2 min

It’s no secret that hospital charges are skyrocketing. What’s worse is that these charges are disproportionate to actual hospital costs and that patients are often on the hook for outrageous medical bills that can result in extraordinary collection actions (ECAs) against them.

2 min

The outdated health insurance system is feeling increasingly less safe and prudent for employer-sponsored health plans, making change more attractive and attainable. What’s behind this significant shift?

In a recent Vitori Health Digital Forum, hundreds of advisors and employers shared the key factors that have heightened their willingness to take a more progressive approach to employer-sponsored health plans. Behind these dynamics is a compelling impulse to seek a competitive advantage, avoid future risk, and not lag behind more forward-looking peers.

1. Health Care Cost Increases
   Employers and advisors are tired of the continuous cost increases in the legacy insurance system. They are no longer willing to shift these costs to employees, who have seen their disposable income dwindle.
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2. Self-serving Industry Practices
   Continual revelations of unethical and potentially criminal practices on the part of hospital systems, insurance carriers, PBMs, and traditional insurance brokers have raised employer awareness that the legacy system does not serve their interests.
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3. Talent Acquisition and Retentions
   To win the war for workers and talent, employers must free up money to increase salaries and bonuses, improve benefits, and more.
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4. Reduced Market Competition
   Mergers and acquisitions among and between health systems, insurance carriers, PBMs, and pharmacies continue unchecked, each one reducing competition and increasing prices. Employers are demanding more competitive and more cost-effective health plan options.
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5. Increased Adoption of Alternatives
   Approximately 1 in 15 employers currently deploy an alternative to legacy insurance carriers and PBMs. That number continues to grow as employers realize the benefits of alternatives.
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6. Regulatory Actions
   Incumbent stakeholders are under tighter scrutiny from the Healthcare Price Transparency and No Surprises Acts, elements of the Consolidated Appropriations Act, proposed prescription drug pricing legislation, and more.
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7. Fiduciary Responsibility
   Employers and their boards of directors, are increasingly concerned that they are breaching their fiduciary responsibility to manage shared employer and employee health plan assets and expenses, exposing them to the harsh litigation risks that have impacted employee retirement plans.

Collectively, these factors are accelerating employer transitions to health plans that reduce overspending, offer better member service, and free up money for workforce and business investments. Our ability to meet this market-driven need with a unique and comprehensive next-generation health plan helps to explain Vitori’s exponential growth.

2 min

A recent article posted to JAMA Network reveals how the dysfunctional interests of insurers, hospitals, pharmaceutical companies, and PBMs ultimately reduce quality of life for U.S. employees through financial distress induced by the health benefits market.

According to the authors, “It is assumed that insurers compete intensely to improve the value received by employers and employees by negotiating to keep prices down and advocating for employers and employees.” This is not the case, however.

The article shares that “…the mean premium for family coverage increased by 55% from 2010 to 2020 (from $13,770 to $21,342) and employee contributions increased by 40% (from $3,997 to $5,588). Deductibles per enrolled individual increased 110% (from $646 to $1,364) and, to reduce monthly premium deductions from their paychecks, 31% of employees are now enrolled in high-deductible health plans.

“Partly as a result of employer-paid costs of employee benefits rising faster than employer income…take-home pay for most workers stagnated, with real median wages increasing 11% from $62,865 in 2007 to $69,560 in 2019, depriving employees of wage gains resulting from growth in their productivity.

“In the absence of intense counterpressure from insurers, hospitals and most other health care organizations have prioritized growth of high-priced services and developed costly marketing strategies, rather than restructuring to become a low-cost, high-quality solution for employees.”

The top three health insurers work aggressively to increase their monopoly market share of provider contracts that offer little value yet keep providers from pursuing arrangements with alternative payers. Compounding this, healthcare competition is severely hindered as more health systems, many of which don’t pay taxes, merge and purchase hospitals and physician practices, raising prices with each acquisition.

In examining insurance company revenue, profit, and shareholder dynamics, the authors illustrate, shockingly, that “Even if an insurer manages to improve profit margins by 20% while slowing per capita spending growth to 2%, their projected share prices would be lower than if per capita spending growth continued to increase at a 4% rate.” Read that again.

Employers and employees are effectively trapped in this dysfunctional industry matrix that prioritizes rapid growth and financial performance for shareholders.

