Last year we witnessed the Trump administration, Congress and the American people engage in a fractious debate about healthcare reform. In a national discussion marked more by heat than by light, some called for an end to employer-sponsored insurance (ESI), but ESI shows no signs of going away and continues to meet the healthcare needs of a multitude.
The majority of Americans receive coverage from employers – about 54 percent, or 169 million people.1 And most of them say they are satisfied with their health benefits.2 For their part, employers say ESI puts them in the driver’s seat; they can negotiate financially sustainable rates, whereas they would cede control if they sent employees to insurance exchanges or operated under national, government insurance. Plan sponsors also say they can create the best plans for their employees because they are in touch with them daily, gleaning their insights and hearing their feedback.3
However, HR executives broadly agree that ESI is unsustainable in its current form. For companies large and small, ESI offers limited choices, they say, and those limited choices lead to higher rates and growing costs.4
To broaden those choices, one organization, Health Rosetta, aggregates data, case studies, best practices and solutions from the employer community. The organization says what works combines one or more of the following “foundational components”:5
- Value-based primary care
- Benefits concierge services
- Active ERISA plan management (bringing rigorous fiduciary oversight to health benefits)
- Transparent medical markets (i.e., focusing on outcomes to lower costs, as well)
- Payment integrity
- Transparent pharmacy benefits
- Transparent advisor relationships
- Major specialties and outliers (i.e., early, high-quality treatment of cardiometabolic, musculoskeletal and cancer cases)
Several of these foundational components are found in value-based surgery benefits. Offered alongside an employer’s managed care plan, these specialized benefits offer a compelling way to not only contain costs but also improve quality.
With BridgeHealth, plan sponsors typically save 30-50 percent per surgery on average when employees schedule surgeries through our value-based surgery solution instead of through employers’ managed care plans.6 After monthly access fees and employee incentives, plan sponsors enjoy a positive ROI averaging 4:1.7
Just as importantly, workers benefit from the highest-quality care and better outcomes. Our value-based surgery program provides members access to the nation’s top-quality hospitals and surgical centers — by practice, procedure and specific physician group — based on nationally recognized, independent healthcare quality rankings. We negotiate with these high-performing surgical teams for episode-of-care case rates for planned surgical procedures that can include orthopedic, bariatric, spine, women’s health, cardiac, and neurologic, bundling the various charges for each surgery into a single price that is much less than that paid through PPO plans.
All eyes, in fact, may be on Washington, D.C. But the shots over the bow you hear come outside the Beltway; they come from businesses using innovative solutions to take direct aim at unacceptable healthcare costs and outcomes. This is the battle for the future of ESI.
- Troy, Tevi D., and Jones, Kara L., “State of Employer-Sponsored Health Care: Part 1 – Top Concerns of CHROs and Their Teams,” American Health Policy Institute, 2016.
- Health Rosetta, https://healthrosetta.org/health-rosetta/, 2017.
- BridgeHealth bundled surgical case rates versus negotiated in-network surgical rates of clients’ managed care plans.