A system that encourages shared savings and shared risk between health plans and providers could address many of the Affordable Care Act's problems. Health plans are likely to move away from fee-for-service payments to a managed care approach, one analyst says.
The government could be sitting on a solution to the healthcare debate and not even realize it, suggests one analyst. The act that finally fixed a problem threatening to bankrupt physicians every year could show the way to fixing the Affordable Care Act, he says.
The Medicare Access and CHIP Reauthorization Act (MACRA) may provide a roadmap and policy vehicle to address questions of quality, cost, accessibility, says Bruce A. Johnson, JD, a shareholder with the Polsinelli law firm in Denver, CO.
MACRA is based on the idea of shared risk and shared savings, and Johnson says the same theory could be applied to the ACA. Health plans are already moving in that direction, without waiting for the government to lead, he says.
Known as the "doc fix," MACRA is a recent bi-partisan legislative action that eliminated a nearly 20-year-old problem with how Medicare set payments to physicians. Congress passed the act in 2015 to put an end to an annual drama in which physicians faced huge Medicare pay cuts, 21% that year, if legislators didn't take emergency measures to stop it for another year.
By fixing the problem, MACRA eliminated substantial uncertainty about the stability of Medicare related to physicians leaving the program because they couldn't make enough money – similar to how profitability issues have driven health plans out of the state exchanges.
MACRA introduced performance-based reimbursement by rewarding practices that participate in alternative payment models (APMs) such as accountable care organizations (ACOs), and through a merit-based incentive payment system (MIPS).
The first couple of years focused specifically on Medicare-only programs, but then in future years some of the MACRA models include consideration of commercial populations, he notes.
A health system with a Medicare-only population may not meet the MACRA requirements for and APM and the associated rewards, but MACRA could allow them to create relationships with commercial payers, he says.
"As they bundle together more people receiving similar types of care, combining Medicare, Medicaid and commercial, the organizations may be able to qualify as an APM," he says.
That would benefit the health system financially but also health plans, Johnson says. By working with providers to reduce costs and improve outcomes, they could conceivably share in the savings offered by a MACRA-style arrangement.
"Health plans are incrementally trying to move toward different forms of shared savings programs and some level of risk for providers. We're seeing United and the Blues doing some of that, and clearly Medicare Advantage plans are in one way or another willing to have providers take risks through capitation or basically managed care," Johnson says.
"That is probably a long term strategy. The timeline MACRA has laid out for implementation may be too aggressive because I don't think the health plans have plan types and resources to change that fast, but I think the trajectory is going to be a move from fee-for-service to shared financial risk over time."
UnitedHealthcare was an early proponent of value-based care and is well positioned now that value is increasingly seen as a healthcare solution. Providers will have to demonstrate that they provide better care at a lower cost.
Value-based care is gaining attention as one way to address the rising costs of healthcare and insurance. And one of the nation's biggest insurers is finding it made the right choice by adopting this reimbursement strategy early on.
UnitedHealthcare started tying healthcare reimbursement to outcomes when that was still a radical new idea, but its experience now leaves the company well suited for what seems to be the future of healthcare.
Lisa McDonnel, senior vice president of national network strategy and innovation at UnitedHealthcare, notes that UnitedHealthcare was heavily invested in the value-based care concept long before the ACA became law. The insurer has been using bundled payments for transplants for more than 25 years.
It recently expanded its value-based care efforts into new products and lines of business, lining up with the increased focus on accountable care organizations and other value-based programs.
In the early 2000s, UnitedHealthcare had about $12 billion of its total $100 billion spent on medical care tied to value-based care, McDonnel notes. Now it has about $54 billion tied to value-based care, she says.
That increase came from incorporating value-based reimbursement with Medicaid, expanding Medicare Advantage offerings across the country, and through the increased use of pay-for-performance and bundled payments in the commercial space.
'Part of Our DNA'
The health plan has pledged to hit the $65 billion mark with value-based care in the next two years, McDonnel says. More than 15 million UnitedHealthcare members, or one in almost every three enrollees, are accessing care from a physician who now has a value-based relationship with UnitedHealthcare.
“We consider this part of our DNA now, how we contract with providers. Fee-for-service alone is not getting the results in terms of quality and efficiency that will sustain healthcare as we know it in this country, so we recognized that we had to change how providers are reimbursed to something based on value,” she says.
“We are well down that path across all our business, not just the products that were on the exchange.”
