Monitoring broad workforce implications of the AHCA
Although many provisions of the American Health Care Act affect the individual market and Medicare/Medicaid recipients, Julie Stone, specialty practices and intellectual capital integration leader, health and benefits North America, for Willis Towers Watson, says advisers need to pay attention to the bill, as it will still have serious implications for the employer-sponsored market.
EBA spoke with Stone about the AHCA. What follows is an edited version of the conversation.
EBA: How are you helping clients to think about changes in healthcare benefits?
Stone: The focus is on a couple of priority areas. At the top of the list, from my perspective, is employee engagement — truly looking to move the needle on employee accountability and involvement in a range of their healthcare usage issues, such as transparency tools and optimizing care delivery.
Next on the list is optimizing plan design and vendor management. Looking at the features [such as] decision support, engagement with health coaches, vendor optimization and high-performance networks. Within the plan itself, how do we get the most value? And then, what are some of the other services and tools [available]? Telemedicine is an example where there was really high adoption quickly from employers, but utilization within employee populations lagged in some places.
That is how you put vendor optimization and employee engagement together to achieve the desired outcomes. Looking at specific opportunities and solutions to change behavior and achieve better outcomes from a financial perspective, as well as population health.
EBA: Who is driving the conversation?
Stone: It is employer and consultant. There are always employers who are leading-edge and want to know what the next new thing is. But, in many circumstances, we are leading our clients to the conversations about what is new and next. It is not singular in one direction or the other. We need to meet our clients often where they are. But, they depend on us to bring to them what is truly emerging as a pattern or opportunity.
EBA: What are you keeping your eyes on, regulation-wise?
Stone: It is interesting to watch the large industry associations, such as the American Hospital Association, AARP, AMA and others. [Also,] how the health plans are navigating this space. We are coming up to the deadlines relative to the public marketplaces [ to determine 2018 pricing] and what will happen relative to pulling out and price increases. It is such a complex, interdependent system. You have to be watching everything.
EBA: Why are you keeping a close eye on it?
Stone: The legislation may not impact active group health plans today to the same extent it impacts the public exchange/Medicaid market, etc. But, many employers have workforce strategies that rely on the gig economy more and more. Individuals have had a viable marketplace over the last two years to go out and get healthcare coverage. What they are expecting from an employer and the willingness to go from contract to contract in part is enabled by a robust individual marketplace.
It’s the same thing with readiness to retire. We have seen changes in retirement patterns with people willing to retire pre-Medicare eligibility because there was a reasonably financially-sound alternative to individual coverage.
If the 5-to-1 ratio goes into play, or there are other changes, that could have an impact on retirement patterns. While you don’t have the loss of knowledge [from people exiting the workforce], on the flip side, you have a block in the workplace for upward mobility if people stay longer with their employers. There are broader workforce implications.
Additionally, on a healthcare cost perspective, if the public exchanges go away and the Medicaid funding expansion changes, then you are likely to have so many more un-insureds showing up in the emergency room. And the cost of their care is not compensated. That cost shifting [is going to impact] other payers — larger employer-sponsored health plans — largely because of how Medicare and Medicaid contracts [work]. We are going to see implications for health plans and employers if that pendulum swings back and there are many fewer people truly having coverage.