increasingly rely on direct contracting with physicians and using other means to steer patients to certain physicians in an effort to bring employee benefit costs in line, according to a new survey.
Besides direct contracting, employers say they will use additional ways to get patients to use particular providers, such as reimbursing less for higher-cost providers and encouraging use of work-site health clinics, according to the National Business Group on Health.
The nonprofit NBGH surveyed its members in June, after the employers had finalized benefit plans for 2013, but before the Supreme Court issued its decision upholding the Affordable Care Act.
Courtesy the National Business Group on Health
Helen Darling
The Supreme Court ruling means that employers are facing slightly less uncertainty about the future, but costs were still an overriding concern, said Helen Darling, CEO of the NBGH. "Employers are very concerned about the severe cost pressures from providing comprehensive health services and health benefits," she said.
The 82 members that responded to the survey said that they expected the cost of benefits to rise 7% next year. While that is in keeping with the past several years’ increases, it comes during a time when revenues for many are flat or decreasing.
As a result, employers are exploring a variety of ways to control costs and improve quality. Eleven percent of respondents said they were using direct contracting with surgical centers of excellence to control costs, improve quality, and ensure appropriate care. Twenty-one percent said they were considering it. Fully 11% indicated that they were currently using direct contracting with patient-centered medical homes, and 18% said they were thinking about doing so in the future.
Making employees aware of the cost of their health care is another tactic being used by employers. Seventy-nine percent said they give their workers access to an online database showing the price of various services.
Employers also have begun to use "reference pricing" for health care services. The employer sets a price for a service, and if a worker wants something that is more expensive, he or she will have to pay the difference. Reference pricing is largely used with pharmaceuticals, but 4% said they use it for lab services and the same proportion do so for imaging.
Ms. Darling said she expects reference pricing to be applied to physician services in the near future.
Overall, employers said that using consumer-directed health plans – such as high-deductible plans – and wellness initiatives were proving to be more effective than shifting costs directly to workers through higher premiums or deductibles. Even so, 60% said they would ask employees to pay a larger percentage of the premium in 2013. More than a third also said they would increase in-network deductibles, out-of-network deductibles, and out-of-pocket maximums.
Employees will be influenced in other ways, too. Some 46% of the respondents said they have on-site health clinics in at least one of their locations, providing primarily acute care, but also health improvement programs and occupational health services. More than half of those clinics also offer primary care services.
In addition, companies are increasingly offering financial incentives for participating in weight management or tobacco cessation programs, or for meeting particular health outcomes. Almost half said they offer incentives just for participating, with a median payout of $450 per worker – a 50% increase from 2012.