UnitedHealthcare also is diversified with its insurance products, McDonnel notes. With all the uncertainty over healthcare legislation, that diversification couples well with the focus on value-based care, she says.
Ready for What Comes Next
“Value-based care prepares us better for whatever might be coming in terms of the Affordable Care Act or other legislation, and our diversification allows us to flex perhaps more easily, more readily with changes that might occur,” she says.
UnitedHealthcare is focusing more than ever on providers who can demonstrate that they deliver better care at a lower price, McDonnel says.
“Now it’s not just that they’ve been working on their performance, but when we measure their performance relative to their peers, we are looking for the ones that have emerged and are delivering higher value care,” she says.
“We’re figuring out how we can align higher volume to those providers that are delivering higher value. We’re seeing narrow networks emerging, tiered networks, different iterations depending on the market. But we are definitely focused on shifting volume to providers who can demonstrate they are delivering that improved value.”
It’s not a one-way street, however. Providers are questioning how much additional volume they can expect by providing better care at a lower cost, McDonnel says, seeking to find the right balance in terms of volume and reimbursement.
“They’re trying to figure out how much steerage they can expect and who is participating. If everyone is in that network, they’re not going to get as much increased volume and they will be less inclined to step up and do something for less money,” McDonnel says.
“They can’t manage that patient population most effectively and really focus on our population of members unless they can depend on that steerage.”
Managed care models already are saving more than $7 billion this year in Medicaid. Moving all Medicaid fee-for-service to managed care could save $63 billion over a decade, a study concludes.
Moving all Medicaid fee-for-service spending to a capitated managed-care model could produce total savings of $63 billion over 10 years, including $35 billion in federal savings, according to a newly released analysis.
A report from the Association for Community Affiliated Plans (ACAP) analyzes the current and potential savings to Medicaid programs around the country from the adoption of the managed care model.
The report estimates that in 2016, Medicaid managed care already results in nationwide savings of $7.1 billion, and it projects savings from these existing managed care programs to total $94.4 billion over the next 10 years.
Managed care is poised to become the dominant payment model for Medicaid, the report notes. As recently as 2010, capitated managed care represented only a quarter of total Medicaid spending nationwide. That figure rose to 48.9% of national Medicaid expenditures by 2016, and this percentage will likely continue to increase, the report says.
ACAP CEO Margaret A. Murray says the report "puts in black and white the fact that managed care can save precious Medicaid resources while at the same time maintaining a high level of access and quality care. Should Congress continue to turn to managed care's predictable budgeting and quality management tools to effect further savings, they must assure that Medicaid managed care plans are reimbursed in an actuarially sound manner."
Legislators should be pushing states to adopt the manage care model more extensively, the report suggests, targeting the potential savings of transitioning remaining Medicaid fee-for-service expenditures and beneficiary subgroups into the capitated model.
"These costs currently represent roughly half of the nation's Medicaid spending. Transitioning these fee-for-service costs to the capitated setting to the fullest extent possible is estimated to yield care coordination savings of $63.2 billion across the 2017 to 2026 10-year timeframe," the report says."
The majority of these 10-year savings ($35.7 billion or 56.5% of the total) are estimated to accrue to the federal government. The savings potential for remaining non-capitated costs is lower than for existing capitation programs because some Medicaid costs—such as [disproportionate share hospital] and [graduate medical education] payments and coverage of retrospective eligibility periods—are not 'impactable' by managed care techniques."
Managed care organizations (MCOs) bring improved quality along with the savings, the report says.
"MCO and provider performance on these access and quality fronts is being measured with ever-increasing sophistication, and these measurements are increasingly tied to performance-based payments both in state contracts with MCOs and in MCO contracts with their front-line providers," the report says.
"The results of these efforts are evident in the ongoing improvement in Medicaid MCOs' quality scores across time, both at the individual plan level and program-wide."
Murray notes that further adoption of the managed care model could save significant sums without the nearly $800 billion in cuts to Medicaid spending currently under consideration on Capitol Hill.
"There are ways to improve the efficiency of the Medicaid program, to be sure," Murray says. "$800 billion in budget cuts are simply a different order of magnitude than what innovation and system reform can provide. These cuts aren't just trimming fat from the Medicaid program. They get at muscle and bone."
Health plans may focus more on employer coverage and Medicare Advantage as they wait out healthcare reform efforts. The current Senate bill could hold some benefits for them, however.
