More and more employer and union-sponsored retiree health plans are offering Medicare-eligible coverage through Medicare Advantage (MA), a new analysis finds.
The analysis from the Kaiser Family Foundation, released Thursday, comes as MA is expected to surpass traditional Medicare in total enrollment for 2023 and more insurers enter the lucrative market. Employers and unions are turning to MA in a bid to control retiree healthcare costs.
“For some large employers, the shift to Medicare Advantage appears to be a strategy to maintain benefits for their retirees, without terminating coverage or adopting other changes that more directly shift costs onto retirees,” the analysis said. “However, the shift to Medicare Advantage has implications for retirees that extend beyond supplemental benefits.”
Kaiser relied on data from its 2022 employer health benefits survey of large private and nonfederal public employers. It showed that half of the large employers with 200 or more workers are offering health benefits to retirees through an MA contract, nearly double the 26% doing the same in 2017. Another 44% that offer MA coverage to retirees don’t give them another choice in coverage.
Among the companies with 2,000 or more employers, 60% offered benefits through an MA plan. The top reason such companies turn to MA is to combat higher costs, with 42% citing it as a reason compared with 14% for flexibility for enrollees.
Unlike traditional Medicare, MA relies on provider networks and cost management tools to cut down on costs. Kaiser warned that this shift toward MA has some unintended consequences for retirees.
“This approach has potential to restrict retirees’ access to doctors and hospitals, depending on the plan’s provider network, and subject retirees to cost management tools, such as prior authorization, that may limit access to Medicare-covered services,” the analysis said.
Kaiser cited a recent move by New York City to move its city worker retirees to an MA plan, a decision that is on hold after the insurers Elevance Health and Empire Blue Cross Blue Shield dropped out, according to a published report on The City news site.
The MA market has grown in popularity among seniors in recent years. The program has also received heightened scrutiny surrounding overpayments to plans based on inaccurate risk scores and aggressive marketing tactics by agents and brokers.
Employers face a brutal increase in health-insurance premiums for 2023, Axios’ Arielle Dreher writes from a Kaiser Family Foundation report out this morning.
Why it matters: Premiums stayed relatively flat this year, even as wages and inflation surged. That reprieve was because many 2022 premiums were finalized last fall, before inflation took off.
“Employers are already concerned about what they pay for health premiums,” KFF president and CEO Drew Altman said.
“[B]ut this could be the calm before the storm … Given the tight labor market and rising wages, it will be tough for employers to shift costs onto workers when costs spike.”
🧠 What’s happening: Nearly 159 million Americans get health coverage through work — and coverage costs and benefits have become a critical factor in a tight labor market.
Healthcare costs are expected to jump 6.0% next year. CFOs must prepare accordingly, advises WTW’s Tim Stawicki.
CFOs need to be prepared for a “higher tail” of medical inflation — even if general inflation eases in the near future, Tim Stawicki, chief actuary, North America health & benefits of Willis Towers Watson (WTW) told CFO Dive.
“CFOS need to be prepared for the case that if general inflation eases, there may be two or three more years where they need to think about how they are managing the costs of health care plans,” he said in an interview.
Inflation, which can more immediately impact consumer prices, works somewhat differently when it comes to costs of medical care. “Employers are paying healthcare costs based on contracts that their insurer has with providers, which are multiple years in length. So if a deal with the hospital or contract does not come up until 2023, then that provider has the opportunity to renegotiate higher prices for three years,” said Stawicki.
The recent Best Practices in Healthcare Survey by WTW consisting of 455 U.S. employers found that employers project their healthcare costs will jump 6.0% next year compared with an average 5.0% increase expected by the end of this year.
Further, employers see little relief in sight — seven in 10 (71%) expect moderate to significant increases in costs over the next three years. Additionally, over half of respondents (54%) expect their costs will be over budget this year.
