RI's Healthcare Trends for 2012

RI's Healthcare Trends for 2012

The New Year is certain to ring in one thing for all employers: another year of healthcare cost increases. In fact, local companies can expect hikes of approximately 10% next year. So what happened to the promise that healthcare reform would lower costs?  

Several factors continue to contribute to uncertainty over the future of the legislation and its impact on rates: 

• The constitutionality of the law, which has been questioned
• The outcome of next year’s presidential election
• The stalled regulations that have been written and re-written, yet still not released

 

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If healthcare reform doesn’t hold the answer to affordable solutions, what does? Here are four emerging trends likely to shape the future of healthcare benefits in 2012 and beyond. 

New value-based plan designs

Not yet available in RI, but in practice with other insurance carriers around the country, these plans use incentives like reduced copays and deductibles to encourage patients who are chronically ill to follow physician recommended treatment plans and change unhealthy behaviors. For example, a value-based plan design could provide lower copays to encourage diabetics to see their doctor and /or stay compliant with prescribed medications. By removing cost as the barrier to care, this targeted approach to disease management improves access, leading to better health outcomes and lower costs.

The return of the HMO

Healthcare reform places renewed emphasis on the primary care relationship to manage patient care.  As a result, insurance carriers are revamping products from the 90s that require a primary care physician to oversee care and make referrals to specialists. But this time around, participating provider networks will be tiered. Low cost/high quality providers will cost less than high cost/low quality doctors, increasing the emphasis on best-in-class providers and steering consumers to use them with financial incentives like no deductibles or by eliminating providers from the networks who do not meet criteria set by the insurance carriers.

Wellness

More and more employers are realizing that helping employees to change behavior not only leads to healthier workers, but happier and more productive ones. Top ways to boost participation including positioning the programs as a “free benefit” to employees; keeping activities fresh every year; and offering financial incentives like premium reductions to employees who take part, an easy way for workers to save on monthly healthcare costs

PEOs

Professional Employer Organizations will soon be a much-needed option in Rhode Island for small businesses. Under these arrangements, companies co-lease employees for purposes of benefits only, pooling risk with other small businesses for purchasing clout.  By hiring experienced administrators to negotiate insurance benefits, run payroll and provide most back room administrative functions, PEOs allow the employer to focus instead on its core competencies.

 

Amy Gallagher has over 19 years of healthcare industry experience.  As Vice President at Cornerstone Group, she advises large employers on long-term cost-containment strategies, consumer-driven solutions and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, is a member of local organizations like the Rhode Island Business Group on Health, HRM-RI, SHRM, WELCOA, and the Rhode Island Business Healthcare Advisory Council, and participates in the Lieutenant Governor’s Health Benefits Exchange work group of the Health Care Reform Commission.

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