Although higher healthcare costs are an obvious result of this aberrant system, other costs are more subtle and toxic. In an effort to maintain financial viability, employers often transfer higher health plan costs to employees through lower or no wage increases and higher payroll deductions, plans deductibles, co-insurance, and co-pays.

In the end, employees experience net wage stagnation, are unable to pay their out-of-pocket share when they use healthcare, avoid getting preventive and chronic care, and endure a diminishing quality of life as a direct result of an underperforming healthcare market.

What’s needed are seismic structural changes throughout the industry and better enforcement of regulations designed to accelerate price transparency and competition. In the meantime, employers play a key role in disrupting a system that actively works against the best interests of their organization and their employees.

How? By choosing a high-performance health plan that can save 30%+ over legacy insurance carrier plans while delivering high-quality care and improved member support. When better benefits are offered at a lower cost, employers can improve the quality of life of their workforce and their families.

2 min

As we approach two years of coping with COVID-19 and its latest variants, there is a burgeoning need for mental health services. The American Psychological Association (APA) describes it as a “health care tsunami” with 84% of psychologists reporting an increase in demand for anxiety treatment since the start of the pandemic.

This demand has exacerbated the usual difficulties in getting needed mental health care: providers who don’t accept insurance plans, practices closed to new patients, the high cost of out-of-network care, and a limited number of local (and overburdened) practitioners in some areas.

Decreased Productivity

Businesses are also adversely affected by COVID. It’s hard for employees to stay focused and efficient when they’re worried about their health and safety at work, at home, and in the community. Concerns are compounded with children in school or daycare and family members in shared or congregate housing.

As a result of these pandemic-related stresses, Harvard Business Review reports that most companies “are less productive now than they were 12 months ago” as employees struggle to balance the new realities of work and home. The best way to improve productivity is for employee health plans to effectively reduce the barriers to quality mental health care.

Telehealth Leads the Way

Collaborative technologies have changed the way we work and access health care during the pandemic, and that change is here to stay. According to an APA survey, 96% of psychologists said that telehealth “has proven its effectiveness as a therapeutic tool” with 93% intending to continue providing telehealth options after the pandemic.

Telehealth eliminates the physical barriers to quality mental health services, making it available to all employees regardless of location. It can also make such care financially accessible. Forward-looking employee health plans offer telehealth services that are completely free to members. It’s a small price to pay for the priceless benefits of employee wellbeing and productivity.

3 min

We are living in a time when leadership is at a premium. This is especially true as we adapt to a “new normal” in our personal and professional lives. In the healthcare arena, the premium on leadership is multiplied by several factors.

• We have a costly, opaque, anticompetitive, and inefficient system.
• Health care represents 1 in every 5 dollars of Gross Domestic Product and continues to grow faster than any other consumer price index category.
• Like food, housing, and a means to support oneself and one’s family, health is a deeply personal necessity. Illness, injury, and disease compromise our ability to meet life needs. A lack of access to health care or to affordable health care compounds the consequences of personal and family health challenges.

These factors should elevate the expectations of next generation leadership in the health sector and hold us to higher standards in our current efforts and especially in our capacity to influence change.

It is not my intent to define leadership here. This has been done many times in many places. However, I’d like to suggest that as executive leaders within a healthcare ecosystem that needs great improvements, we should hold ourselves to next generation aims and actions. Here are some tenets that might help to keep us pointed in the right direction.

Leading Healthcare with Integrity

1. Do no harm.*

Questionable practices across stakeholders in the U.S. healthcare, pharma, and insurance systems have shaken the foundation of trust. Many “solutions” created by the legacy industry and new entrants inherit the current system’s ethical challenges, such as egregious billing and shared savings, hidden fees, and unscrupulous contracts.

Many are smaller versions of the same problems. For example, direct contracting meant to address valueless provider networks is often based on the same model of discounts off price-blind billing.

As next generation leaders, we need to ask, and answer, hard questions. Are we creating and delivering integrity-based products and services? Are our decisions and actions improving affordability? Lowering barriers to access? Increasing transparency? Creating more competition? Eliminating conflicts of interest? Making things better for patients, care providers, and payers?

* Contrary to popular belief, “do no harm” isn’t actually a part of the Hippocratic Oath.

2. The majority is almost always wrong.

This is the reason ingenuity, innovation, and positive change can take hold in the first place. Consolidating entities in a compromised system, like the unchecked hospital, PBM, and insurance carrier acquisition activity over the past decades, worsens existing problems, monopolizes thinking, and homogenizes behavior. This creates a spiral of further system regression, making change much harder.