Uncertainty over healthcare reform has created considerable challenges for health plans participating in Medicaid and the exchanges, leading many large national plans to focus on the two markets that appear to be insulated from the healthcare reform debate: employer coverage and Medicare Advantage, says one analyst.
Health plans considering exchange participation are submitting proposed rates and making participation decisions without knowing whether cost-sharing reductions will be paid or whether healthcare reform will put exchanges on a path toward being phased out, says Jeremy Earl, JD, partner and healthcare analyst with the law firm of McDermott Will & Emery in Washington, DC.
Some large plans are moving more to employer coverage and Medicare Advantage as a sort of safe harbor, letting the debate continue over Medicaid and the state exchanges while they work in the areas least affected by the controversy, he says.
The potential effect on health plans is split according to their business models, he explains. Plans that are heavily invested in the Medicaid managed care business model are likely to experience setbacks if the bill passes, Earl says, because over time the population on Medicaid would be reduced.
There also is the potential for some health plans to benefit from passage of the Senate bill, he says.
"If it does pass, the funding for cost-sharing reductions for 2018 and 2019 is one of the big goals for plans that have already committed to the exchanges for those years," he says.
"Another potential positive for the health insurers is an elimination of the health insurance tax for 2018. That's one of the biggest focuses for the industry—trying to get the moratorium on that tax made permanent—because it works out to about a 3% tax on all the premiums they receive."
That tax, like most taxes, is passed along to the consumer, so eliminating it would also help consumers with lower premiums, Earl notes. That wouldn't happen immediately, though, as the health plans would have to factor the savings into the next years' premiums.
Earl expects the bill to be revised significantly, but he is not at all certain it will eventually be passed by the Senate. At this point, he says, some health plans might be more comfortable with a bill they don't entirely like instead of seeing the bill die and knowing further reform efforts, with unknown impact, will follow.
"The longer this bill is debated, the worse it is for insurers because they can't look into the future and have a good idea of where they will stand. That means they are going to brace for the worst because that is just prudent in the business world, to anticipate the worst outcome of an uncertain situation and make sure you can survive it as a business," he says.
"We're hearing now that the delay could even go into the August recess, and that's not what the insurers wanted. Good or bad, they want to know what's coming."
The potential for further healthcare reform is only one aspect of the fast-changing landscape for health plans. Insurers are also facing significant upgrades in technology and human resources.
The biggest challenge for health plans now is the need to stay agile and to have the people, processes, technology, and systems that can respond to the constant changes in the healthcare insurance industry.
Insurers are scrambling to keep up with legal and societal changes that upend everything they have known in past years, says Harry Merkin, vice president of marketing at of HealthEdge, a company providing software management for payers.
They are being forced to modernize in costly ways that could affect their overall financial health as much as anything that happens to them in the insurance market, he says.
"For decades health insurance was pretty straightforward, one size fits all. It was a bunch of actuaries in a room figuring out probabilities, and people getting sick or dying. Now there are so many permutations of different types of insurance, and the rise of consumerism has people much more aware of the type of insurance they're buying, even through an employer," Merkin says.
"The result is that the health plans have to be able to flex quickly in response to both regulatory changes and consumer demands."
Health plans relying old systems–both technological and organic (state of mind)–are struggling to keep up, he says. Many insurers have managed to put off billions of dollars of costs in technical upgrades and improvements in human resources, but they can't wait much longer, Merkin says.
"We've actually seen examples of CIOs buying parts for old mainframes on eBay and keeping COBOL coders on staff to keep the old systems chugging along, preserving them as long as possible because it is a big investment to modernize," he says.
"But now the incentives for modernizing are much stronger, especially with the influence of Medicare and Medicaid rolls growing every day. Their size exerts a lot influence on the government tends to change things on a whim, not just legislative changes but even things like CMS guidance on enrolling a new member."
The push to value-based reimbursement has increased pressure on IT systems, along with the rapid advances of technology in all of healthcare, he says.
Health plans are none too happy about it, but they are realizing they must make major investments in upgrades at a time when many are struggling to remain viable under the Affordable Care Act or whatever permutation of healthcare reform is coming down the road.
"The old systems can't adjust. Things have been put off because they couldn't afford them, but the day of reckoning is here," Merkin says. "They're unavoidable at this point. They're all trying to deal with changes on the outside and now there is this imperative to make infrastructure changes on the inside."
Most insurers are either taking those steps or planning to, Merkin says, but some are still resisting the pressure.