Balancing talent retention and healthcare costs
Talent retention has also remained an entrenched challenge for CFOs over recent months and continues to be top of mind.
Given inflationary pressures and a potential looming recession, employers are having trouble finding the workers they need to run their businesses. A rise in healthcare benefit costs will make this all the more challenging, said Stawicki. “Employers are looking around and saying ‘I need to find talent to help me run my business and I can’t do that if I have an ineffective program in healthcare benefits,’” he said.
There is a direct link between business outcomes and in particular employee productivity and employees’ ability to manage their health and financial environment, according to WTW’s Global Benefits Attitude Survey. “Losing the ability to offer programs and benefits that meet employee needs is impacting business,” said Stawicki.
It comes down to finding the balance between cost management in an environment where talent is hard to come by, he said. In order for CFOs to be successful in financing benefit programs they need to look at finding ways to partner with their counterparts in human resources, said Stawicki.
Sixty-seven percent of employers said that managing company costs was a top priority in the company’s August Best Practices in Healthcare Survey, versus the 42% who said that achieving affordability for employees was a top priority. In the near future, CFOs need to establish a relationship with HR counterparts that can facilitate “ways to manage company costs without shifting it to employees,” said Stawicki.
Ultimately, company costs remain paramount for employers but running a successful business will also require keeping employee affordability top of mind.
As hospitals and health systems continue to grapple with staffing shortages, employers are using perks beyond pay to recruit and retain talent.
Incentives beyond the norm are attractive to employees: They prove the employer values them personally, beyond their work performance.
These four health systems offer perks beyond pay, like extra paid time off, well-being coaches, adoption assistance and local discounts.
Food, entertainment and staycations
Nashville, Tenn.-based Vanderbilt Health said it will launch a new employee awards program in September that offers workers perks, discounts and a grand prize “staycation.”
The month-long Work Perks program will feature a website where employees can play games to earn perks in music and entertainment, health and wellness, dining and Nashville-area attractions, according to an Aug. 29 news release shared with Becker’s.
Workers will also be able to enter a drawing for a staycation. Five employees will win grand prizes including a one-night stay at a downtown hotel, passes to Nashville attractions, dinner at a local restaurant and a gift basket with items from Nashville businesses, including a winery and chocolate company, Vanderbilt Health said.
“We’re excited to show appreciation for our dedicated workforce in this way, and we’re grateful to so many generous partners to help make it happen,” Amy Schoeny, PhD, chief human resources officer, said in a release. “This is just one of the many benefits and perks that we offer to those who choose to pursue careers in making healthcare personal for our patients today and in the future.”
Work Perks will launch Sept. 5.
“We Hours” program
Marlton, N.J.-based Virtua Health told Becker’s it has instituted a “We Hours” program “to give employees more time to do the things that are important to them — from self-care to community service.”
The program offers eight additional hours of scheduled, paid time off per year for most of Virtua’s 13,000 employees.
“The ultimate goal is to encourage mindfulness and a healthy work-life balance,” Rhonda Jordan, Virtua’s executive vice president and chief human resources officer, told Becker’s. “We Hours are intended for colleagues to pursue something rewarding or fulfilling, such as volunteering, recognizing a religious or cultural event, or ‘recharging their battery’ with extra time away.”
Ms. Jordan said Virtua workers may also use the program for practical matters, such as a physician’s visit or attending to household repairs.
The program name stems from Virtua’s “Culture of We,” a set of guiding principles that include continuous learning and innovation, open communication and inclusive teamwork, among others.
A colleague committee developed the tenets in 2019, and employees are encouraged to share how they spend their We Hours in a private Facebook group, according to Ms. Jordan. She cited examples including photos from a visit to a botanical garden, a description of volunteer work helping nonprofit organizations, and a photo of the day one worker spent with her son, who’d been away serving in the U.S. Marine Corps.
“One of my favorite outcomes of the We Hours is that they invite us to learn more about our colleagues and the people, causes and activities that are most important to them,” Ms. Jordan adds.
