We’re seeing an increase in the number of partnerships forming in the benefits and retirement arena this second half of 2021. Companies with expertise in those areas are working with technology companies to make benefits and financial platforms and dashboards for employers, employees, and advisors. What effects might we see from such partnerships, beyond the immediate products offered? At the least, perhaps, a greater awareness of the value of a good user experience in delivering what is often complicated financial and insurance information.
Health care purchasing experts tell AIS Health that employers are beginning to realize that high-deductible plans have deep flaws. “More and more of the data seems to show that there are some unintended negative consequences from high-deductible health plans, especially for lower-income employees,” Candice Sherman, CEO of the Northeast Business Group on Health (NEBGH), tells AIS Health. NEBGH is a purchaser group whose members include large firms, such as Comcast Corp. and Verizon Inc., unions and public employee plans. Its members also include the nation’s largest health insurance carriers: UnitedHealthcare, CVS Health Corp. and its Aetna arm, Anthem, Inc., and Cigna Corp. “There’s been some loosening up of the regulations that allows some first-dollar coverage for high-value classes of medications and services, which is certainly helpful. But I do think that [plan sponsors] are looking at high-deductible plans a little bit more closely,” Sherman says. She points out that high deductibles can deter patients from accessing necessary care. Sherman says plan sponsors have begun to revamp their benefit offerings to address diversity, equity and inclusion concerns over the last year — and points out that high-deductible plans’ deterrent effects are disproportionately harmful to people of color, who generally have less household wealth than white people due to institutional racism. “I think the issue of equity versus equality is an interesting issue to contemplate when it comes to these kinds of things,” Sherman points out. “We may have a desire to treat everyone equally. But what does that mean in terms of people’s ability to actually access and receive quality health care?”
In the early 2000s, The Trust made a series of grants to the Alliance to advocate for insurance reimbursement parity for mental health, which resulted in the federal Mental Health Parity and Addiction Equity Act of 2008. With the passage of the federal Affordable Care Act in 2010, much of The Trust’s work in mental health in the decade that followed included grants to nonprofits such as the Coalition for Behavioral Health, to help mental-health clinics acclimatize to Medicaid expansion, secure better reimbursement rates, and adapt to the world of managed care.
In 2020, The Trust sought to expand insurance parity with a grant to the Northeast Business Group on Health to be part of a national drive to improve behavioral health care access for people with employer-sponsored insurance. To guide systemic change, The Trust made a grant to the Bipartisan Policy Center for a 2021 report on integrating primary health care and mental health care and to promote its recommendations to improve care in New York and nationally.
Employers weighing whether to follow Delta Air Lines’ lead and impose financial penalties on their unvaccinated employees could charge an unlimited amount depending on the type of wellness plan they choose.
Other companies will “probably watch and see what negative impact Delta has from doing that,” Mark Cunningham-Hill, medical director of the Northeast Business Group on Health, said of the surcharge. The NBGH, which represents employers on health plan issues, has about 170 member companies covering 6 million to 7 million people in New York, New Jersey, and Connecticut.
The chief concern would be losing employees in the tight labor market, he said.
“Delta is ahead of the curve on this one.”
As the Covid-19 threat spread in early 2020, some state licensing requirements were eased by the federal government to allow telemedicine providers to work across state lines. A CDC report said virtual health services could “facilitate access to care, reduce risk for transmission of SARS-CoV-2, conserve scarce medical supplies and reduce strain on health-care capacity and facilities while supporting continuity of care.”
As a result, the policy shift “literally opened up access in the mental-health [and physical health-care] services,” said Mark Cunningham-Hill, medical director of the Northeast Business Group on Health, a nonprofit group of employers and health-care providers based in New York City. “Before the pandemic, utilization was relatively low.”
Convenience was a big attraction for workers, but employers’ fears that it would be overused — and increase benefit costs — were unfounded. In fact, Cunningham-Hill notes that telehealth can help patients get the care they needed early on before a condition becomes more complicated and costly.
“Maybe we’ll move to a hybrid model going forward where we’ll see people once and make that physical and personal connection, and then we’ll transition to video telehealth,” said Cunningham-Hill, who is based in Paoli, Pa. “It might be a steppingstone to make it more ingrained in how things work.”