"There are some health plans with top executives nearing retirement and they are very risk-averse. It's just easier to play it out for the next two or three years," he says.
"Each company's situation is a little different, but the great majority are contemplating their next move because they know they can't wait and they have tomake that investment. They don't want to, but they're realizing they have to."
"It's not just the expansion population that is being affected by this bill. It's every man woman, and child who is supported by Medicaid," says the CEO of L.A. Care.
The healthcare reform bill offered by Senate Republicans worsens the Medicaid funding burden placed on the states by the earlier House bill, says one health plan CEO, and the effects could be profound.
The cuts in Medicaid funding are so severe that the healthcare industry in some states could see a cascade of unintended consequences, says CEO John Baackes of L.A. Care, which covers more than 2 million Medi-Cal members and is the only publicly operated health plan in the state of California to have a product on the exchange.
"It's worse than the House bill. While it slows down the implementation of the cuts in funding, by the time you get out 10 years from now, you're in a worse position than we would have been with the House bill, because of the formula that're going to use to determine the government's share of the per-capita cap," Baackes says.
"This takes what was already bad in the House bill and makes it worse."
The Senate bill cuts deeper into Medicaid funds than the House proposed, capping overall federal spending on Medicaid, and providing states a per-beneficiary allotment of money.
The House bill proposed a similar structure, but the Senate version calls for the federal payments to grow more slowly starting in 2025. States also could opt to receive an annual lump sum of federal money for Medicaid in the form of a block grant.
"Both bills take a period of time. The House version takes one year and the Senate bill another, and says those are your costs and from this time forward we're going to apply the sharing formula to that number," Baackes says.
"That number will be less than what the actual costs are for providing care for the population, so you're creating a shortfall that only accumulates over time. The bill says they're giving the states more flexibility, but in my opinion all they're doing is giving the states more flexibility to raise taxes to pay for it."
Some states, like California, will find it is not feasible to raise taxes enough to make up the shortfall in federal Medicaid funding, Baackes says, and that would force them to cut back on the reimbursement they provide healthcare providers. That would be especially harmful in California and other states where reimbursement already is comparatively low.
"If that starts to happen, providers are going to say 'We're done. We can't do this anymore,'" Baackes says.
"If providers start to drop off and we're still covering the same number of people with fewer dollars, we're going to have people going to emergency rooms for routine care. The emergency rooms will get backed up, and because emergency care is more expensive we'll go through the dollars even faster, forcing even further reductions."
The Senate bill eliminates the individual and employer mandates for having and providing insurance. It also would provide more flexibility on insurance regulations but it does not include the controversial House waivers letting states charge consumers more based on health status and lifting a requirement to cover some essential health benefits.
In a move that should provide some reassurance to health plans struggling to remain profitable under the Affordable Care Act, the Senate bill would continue funding cost-sharing reduction payments through 2019.
All of the ObamaCare taxes would disappear, except for the Cadillac tax levied on expensive employer-provided insurance plans. That tax would be delayed until 2026, however.
The bill also would change the age rating from 3:1 to 5:1, meaning insurers could charge older adults five times as much as younger people.
Baackes says the most important thing about the Senate bill is its expansive effect on Medicaid recipients.
"This bill is going to cut support for 75 million people who are on Medicaid across the country," he says. "It's not just the expansion population that is being affected by this bill. It's every man woman, and child who is supported by Medicaid."
The insurance giant breaks from the pack and says the Senate Republican healthcare reform bill would improve the insurance market.
Perhaps concluding that the individual healthcare insurance market couldn't possibly get any worse for insurers, Anthem surprised many in the industry by endorsing the Senate Republican bill for reforming the Affordable Care Act.
The consensus in the industry is still negative, however.
Oddly, Anthem makes no mention of how the Senate Better Care Reconciliation Act (BCRA) eliminates the key feature of Obamacare that, in theory at least, has been the biggest draw for insurers:the mandate for every American to buy their products.
Anthem issued a statement saying company leaders believe the BCRA "will markedly improve the stability of the individual market and moderate premium increases."
The reform will do that by earmarking billions of dollars to help stabilize the markets, eliminating a tax on health insurance plans, and aligning premium subsidies with premium costs, the company said.
The Anthem statement acknowledged "the challenges the current bill proposes to the Medicaid program, knowing how important it is to achieve the necessary funding and access to healthcare services and supports are for the individuals and families who rely on them to live healthy meaningful lives in their communities."
