Innovating health care

A growing number of employers see themselves as catalysts for change or early adopters in developing innovative health benefit programs for their employees and families (53 percent up from 42 percent), according to the latest purchaser survey conducted by the Midwest Business Group on Health (MBGH). Employers said that the greatest threats to affordability of employer provided coverage are high-cost pharmacy claims (100 percent), specialty drug costs (94 percent), high-cost medical claims (93 percent), and medical inflation (90 percent).

“Unsustainable and rising medical and drug and costs have a far-reaching impact on the ability of businesses to remain competitive or offer salary increases for their employees,” said Cheryl Larson, MBGH president and CEO. “As a result, employers are getting engaged in health reforms and more creative in their contracting strategies.”

The survey found the following:

• Top employer health benefit priorities for 2024 are a focus on engagement in programs and use of benefits (52 percent), chronic condition management (48 percent), high-cost medical claims (44 percent), and wellbeing/building a culture of health (42 percent).
• Payment reform priorities are specialty drug management (64 percent), reduce waste, inappropriate and low-value care (39 percent) and centers of excellence/episodes of care (33 percent).
• Strategies for covering GLP-1 anti-obesity medications are covered with prior authorization (49 percent currently do so and 25 percent are considering), covering with risk stratification such as BMI and comorbidities (41 percent currently, 29 percent considering), and not covering due to lack of evidence (19 percent currently, 5 percent considering).
• Strategies to manage pharmacy benefit costs are defined PBM contract terms to optimize savings (48 percent), plan design steers to lowest cost drugs (42 percent), pharmacy benefit transparency/pass-through pricing (33 percent), coverage of biosimilars (33 percent), and comprehensive medication management (32 percent).
• Mental health benefits and behavioral health services being considered are manager training (42 percent), no-or low-cost onsite counseling (31 percent), flexible work schedule (29 percent), expand networks (29 percent), and increased number of covered visits (24 percent).
• Women’s health at every stage of life such as childbirth, caregiving and menopause are gaining traction with paid maternity leave of absence (50 percent), paid paternity leave of absence (45 percent), paid adoption leave of absence (28 percent), and financial fertility treatment support (23 percent) noted as top strategies.

SOURCE: www.mbgh.org

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