Walking trails and well-being coaching
Charlotte, N.C.-based Atrium Health encourages all-around health through their LiveWell programs.
“[LiveWell] exists to support teammates in working meaningfully, eating healthfully, learning continuously and living fully … living their best lives so that we can deliver on the mission of Atrium Health,” Scott Laws, vice president of enterprise total rewards at Atrium Health, told Becker’s.
Physical health is encouraged through perks like discounted gym enrollment, tobacco cessation programs and on-site walking trails at Atrium Health facilities. Financial assistance is provided through free webinars and individual medication management consultations. One-on-one well-being coaches encourage employees to consider personal health.
Those that take advantage of the LiveWell resources are rewarded.
“By completing certain physical, personal and financial well-being goals — which include participation in wellness exams and programs or financial education — teammates are eligible for financial incentives, paid into their HSAs,” Mr. Laws said.
Adoption assistance
Springfield, Ill.-based Hospital Sisters Health System offers adoption assistance as part of its benefits package.
“HSHS provides financial support up to $7,500 per child for eligible adoption expenses to qualified colleagues,” Catie Sheehan, vice president of advocacy and communications at Hospital Sisters, told Becker’s.
Alicia Corman, an occupational therapist in the health system, was first to receive the benefit. After the adoption decree was signed, the human resources department helped her submit a breakdown of what the financial support would cover, Ms. Corman said in a video shared with Becker’s. The funds she received aided Ms. Corman and her husband in adopting their son.
“I’m very grateful because if you look across the U.S., adoption is not very supported in a workplace,” Ms. Corman said.
As employers plan for 2023, attracting and retaining talent is top of mind amid a competitive U.S. labor market. That’s led to over two-thirds of companies planning to enhance employee health and benefit offerings next year, according to survey results from Mercer published July 6.
The survey was conducted April 26 to May 13. In total, 708 organizations participated, from all industries and of all sizes ranging from fewer than 500 employees to more than 5,000.
Nine things to know:
Among large employers, 70 percent are planning to enhance health and benefit offerings in 2023.
Among all employers, 61 percent are conducting surveys on employee benefit preferences.
Among large employers, 41 percent currently provide a plan option with a low deductible or none at all, and 11 percent are considering it.
Over half of employees say no remote or hybrid work is a deal breaker when considering to join or stay with an organization. Among all employers, 78 percent now allow employees to work from home regularly, compared to 26 percent in 2021.
Among large employers, 52 percent will offer virtual behavioral healthcare in 2023, and 40 percent will offer a virtual primary care physician network or service.
Though 64 percent of employers are not prioritizing a single employee group for benefit enhancements, 35 percent say they are focusing on hourly and low-wage employees.
Nearly one-third of employers will offer benefits such as fertility treatment coverage and adoption and surrogacy benefits by 2023, and almost another third are considering it.
Among all employers, 70 percent currently offer or plan to offer paid parental leave in 2023.
Among all employers, 75 percent offer or plan to offer tuition reimbursement in 2023.
Although the nursing shortage has attracted much attention in recent months, the healthcare workforce crisis is hitting at all levels of the labor force. As the graphic above shows, the attrition rate for all hospital workers in 2021 was eight percentage points higher than in 2019.
Among clinicians and allied health professionals, certified nursing assistants (CNAs) have the highest turnover levels. Given the demands of the job and relatively low pay, CNA openings have been consistently difficult to fill. But it’s become even harder to hire for the role in today’s labor market as job openings near an all-time high.
Although labor force participation rates have rebounded to 2019 levels, pandemic-induced economic shifts have led to a boom in lower-wage jobs. In 2021 alone, Amazon opened over 250 new fulfillment centers and other delivery-related work sites. The company is competing directly with hospitals and nursing facilities for the same pool of workers at many of these new sites.