Despite its size and influence in the market, Anthem has struggled to find profits under the ACA, recently announcing plans to withdraw from the exchanges next year in Indiana, Wisconsin and Ohio.
Anthem's endorsement of the BCRA runs counter to what most in Washington and in the insurance industry are saying about the potential effects of the bill on the individual insurance market.An analysis by the Kaiser Family Foundation suggests that the Senate bill would result in significant increases to the cost of non-group coverage and medical care.
The foundation estimated the average premiums that current marketplace enrollees would pay for a benchmark silver plan in 2020 under current law and under the plan proposed in the Senate Republican bill.
"Overall, marketplace enrollees would pay on average 74% more towards the premium for a benchmark silver plan in 2020 under the BCRA than under current law. Younger enrollees would see modest increases on average (10% for those under age 18; 17% for those ages 18 to 34), while average premiums would more than double for enrollees ages 55 to 64," the report says.
"These results vary significantly by income as well. Marketplace enrollees with incomes below 200% of poverty would see an average increase in their premium costs of 177%, while higher income enrollees would see an increase of 57%."
The future looks grim for health plans unless substantial changes are made in their favor to the Affordable Care Act, says one healthcare economist. That outcome doesn't look at all certain, though.
Healthcare insurers are fast approaching the late summer deadlines for revealing their cards and telling state regulators what they will charge in the coming year, and indications are that in most cases those numbers are going to be significantly higher than this year.
The insurers' experience with the Affordable Care Act has been a dismal one financially, and unless substantial revisions are made to make it more feasible for them to comply with the law and remain profitable, they will have little choice but to make consumers pay more, says Michael A. Morrisey, PhD.
He is a professor and head of the Department of Health Policy & Management in the School of Public Health at Texas A&M University.
"The near future looks bad for health plans. I think a lot of them are going to raise premiums and I've seen a lot of them planning increases in the range of 20-plus percent," he says.
"And how do you not, when you don't know what's going to happen and you certainly know that the utilization has been high? That high utilization doesn't seem to be a one-time phenomenon; it stays up."
Not all consumers will take the hit, however. Those receiving healthcare coverage subsidized by the government will be insulated, while those buying their coverage on the exchanges without government assistance will have to take up the slack, Morrisey says.
"It's not everyone that gets hurt. If you currently have a subsidized health plan, you're kind of alright. If your income doesn't' change, you will pay the same percentage of your income for coverage that you paid this year, even when premiums go up. The higher cost is picked up by the government and the taxpayers," Morrisey says.
"The people that are potentially hurt a lot are those buying coverage off the exchange with no subsidies. They will have no choice but to pay the higher premiums."
How much premiums increase, and the business outlook for health plans, will depend significantly on what the Congress ultimately does or doesn't do in passing healthcare reform, Morrisey notes.
Meaningful reform could include changes that would shore up the state exchanges and make them more viable for insurers, which are continuing to abandon them state by state, he says.
And the Trump administration may be able to make administrative changes that reassure insurers.
"I don't think we are going to get a bailout from the Congress, so that means it will come down to what the administration will do to keep the exchanges stable. The administration may say they don't want their fingerprints on this and whatever happens they want it tied to the Obama administration, so they do nothing meaningful and just watch the exchanges slide down the hill," Morrisey says.
"That may come down to whether the administration thinks they can do that and not be blamed. I'm not a political scientist, but apparently plenty of my colleagues in that area doubt they can do that."
Some kind of reform is necessary, health insurers say, but the deep cuts currently proposed for Medicaid would leave states struggling to care for poor residents.
Saying Medicaid reform is necessary, but not in the way it has been suggested recently in Congress, the leaders of 10 health insurance plans have issued a joint letter to all 100 Senators and key committee members urging them to reconsider proposed Medicaid provisions and their potential impact.
The health plans cover nearly 13.5 million consumers in 23 states across the country.
The letter asks Senators and other influential leaders to carefully consider the consequences of altering Medicaid. It is signed by the CEOs and presidents of AmeriHealth Caritas, Blue Shield of California, CalOptima, CareSource, Gateway Health Plan, Healthfirst (NY), Inland Empire Health Plan, LA Care Health Plan, Molina Healthcare, and UMPC for You.
They say the Affordable Care Act and the underlying financing structure of the Medicaid program should be modified in ways that promote overall savings in the system, rather than cutting funding to states.