According to National Alliance for Caregiving and AARP, Caregiving In The U.S. Report (2015), more than 1 in 6 Americans are caring for an elderly family member, disabled relative or friend. The same report states that 39% have to leave their jobs to care for the patient, due to inflexibility in work schedules. 10 Million caregivers, age 50+, lose $3 trillion dollars in wages, retirement, and benefits.
Northeast Business Group on Health Survey (2019-2020), finds that 91% of employers say their employees caring for elderly patients will abandon self-care. The companies surveyed believe that 51% of caregivers would not report their status to employers. The Caregiver Health Effects Study (1999), claims that, "Elderly spousal caregivers (aged 66-96) who experience caregiving-related stress have a 63% higher mortality rate than non-caregivers of the same age."
The WELL Health-Safety Rating covers quite a number of areas, said Mark Cunningham-Hill, MD, medical director at the Northeast Business Group on Health. The nonprofit, employer-led coalition focuses on helping its members achieve quality and value when it comes to healthcare benefits and services.
One consideration when it comes to achieving COVID-19 safety is that it's not just about the building itself, but the number of people in it and what they're doing, Cunningham-Hill said. For instance, ventilation considerations would be different between a building in which a group of opera singers convened and one in which office workers sat typing at their desks.
In principle, a business having a WELL Health-Safety Rating or a similar credential probably means its building is better than ones that couldn't meet those levels, he said. And for employers, "it certainly might help with attraction and retention."
To help consumers, clinicians and other stakeholders make informed choices, a team of researchers launched a searchable online database, called MIND (M-Health Index and Navigation Database), that evaluates apps based on cost, features, privacy policies and scientific evidence. That database draws on an evaluation framework that has been endorsed by the American Psychiatric Association.
Another app evaluation site called One Mind PsyberGuide reviews apps against rating criteria developed by experts in the field. The organization also offers a guide to digital mental health apps for employers, which it developed in collaboration with the Northeast Business Group on Health.
At the height of the pandemic, employee health care claims dropped steeply when people avoided visiting doctors' offices. Now as coronavirus vaccinations are widely available, Americans are expected to seek long-delayed care. Health claims could reflect the consequences of letting risky health conditions go untreated for more than a year, exacerbated by stress, poor diets and suspended gym memberships.
A financially strong 2020 for self-funded health plans could turn into a challenging 2021.
A recent survey by the American Psychological Association, conducted in February with responses from more than 3,000 U.S. adults, found that:
Despite these warning signs, the pandemic's effect on health care usage may provide an opportunity to rethink how health benefits are designed, offered and used.
"My concern is that [health plan sponsors] may be focused on getting everyone back to the office and getting everyone vaccinated, and they won't take the time to review other opportunities that may be bigger in the long run and more sustainable," said Mark Cunningham-Hill, medical director for the Northeast Business Group on Health, one of several regional employer coalitions focused on improving employee health care. "This may be an opportunity to reboot things not as they were before but doing [health care] better."
Mark Cunningham-Hill, M.B., Ch.B., medical director of the Northeast Business Group on Health and a former Johnson & Johnson, Inc. and GlaxoSmithKline PLC executive, says that coverage losses have mainly been confined to the hospitality, retail and travel industries. Cunningham-Hill notes that membership of his organization is mainly composed of white-collar employers.
“Most of the major, blue chip players have probably kept most of their staff on,” Cunningham-Hill tells AIS Health. “I know some have had to furlough some staff for periods, certainly the ones that have retail operations, but generally I think they’ve tried to keep staff on and have as few layoffs as possible. So I’m not sure if there’s been a massive shift in our membership away from benefits.”
More than bringing people back on board, Cunningham-Hill says his membership is concerned about the looming wave of delayed care claims. The entire health insurance industry faces that challenge: Care utilization plummeted during the second quarter of 2020 and has still not entirely rebounded (HPW 1/22/21, p. 1). Experts expect that patients will schedule replacement appointments to receive some of that delayed care eventually, but are not sure when or to what extent.
The deferral also likely worsened chronic health problems or prevented early discovery of pre-acute conditions, which could introduce otherwise preventable cost to the system.