Blog Post How Maestro Health Does Clinical Care Management Better. Going self-funded has big benefits for many employers which can result in serious cost savings and better health outcomes. Our in-house clinical care management program leverages a data-driven approach...
HR’s 2022 Healthcare Agenda
HR leaders will face big challenges in the year ahead — including, another year of rising health plan costs and worsening population health.
To understand how HR plans to move forward and what support they’re receiving from insurers and plan administrators, Maestro Health surveyed 600 U.S.-based HR professionals. All are directly involved in managing their company’s health insurance plan.
At a glance, our 2022 Healthcare Insights Report found that:
- HR is considering an array of cost management strategies, but the majority of insurers aren’t offering certain high-impact tactics.
- Engaging members is a challenge — more than three-quarters of respondents (78%) say that at least 11-20% of benefits go unused.
- Organizations want greater health plan flexibility — 73% of HR professionals are considering switching insurers or providers.
Let’s take a deeper dive.
High-impact cost management tactics are being overlooked.
Nearly all respondents (94%) anticipate their company’s medical costs will increase — of this group, 62% expect a year-over-year increase of at least 20%. HR expects these increases to come from a greater amount of claims from increased risk areas and are considering several cost management tactics to reign in expenses.
Top ranked risk areas:
- Decreases in annual physicals/screenings: 62%
- Increased pharmaceutical costs: 49%
- Unvaccinated employees: 47%
- More elective surgeries: 46%
- Increased urgent care costs: 45%
What’s surprising is that the most overlooked cost management strategies — out-of-network repricing management, provider network partnerships and quality and cost transparency tools — often provide the most savings. In addition to reducing costs, these tactics can help expand and better personalize health services for members.
Out-of-network repricing management, provider network partnerships and quality and cost transparency tools are more prevalent in self-funded or level-funded healthcare plans. The underutilization of these tactics makes sense considering 96% of respondents in our survey use fully insured healthcare plans. However, cost transparency tools are available with nearly all health plan types (sometimes for an added fee).
Top ranked cost management tactics:
- Penalties for employees not receiving proactive COVID-19 care: 52% and Alternative reimbursement strategies: 52% (tied)
- Pharmacy benefit management for specialty, mail and retail pharmacies: 51%
- Care access solutions: 45%
- Out-of-network repricing management: 38%
- Provider network partnerships: 38%
- Quality and cost transparency tools (e.g., analytic insights on member population data): 24%
Despite engagement efforts, many plans see a high percentage of unused benefits.
Regarding member outreach, 94% of HR professionals feel they reach out to plan members about health benefits often enough and 92% say they use personalized materials tailored to their member population. In addition, a majority of HR decision-makers (96%) receive member engagement support from their healthcare insurer or plan administrator.
Cadence of communication with plan members:
- Weekly: 35%
- Monthly: 30%
- Daily: 15%
- Quarterly: 14%
However, despite HR’s best efforts, health benefits are still underutilized. More than three-quarters of respondents (78%) say that at least 11-20% of the services their organization pays for as part of its healthcare plan go unused; 14% of HR decision-makers say that number is 31% or higher.
The connection between high member outreach efforts and unused plan benefits suggests organizations may be paying for services their member population doesn’t need, aren’t aware of or potentially don’t understand. Alternatively (or perhaps, in conjunction), HR may not be receiving the right support or tools to engage members effectively.
Healthcare insurers and plan administrators are in the hot seat for 2022.
The majority of respondents (98%) agreed that their healthcare insurer or plan administrator understands the healthcare needs of their organization’s plan members. Despite this confidence, HR professionals recognize there’s room for improvement.
Nearly three-quarters (73%) said their organization is considering switching its healthcare insurer or plan administrator in 2022. Of this group, the top reason for switching is the need for more healthcare plan flexibility (like access to more providers).
Top ranked reasons for switching healthcare insurers/plan administrator:
- More healthcare plan flexibility: 73%
- Better customer service: 65%
- Greater support on member engagement: 52%
- Costs are too high: 44%
- Better data analytics capabilities: 23%
The desire to switch healthcare insurers or plan administrators shows providers may not be delivering what’s needed to manage companies’ member population needs and lower costs. Given that the majority of respondents (96%) have fully insured healthcare plans, HR decision-makers may want to consider if going self-funded could better serve their organization’s needs and reign in rising costs.
Better benefits exist.
Managing costs, boosting benefit utilization and improving employee health outcomes aren’t new priorities, but achieving them seems more difficult than ever. What’s clear is that off-the-shelf plans from traditional carriers don’t provide the customization or support that employers need today.
Learn more about how a self-funded healthcare solution could work for your organization. Check out some of our popular resources below or contact us for a demo.