"This year's discussion began with a focus on the ACA's individual insurance market, but current healthcare proposals go further and do not enact meaningful, needed repairs to the ACA," the letter says.
"However, our primary concerns lie in the impacts these policies will have on the 74 million low-income, disabled and elderly Americans whose healthcare coverage through Medicaid rests in the hands of the Senate as you craft new legislation and policy options."
Rather than the funding cuts under consideration, the letter urges Senators to include other options to preserve access to care, such as:
Regulatory simplification to increase efficiency
Continued expansion of waiver flexibility for states
Regulatory relief to determine prescription drug formularies and improved prescription drug price transparency
Alternative payments for healthcare providers based on population management instead of piece work reimbursement
Consolidation of administration and benefit design of those eligible for both Medicaid and Medicare, the dual-eligibles who make up the most costly segment of Medicaid
The health plan leaders state that they are united in opposition to the Medicaid policies currently debated by the Senate, but not to the idea of reform.
"We are not advocating to maintain the status quo; rather we are advocating for meaningful Medicaid reform," the letter says.
The letter notes that under the policies being considered in Congress, the federal government would establish a limit on the amount of funding it would provide to states each year beginning in 2020, and instead of actuarial computations the government would use 2016 Medicaid costs
trended forward by the Medical Consumer Price Index.
That approach is estimated to reduce the federal share of Medicaid funding by more than $800 billion over 10 years, amounting to a 25% shortfall in covering the actual cost of Medicaid.
"While this may appear positive from an immediate budgetary perspective, these amounts spell deep cuts, not state flexibilities, in Medicaid. There are no hidden efficiencies that states can use to address gaps of this magnitude without harming beneficiaries or imposing undue burden to
our health care system and all U.S. taxpayers," the letter says.
"Reducing the federal government's share of Medicaid in this manner is not meaningful reform to bend the cost curve. It is simply an enormous cost shift to the states. It does nothing to address underlying drivers of the cost of care, like expensive new drugs and therapies, and an aging population living longer with disability."
States would have to cope with the budget shortfall with strategies such as increased state
and local taxes, reducing benefits, cutting reimbursement to healthcare providers, and
eliminating coverage for certain categories of currently eligible beneficiaries, the letter says.
Even if required benefits are trimmed in the next version of the American Health Care Act, the employer market is not likely to react soon. Employers do need to brace for more price sensitivity, however.
The potential changes to healthcare plans resulting from Republican efforts to reform the Affordable Care Act could have far reaching effects for some consumers. But those who receive insurance coverage through their employers will be slow to feel any impact, says one analyst.
That doesn't mean employers can rest easy, however, because they must still adjust to the growing price sensitivity of their employees.
Republicans in the Senate have not yet released their bill for reforming Obamacare, which is expected to pull back on some provisions of the House bill such as those trimming the essential health benefits.
On Tuesday, President Trump characterized the House-passed healthcare bill as "mean" and urged lawmakers to come up with a version that is "more generous."
But even if the House bill as it stands now were to become law, it would be years before there was any real impact on the employer market, says Kim Buckey, healthcare regulations expert and vice president of client services at DirectPath.
The company provides strategic employee engagement, compliance management, and benefits plan management services for Fortune 1000 companies.
"First, states would have to elect to waive essential health benefits, then, we'd have to see the first 'brave' employers decide to base their plans on one of those pared back definitions. That would affect annual and lifetime coverage limits and out-of-pocket limits," Buckey says.
"Since we know how important health insurance is to employees and prospective employees, employers will be very cautious about adopting such a change given the potential impact on employee attraction and retention."
However, employers will only be able to hold out for so long before economic pressures make them consider altering their employee coverage, she notes. They would be well advised to lay the groundwork now for changes that might have to be made in the future, Buckey says.
"Employers should address the elephant in the room during the upcoming enrollment period. If they haven't done so already, they should share their benefits and compensation philosophy, and maybe even share some of the costs they are facing and what the trend has been."
"Employees are never going to like increased cost-sharing, but if they can understand why it's happening, it should reduce some tensions," she says.
Employers also will see greater demand for transparency and advocacy services, which are already popular, Buckey says.
"Employees will be more wary of big-ticket items like expensive tests and surgeries, and will look for all the help they can get in controlling those costs. And that applies just as much to expenses after the fact. As more employees become aware of the error rate in medical bills, they'll want to see where they can potentially save on the back end as well."