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Smart Benefits: Healthcare Is A-Changing

Monday, February 03, 2014


According to industry expert Robert Laszewski, of Health Policy and Strategy Associates in Washington D.C., the healthcare market is in the midst of an historic shift. And it will change the business of healthcare in this country.

During his presentation last week to over 100 benefit advisors and consultants at Milliman’s annual conference, Laszewski said that, as a result of five key drivers, providers are at greater risk for the quality and cost of care, consumers are becoming more accountable for their healthcare expenses, and employers are evaluating their place in providing benefits.

5 Reasons for Change

The five key reasons behind these changes?

• The federal debt challenge. The country's growing debt will force changes in the way healthcare is paid for. The government's interest on debt will climb from 2.2 percent of GDP to 3.7 percent by 2023. And costs for Social Security and major healthcare programs like Medicare and Medicaid will jump from an average of 7.2 percent to 11.8 percent by 2023. These increases will continue to eat up more government spending, creating more reliance on the private sector and fundamental changes in provider reimbursement.
• The shift of government healthcare programs to private sector insurers. Government healthcare programs are increasingly being shifted to the private sector. As Medicaid and Medicare enrollment continues to grow, health insurers will manage most of the enrollment for the government.
• New methods of provider reimbursement. Physicians recognize that the government is looking to overhaul Medicare reimbursement schedules. So new models of care delivery – like patient-centered medical homes and accountable care organizations – are giving doctors the ability to improve and restructure how care is delivered and paid for. Changes at the hospital system level are also expected and reimbursements will be changed there as well.
• Exchange enrollment. The Obama Administration has proven it can enroll the sick in exchanges, but it remains to be seen whether healthy people will sign up. Laszewski believes the problem is that the exchange plans don't offer consumers the value they are seeking, but rather higher deductibles, sometimes coupled with narrow provider networks (depending on the state). And the subsidies offered aren’t incentive enough. The exchanges must enroll a majority of eligibles to be viable long-term; in fact, Laszewski says 22 million will be needed by 2016 for the exchanges to make sense.
• New health insurance models. Employers are moving to new models of healthcare insurance that include defined contributions by employers (rather than defined benefits) and greater individual responsibility. Private exchanges are quickly gaining traction as employers look for ways to control their expenses and give employees the choice of plans they want.

All these changes point to one big question: will employers continue to offer insurance? Laszewski predicts an employer’s commitment to benefits will be tied to how important benefits are to attracting workers, meaning those who seek highly skilled employees will continue offering benefits.

Amy Gallagher has over 21 years of healthcare industry experience guiding employers and employees. As Vice President at Cornerstone Group, she advises large employers on all aspects of healthcare reform, benefit solutions, cost-containment strategies and results-driven wellness programs. Amy speaks regularly on a variety of healthcare-related topics, and is often quoted by national publications on the subject matter. Locally, Amy is a member of SHRM-RI, the Rhode Island Business Group on Health, and the Rhode Island Business Healthcare Advisory Council. 


Related Slideshow: New England’s Healthiest States 2013

The United Health Foundation recently released its 2013 annual reoprt: America's Health Rankings, which provides a comparative state by state analysis of several health measures to provide a comprehensive perspective of our nation's health issues. See how the New England states rank in the slides below.



All Outcomes Rank: Outcomes represent what has already occurred, either through death, disease or missed days due to illness. In America's Health Rankings, outcomes include prevalence of diabetes, number of poor mental or physical health days in last 30 days, health disparity, infant mortality rate, cardiovascular death rate, cancer death rate and premature death. Outcomes account for 25% of the final ranking.

Determinants Rank: Determinants represent those actions that can affect the future health of the population. For clarity, determinants are divided into four groups: Behaviors, Community and Environment, Public and Health Policies, and Clinical Care. These four groups of measures influence the health outcomes of the population in a state, and improving these inputs will improve outcomes over time. Most measures are actually a combination of activities in all four groups. 

Diabetes Rank: Based on percent of adults who responded yes to the question "Have you ever been told by a doctor that you have diabetes?" Does not include pre-diabetes or diabetes during pregnancy.

Smoking Rank: Based on percentage of adults who are current smokers (self-report smoking at least 100 cigarettes in their lifetime and currently smoke).

Obesity Rank: Based on percentage of adults who are obese, with a body mass index (BMI) of 30.0 or higher.

Source: http://www.americashealthrankings.org/

Prev Next

6. Rhode Island

Overall Rank: 19

Outcomes Rank: 30

Determinants Rank: 13

Diabetes Rank: 26

Smoking Rank: 14

Obesity Rank: 13



1. Low prevalence of obesity

2. High immunization coverage among adolescents

3. Ready availability of primary care physicians  


1.High rate of drug deaths

2. High rate of preventable hospitalizations

3. Large disparity in heath status by educational attainment

Source: http://www.americashealthrankings.org/RI

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5. Maine

Overall Rank: 16

Outcomes Rank: 25

Determinants Rank: 12

Diabetes Rank: 23

Smoking Rank: 29

Obesity Rank: 28



1. Low violent crime rate

2. Low percentage of uninsured population

3. Low prevalence of low birthweight  


1. High prevalence of binge drinking

2.High rate of cancer deaths

3. Limited availability of dentists

Source: http://www.americashealthrankings.org/ME

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4. Connecticut

Overall Rank: 7

Outcomes Rank: 15

Determinants Rank: 4

Diabetes Rank: 16

Smoking Rank: 4

Obesity Rank: 12



1. Low prevalence of smoking

2. Low incidence of infectious diseases

3. High immunization coverage among children & adolescents  


1. Moderate prevalence of binge drinking

2. Low high school graduation rate

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/CT

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3. New Hampshire

Overall Rank: 5

Outcomes Rank: 7

Determinants Rank: 5

Diabetes Rank: 16

Smoking Rank: 11

Obesity Rank: 22



1. Low percentage of children in poverty

2. High immunization coverage among children

3. Low infant mortality rate  


1. High prevalence of binge drinking

2.High incidence of pertussis infections

3. Low per capita public health funding

Source: http://www.americashealthrankings.org/NH

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2. Massachusetts

Overall Rank: 4

Outcomes Rank: 14

Determinants Rank: 3

Diabetes Rank: 10

Smoking Rank: 7

Obesity Rank: 2



1. Low prevalence of obesity

2. Low percentage of uninsured population

3. Ready availability of primary care physicians & dentists  


1. High prevalence of binge drinking

2. High rate of preventable hospitalizations

3. Large disparity in health status by educational attainment

Source: http://www.americashealthrankings.org/MA

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1. Vermont

Overall Rank: 2

Outcomes Rank: 12

Determinants Rank: 1

Diabetes Rank: 4

Smoking Rank: 9

Obesity Rank: 5



1. High rate of high school graduation

2. Low violent crime rate

3. Low percentage of uninsured population  


1. High prevalence of binge drinking

2. Low immunization coverage among children

3. High incidence of pertussis infections

Source: http://www.americashealthrankings.org/VT


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