Next generation leadership asks “If we could start anew, what would we do?”

3. Incrementalism is a way to avoid real change.

Incrementalism is an attractive proxy for standing still. In our current healthcare system, staying the same means getting worse by default. We see this in the form of minor tweaks staged as major advances, such as ACOs and value-based care attempts to blunt out of control fee-for-service.

A variant of incrementalism involves offerings designed to “manage the racketeering.” Examples of this include industries that have cropped up attempting to optimize PBM contracts or engage in an auditing arms race with hospital revenue maximization specialists and systems.

Next generation health leaders are not afraid to create much needed separation from the mainstream with offerings that will seem audacious to the status quo.

4. Look out-of-field for solutions.

This is a hallmark of innovation and invention across all disciplines. What can we learn and adopt from operational efficiency in other industries? From healthier buyer-seller-customer arrangements in unrelated arenas? From financial transaction reinvention in other sectors? Or from businesses that take care of people in spaces outside of healthcare? Importantly, what can we learn from those at ground level every day in the current system?

5. Take risks.

Outside of medical research, the established system is averse to risk and change. This prohibits progress. It requires courage from leaders who will embrace the unknown to step away from the majority and make real change happen through better solutions. We need leaders who are not afraid to ask “What if…?”

v2.0 Healthcare Leadership

In our new normal, we are at a time and place that is ripe for next generation health leaders who have the morals and courage to lead with bigger, bolder steps. If not us, who? If not now, when?

2 min

When evaluating a traditional employee health plan, employers and brokers typically focus on premiums, deductibles and co-pays, and the nuts and bolts of the plan’s coverage. Customer service is an afterthought. Historically, it has been enough that employees can call a toll-free number when they have questions.

Thankfully, the opposite is true when employers look at alternatives to these outdated insurance carrier plans. Instead of accepting the unacceptable status quo, there is growing demand for a significantly better member support experience. It’s about time!

A Better, More Compassionate Approach

There is no reason for employees to sit on hold waiting to speak with a random agent at a far-flung call center. Besides taking advantage of the many technologies available to connect and collaborate, members are better served speaking with a dedicated advocate who can guide them through the complexities of finding quality health care at a lower cost.

Health plans that prioritize the member experience help employees access more affordable health care, in all areas of care. Convenient and easy-to-use tools and personalized assistance ensure members (and employers) get the most value from their plan. This is as it should be, yet it is NOT what members get from a legacy insurance carrier.

Checklist for Better Member Support

Before renewing the current health plan, pause and seriously evaluate how well it meets member and employer needs. Apply these attributes to any plan under consideration and all stakeholders will be much better off.

• Compassionate Advocacy
  Advocates are a member’s most important resource. Services should range from simple questions asked and answered, such as benefit verification, all the way to personal assistance in complex matters. When members need to access specialty care or find the physician or facility most capable of providing needed care, they deserve to work with a proven, trustworthy team that’s ready to jump in and advocate on their behalf.
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• Flexible On-Demand Access
  While there will always be traditional phone support, a truly great support experience includes multiple platforms to simplify communication between members and their support team. Options should include in-app and online member portal messaging capabilities, online document uploading, and secure text messaging. This will encourage more and better communication by providing members with the platforms they are most comfortable using.
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• Ongoing Education
  The more members know about their health plan, the more value they can realize. Most “education” takes place during the Open Enrollment period when members are inundated with flyers, fact sheets, and plan summaries. But it’s after enrollment that they really need help. Member-focused education provides readily available process guides, short “how to” videos, and regular communications throughout the year. It also highlights plan features to promote awareness and guidance on how to access them.

Members and their families benefit most from advocacy that supports them every step of the way. They deserve a trusted support team that is empathetic to their needs and is dedicated to removing barriers to needed health care

Comprehensive member support is a critical component of an employee health plan. And it’s what employers are demanding as they seek alternatives to legacy plans. With superior health plan alternatives available, isn’t it time to leave outdated insurance carriers behind and choose something better for both members and the business bottom line?
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As Managing Director of the Client & Member Experience at Vitori Health, Johanna Newsome is passionate about nurturing positive, lasting relationships and building teams with a client-centric focus to collaboratively facilitate a positive member experience.