In mid-July, Hewitt Associates released their preliminary report predicting that once again, HMO premiums will increase by a whopping 11.8% in 2010. This projected increase is consistent with last year's projected rate increases, yet is down from 12.2% in 2008. Final averages increases of 9.0% are expected after plan changes, negotiations, and terminations.
"While HMO rates continue to outpace inflation and underlying health care trends, employers have been increasingly successful in reducing these costs by 3 to 4 percentage points over the past few years through plan design changes, cost shifting and negotiating aggressively with health plans," said Maureen Fay, a principal and co-leader of Hewitt's HMO rate analysis project. "Given these challenging economic conditions, we expect to see employers continuing to implement similar-if not more aggressive-strategies for 2010."
The rates in the Southwest are expected to be the highest at 14.0%, essentially doubling almost 100 percent from 2009. Conversely, the Western states are expected to have the lowest premium increases of 11.1%, down from 12.0 % in 2009.
"There are a number of reasons why HMO premium increases may fluctuate across regions, including variances in demographics, health risks, and plan designs," said Jeff Smith, a principal and co-leader of the HMO rate analysis project. "In the Southwest for example, we weren't surprised to see higher than average rate increases for 2010 because plans in this region needed to make up for revenue and margins they lost from lower-than-average rate increases in 2009."
Even though employers have worked hard to contain healthcare costs during the economic repression, most are considering additional strategies to help alleviate the impact of these projected HMO rate increases. They are:
1). Consolidating vendors or exploring options to self-insure. Consolidating vendors enables employers to better analyze their claims data to implement the right healthcare strategies needed to address underlying health risks, conditions, and utilization patterns according to their employees' demographics. In considering self-insured plans, employers are allowed to customize the package of healthcare programs to meet the specific needs of their covered population allowing cost containment.
Hewitt's report also identified that some employers are eliminating HMO plans altogether. According to their data, 56.6% of employers offered HMOs in 2009, down from 59.1% in 2008. Apparently employers are promoting PPOs and HSAs as a more cost-effective healthcare solution to their employees. It's interesting to note that HSAs are non-existent in the proposed healthcare reform legislation that's under consideration in both the Senate and the House of Representatives.
2). Aggressively negotiating with health plan providers. Employers who have harvested their claims data are using that data to aggressively negotiate with providers. Employers that have moved their prescription drug benefits for HMO enrollees to one centralized plan are able to use drug claims data to identify health risks in their employees, and utilize proactive care management practices to control costs in chronic conditions.
"Most employers are taking a hard stance in negotiating with health plans. They are saying, "either partner with us to cut our costs or we'll eliminate your plan altogether," said Fay.
3). Changing plan design. The trend by employers to increase employee costs is ongoing, with increased co-pays ramping up to a greater proportion. Larger employers are shifting from a co-pay to a co-insurance model, by example, moving from a $15 office co-pay and $250 hospital co-pay to a $200 plan deductible followed by a 90% co-insurance for all services.
More employers are also conducting dependent audits to remove plan costs for dependents who don't qualify for coverage based on the employer's eligibility requirements. Hewitt reported that more than two-thirds of their clients have completed this type of audit, have such an audit in process, or are considering conducting this audit.
4). Improving employee health. This continues to be a focus for employers, with fully 65% actively engaged in wellness programs with their employees. Chronic illness drives rates higher, so if employers can motivate their employees to lose weight, stop smoking, control blood pressure and exercise more, they can have a "win-win" outcome by improving their employee wellness while controlling costs.
"Chronic health conditions have become a major workplace issue that impacts the overall productivity of a company," explained Smith. "And since chronically ill employees and their dependents account for at least half of companies' overall health care costs, employers have a vested interest in helping these workers optimize treatments for their conditions."
Our own Compensation Cafe contributor Margaret O'Hanlon recently wrote a thought-provoking post on this clash between healthcare needs from a chronically ill employee population and the costs of providing that level of coverage in "How Pay & Healthcare Benefits Collide."
While I'm not a fan of the proposed healthcare reform that's now being proposed by the Obama Administration, I do believe that some sort of reform is needed. Recognizing that we have the best healthcare system available in the world, we should work to retain what's working well in our current system and fix what's not.
What are your solutions to control costs and fix healthcare? It's clear we cannot continue to sustain these double digit increases in healthcare premium costs year after year.....
Becky Regan is the founder and President of Regan HR, Inc., a human resources consulting firm specializing in compensation consulting for California employers and purveyor of online HR products. A former Corporate Human Resources Director (10,000+ employees) with more than 25 years of HR work experience in many industries, her team works with private, public and non-profit clients. Becky is passionate about designing HR programs and compensation plans that build organizations.
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