Be prepared: 3% of the healthcare workforce quit their jobs
By Misty Baker
Healthcare costs continue to rise for both consumers and employer sponsored health plans. The key to controlling costs in 2023 and planning for 2024 is staying on top of trends and legislative moves at the state and national levels. While we are still early in the year, here are six national issues and trends you and your clients should be keeping an eye on.
Health benefits costs continue to rise for consumers and employers
While some experts predict a 10% increase in overall health benefit costs in 2023, it’s important to look beyond that stat to understand factors driving the increase. The healthcare industry is not immune to the pressures of labor, inflation and supply that are impacting the economy as a whole, but it also faces some unique challenges.
Labor shortages are driving up costs and making it more difficult to find and schedule some services. According to the U.S. Bureau of Labor Statistics, each month in 2022, around 3% of the healthcare workforce quit their jobs, exacerbating the overall problem and putting more pressure on workers who remain. This is a troubling trend that will take time to reverse.
Additionally, supply chain issues and demand spikes continue to impact the availability of materials and prescription drugs. Healthcare providers are also dealing with the ramifications of delayed preventative screenings due to the pandemic. Delayed screenings have resulted in delayed diagnoses, requiring more intensive and expensive treatment than if issues had been caught earlier.
COVID-19 treatments and testing costs shift
The COVID-19 national emergency and public health emergency (PHE) will end on May 11, 2023. The PHE has been in place since 2020 and has been extended multiple times in order to provide tests, vaccines and treatments to Americans free of charge. At the expiration of the PHE, private insurance and government health plans will need to pick up the testing and treatment costs previously covered by the federal government.
The No Surprises Act
The No Surprises Act addresses surprise medical billing – unexpected and often large out-of-network bills sent directly to patients. According to the Kaiser Family Foundation, 9-16% of in-network, non-emergency hospitalizations involve an out-of-network practitioner that the patient did not choose. Additionally, one in five emergency room visits result in patients receiving unplanned care from out-of-network hospitals, doctors and other specialists.
The No Surprises Act requires healthcare plans and providers to negotiate through an established process to determine payment for unplanned out-of-network services and outlines an independent dispute resolution process if direct negotiations are unsuccessful.
Mental health remains a priority
Over the past decade, consumers have become increasingly aware of the importance of proactively addressing mental health in children and adults. As more employers offered mental health and wellness options, use of mental health services has skyrocketed among the workforce.
Recent legislation has required more transparency and tighter regulations, giving people greater access to and awareness of services and medications that address mental health. But finding and scheduling practitioners continues to be an issue for many people, with extended wait times or a lack of local resources in some areas of the country.
National retailers enter the the healthcare services market
Both CVS and Walgreens have rolled out primary care offerings and diagnostic testing at their retail locations. This may seem a natural move for pharmacy chains, but other major retailers are following suit.
Walmart has acquired a telehealth company that will enable it to expand into virtual visits, building off its rollout of in-store clinics. Amazon not only acquired a primary care organization that gives it an instant national footprint, but also launched a $5 prescription program. Dollar General has begun piloting mobile clinics in store parking lots to offer preventative and urgent care services.
These new healthcare providers could improve access to care for millions of Americans, but it remains to be seen if consumers will trust retailers with their health.
The insurance industry continues to innovate and evolve
Even in a tightly regulated industry, there is room for creativity and innovation. In order to better manage costs, several new models have emerged in recent years:
- Individual Coverage Health Reimbursement Arrangement (ICHRA): Introduced in 2020, ICHRAs are formal group health plans that allow employers of all sizes to reimburse employees for health care plans purchased from the marketplace. Employees can submit receipts for qualified expenses or premium payments and are reimbursed by their employers tax-free.
- Health Care Sharing Ministries (HCSM): HCSMs are not health insurance providers, but organizations made up of members who share religious or ethical beliefs. Members make regular financial contributions, which are used to reimburse healthcare costs for other members of the group. Generally, in order to join an HCSM, an individual must be in good health and agree to a shared statement of belief that may impact the types of procedures and medications that the organization will reimburse.
- Reference-Based Pricing (RBP): RBP is used by some self-insured employers to eliminate the disparity between in-network and out-of-network pricing. Benchmark pricing is established (usually indexed to Medicare reimbursement rates) for healthcare services. This allows covered employees to select providers of their choice, as long as the provider agrees to accept the RBP amounts as payment in full.
Keep an eye out for new models and legislation that can help your clients better manage costs for themselves and their employees.
Misty Baker is BenefitMall’s director of Compliance & Government Affairs and 2022-2023 Legislative Committee chair for the National Association of Benefits and Insurance Professionals (NABIP). Misty is an Affordable Care Act compliance and agent advocate, specializing in ACA, ERISA, FMLA, COBRA, and legislative advocacy for over 20 years. She was a registered lobbyist in Texas for four years and is a strategic leader focused on compliance, agent knowledge, legislative advocacy and ultimate client understanding of how to be successful in the changing world of compliance. Her passions include agent education, insurance advocacy inside and outside of the Capital, and compliance.
Misty was awarded recognition as One of the most influential women in employee benefit advising by Employee Benefit Advisor in 2015. She’s been a member NABIP since 1999.
Contact: www.benefitmall.com