Despite being five years into the Affordable Care Act (ACA), the health care industry is still faced with immense change and uncertainty. While insurers and health care providers continue to learn and adapt, individuals and employers also are adjusting to the new era.
People who don’t have health insurance through their employers and buy individual plans are trying to navigate new insurance marketplace exchanges to pick a health plan that best fits their needs. They are faced with understanding benefits offered in the new “metallic” plans under the ACA, subsidies, penalties, and evolving networks.
The employer market is shifting too, with small employers facing similar questions about new plans under the ACA, even as the small-group market is set to expand under the law to include groups from 51 to 100 employees. Employers also are faced with the ongoing dilemma of whether or not they should continue to offer employer-sponsored plans to their employees. Despite these uncertainties, consumers are demanding a better level of service, and many employers have made it clear that they want to stay in the game and continue to offer health benefits to their employees.
As we look at the year ahead, this is certain: the health care system is changing, and Premera is focused on guiding customers through that process and helping make their experience in that system better. In an effort to answer the demands of the individual and employer market, we will have a critical focus on the following four key areas this year:
*Customer satisfaction: The health care industry is shifting to a retail market that implies a more responsive approach to consumers. Customers are demanding a new experience with health care coverage than they have had in the past. They want more customized offerings, personalized touch, and more value for their health care dollar. We are engaging directly with our individual customers and employer groups and are working to improve their total experience, including a focus on controlling costs and promoting high-quality care.
*Self-funding option: A new trend that we know will continue to grow and evolve in 2015 is more employers exploring the option of self-funding. With self-funded health plans, an employer assumes the financial risk and a health plan administers the benefits. Historically, self-funded health plans have been an attractive option with large and mid-size employers; however, we have heard increased interest in self-funding options from smaller employers, as long as those options are affordable, simple, and predictable.
Premera has worked to answer the demands of the market and rolled out OptiFlex, a self-funding offering that we feel meets the needs of smaller employers. OptiFlex already has proved to be a popular employer option that is being adopted quickly by groups with 50-plus employees. We are committed to offering timely products as the market for coverage evolves.
*Strong drive toward wellness: We know that 75 cents of every U.S. health care dollar goes toward chronic conditions like diabetes, heart disease, and lung disease. We also know that half of all chronic conditions are linked to poor lifestyle choices and habits.
To reduce these staggering statistics and resulting costs on employers purchasing coverage, Premera offers wellness programs that provide incentives to both employers and employees. Employers can receive a reduction in monthly rates by getting their employees to take action, and employees receive a monetary incentive directly from Premera for taking steps toward better health.
Although wellness is not new in the market, we are seeing a higher adoption rate of employee wellness programs. Employers recognize that wellness is a key component of their cost containment strategy and are elevating it as a priority in the workplace. We expect this to continue in 2015 and beyond as employers seek both to control costs and experience the productivity benefits of a healthier workforce.
*Innovative health care delivery: Premera continues to look for ways to expand the access of high value care, while also driving down the total cost of care. With this in mind, we recently launched a virtual care offering that provides members with access to care at a time and place that is convenient to them.
Virtual care, or telemedicine, enables our members to receive health-related services via a variety of telecommunication channels. Premera believes consumers will value these virtual care benefits when in-person care is difficult to access.
We also believe employers will benefit from virtual care. A recent analysis by Arlington, Va.-based professional services company Towers Watson predicts that telemedicine potentially could save U.S. employers $6 billion a year. This savings is a result of telemedicine serving as a cost-saving alternative to emergency room or primary-care visits.
Currently, the use of virtual care is low, but we believe this will change in the months and years ahead. Premera’s virtual care offering started on Jan. 1 and is available to Premera members when they renew their plans.
While Premera will have a sharp focus on all of the areas listed above, 2015 could turn out to be an interesting year for the entire industry. We could see changes to the ACA from Washington, D.C., due to the shift in political landscape. The entire industry will be watching the Supreme Court’s decision later this summer regarding whether or not consumers are eligible for a subsidy if they purchased a health plan through a federally facilitated exchange.
While the Supreme Court’s ruling won’t affect individuals in Washington, the ruling has the potential to impact much of the country. As we monitor the public policy world, Premera will continue to have a critical focus on our customers and will be committed to responding to their needs in a timely fashion this year and beyond.
Bill Akers is the Spokane-based vice president and general manager of Premera Blue Cross’ Washington Group Market.
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