How Employer-Sponsored Health Plans are Changing in 2015

Posted by KUNAL JAIN on Apr 29 2015

Employer-Sponsored Health PlanLast year was a sign that many changes are happening in healthcare for patients and physicians. From what has occurred in 2015, many of these changes indicate a shift to telecommuting healthcare and employer-sponsored health plans. The fact of the matter is: healthcare is changing, and we as physicians must change with it in order to survive.

The following shifts have occurred from 2014, and will bear potential ricocheting effects for reimbursement this year:

Employer-sponsored Programs

While the economy has picked up, and employer-sponsored costs have stabilized over the last 5 years or so (in comparison to the past according to a study by the Kaiser Family Foundation and Health Research & Educational Trust), the truth remains that employers are trying to transfer healthcare costs to employees. An increase in retail and urgent care clinics are popping up everywhere and this is one indicator that “more decisions and economic responsibility is shifted to employees.”

The Center for American Progress’s report on “The Great Cost Shift” explains that the stable slowdown of healthcare costs is “illusory,” and that there are “higher deductibles, higher copayments, and higher coinsurance” as a result of this shift. People are spending less on healthcare when higher upfront deductibles exist, and this means a backlash in higher out-of-pocket costs for those who face serious conditions and medical attention.

Employers that choose greater cost sharing “not only lower their own costs but also encourage employees to be more cost conscious.” While choosing plans that can be more cost-effective, this makes the event of a health complication extremely unaffordable, and in turn, these “high-deductible plans induce customers to reduce or delay their use of preventive care.”

What Does This Mean for Physicians?

Of adults in the study who had deductibles that are 5% of their income or more, 43% reported their deductible was difficult or impossible to pay for. There is even a figure stating 29% of privately insured adults that have the 5% deductible “reported they had skipped a medical test, treatment, or follow-up visit recommended by a doctor because of their deductible.”

Simply put, people are staving off their health to cut costs. Not only that— but the RCM cycle and A/R can be vastly impacted in a practice if patients aren’t able to afford their upfront copayments and deductibles. In the event the employee/patient can’t pay for the services rendered, how is the physician supposed to be fully reimbursed, given the decreasing rate of compensation from health insurers and Medicare? The rest of 2015 will tell, as we examine healthcare metrics and the developing employer-sponsored programs in conjunction with employee rates.

Key Takeaway

Be prepared, because an end to the changes in the healthcare industry shows no sign of stopping. With factors such as the Affordable Care Act’s implementation last year, it’s impossible to determine the long-term effects it will have on healthcare in general as well as employer-sponsored programs (despite the ACA not touching many of these systems).

While it’s important to know what goes on in your own medical practice, understanding the position your patients are being put in as a result of employer-sponsored programs should also be taken into consideration when sorting out health insurers and reimbursement plans you may have established.

Tell us your experiences with patients and their healthcare plans—do many seem to be bogged down by deductible and copay expenses?

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Topics: Revenue Cycle Management, employer-sponsored health plans

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