Employers Eye New Health Delivery Approaches

In the next three years, 73% of employers plan to roll out new health delivery models, according to a survey by Willis Towers Watson. From August 11, 2020 to September 9, 2020, they surveyed 397 U.S. employers, representing 7.1 million employees. Julie Stone of Willis Towers Watson said, “No longer satisfied with traditional strategies,…employers are searching for ways to better manage the quality of health care with emerging and more cost-effective delivery options.” These are some of the solutions that employers view as effective: 

• 82% Programs that target clinical conditions
• 74% High-performance or narrow networks 
• 71% Accountable care organizations 

Network and Provider Strategies
Employers are using various network and provider strategies to manage costs:

• 22% reduce out-of-pocket costs for use of high-value services supported by evidence while another 33% are planning or considering it
• 10% increase out-of-pocket costs for commonly overused services while 29% are planning or considering it  

High-Performance Networks
Employers are offering high-performance networks (HPNs) that provide access to a narrow network of higher-value and lower-cost providers. Cost savings are the key consideration. Half of employers say costs would need to decline a great deal to consider a narrow network with less than 25% of providers while a third say quality would need to improve a great deal. Here are some HPN stats from the survey:

• 40% of employees with access are enrolled in an HPN
• 38% of employers have adopted or are planning to adopt an HPN with 25% to 49% of providers included 
• 90% of those who plan to offer an HPN would do so through their health carrier 
• 18% of employers offer a high-performance/narrow network in one or more locations
• 72% of employers offer a regional/local HPN solution instead of a national solution or plan to do so

Condition-Based Strategies

Employers offered strategies for these conditions:

Steering Employees to High Value Providers 
Twenty-five percent of employers steer members toward higher-value providers using quality and cost data. This figure may rise to 59% by 2023. To establish a high-value network, 67% of employers partner with their carrier while 26% partner with a third-party vendor. 
 
Telehealth and Virtual Care
Fifty-two percent of employers say that telemedicine/virtual medicine will be an important priority following the pandemic. Eighty-one percent say their employees had no problems accessing virtual care this year. More than three-quarters say virtual visits are likely to drive down costs. 

Care Navigation
Some employers are using care navigation services in which a third party (other than a carrier) handles customer service and uses the resulting information to better manage care.
 
Centers of Excellence
Fifty-three percent of employers offer centers of excellence (COE) in their plans. Ninety-two percent say that COEs improve the quality of care while 82% expect COEs to reduce annual health care costs. Using COEs is optional among 70% of employers and mandatory among 21%. 
 
Concerns
Employers expressed concerns about access to services, such as specialty pharmacy, mental health, and substance abuse treatment, particularly in rural areas. 

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