In fact, our analysis shows that more than a quarter of hospital employees currently work in jobs with a lower median wage than Amazon warehouses. Health systems have historically relied on rich benefits packages and strong career ladder opportunities to attract lower-wage employees, but that’s no longer enough—Amazon and other companies have ramped up their benefits, such that they now meet, or even surpass, what many hospitals are providing.
The time has come for health systems to reevaluate their position in local labor markets, and better define and promote their employee value proposition.
In an effort to rein in healthcare costs for its employees, Walmart sends them directly to health systems that demonstrate high-quality care outcomes, otherwise known as Centers of Excellence.
Through the COE program, Walmart will cover the travel and treatment costs for employees seeking a range of services, but only with providers the company is contracted with. Walmart then reimburses with bundled payments negotiated with the providers.
To determine which providers get access to its 1.6 million employees, Walmart starts by examining health systems. Lisa Woods, vice president of physical and emotional well-being at Walmart, and her team analyze public data, distribute requests for information and conduct detailed on-site visits.
Below are the 18 health systems or campuses to which Walmart will refer patients for defined episodes of care in 2022. (See how COE participants have evolved since 2019 or 2021.)
The explosion of apps, wearables, and other health tech solutions targeted at employers has overwhelmed and frustrated many HR executives who make decisions about employee health benefits. At a recent convening of health insurance brokers we participated in, several bemoaned the challenge of helping their clients understand which solutions might bring real value.
One shared, “For the past few years, it’s felt like ‘App-apalooza’ out there. CHROs [chief human resource officers] get pitches for new apps every day…there are literally thousands out there saying they’ll reduce costs and improve employee health, but it’s next to impossible to tell which ones of them actually work.”
Brokers expressed surprise at how little evidence, or in some cases, actual patient and client experience, some health tech companies brought to the table: “We have startups coming to our clients talking about their millions of dollars in funding, but when you dig into what they’re actually doing, not only can they not show outcomes data, you find out they’ve only worked with a few dozen patients!”
But among the sea of apps purporting to manage any and every employee health need, from chronic disease to fertility to sleep quality, brokers reported their clients were finding value in a few distinct areas.
Technology-based mental health solutions received high marks for increasing access to care, with the prediction that “tele-behavioral health could become a standard part of most benefits packages very quickly”.
More surprisingly, employers shared positive feedback on the impact of virtual physical therapy solutions: “I was skeptical that it would work, but people like being able to rehab at home. And not only is it cheaper, we’re seeing higher adherence rates.”
But even the best apps are often challenged by a lack of connectivity to the rest of a patient’s healthcare. The technologies that will have the greatest staying power will be those that not only deliver results, but are able to move beyond point solutions to become part of an integrated care experience, meaningfully connected to other providers involved in a patient’s care.
Seeking stronger workplace protections, physician residents and fellows at both Stanford Health Care and the University of Southern California’s (USC) Keck School of Medicine have voted to join the Committee of Interns and Residents, a chapter of the Service Employees International Union (SEIU).
Despite being frontline healthcare workers, most Stanford residents were excluded from the first round of the health system’s COVID vaccine rollout in December 2020. The system ultimately revised its plan to include residents, but the delay damaged Stanford’s relationship with residents, adding momentum to the unionization movement. Meanwhile, Keck’s residents unanimously voted in favor of joining the union, aiming for higher compensation and greater workplace representation.
The Gist: While nurses and other healthcare workers in California, as in many other parts of the country, have been increasingly banding together for higher pay and better working conditions, physician residents and fellows contemplating unionization is a newer trend.
Physicians-in-training have historically accepted long work hours and low pay as a rite of passage, and have shied away from organizing. But pandemic working conditions, the growing trend of physician employment, and generational shifts in the physician workforce have changed the profession in a multitude of ways.
Health systems and training programs must actively engage in understanding and supporting the needs of younger doctors, who will soon comprise a majority of the physician workforce.
HENRY KOTULA 