美世Mercer美国保险公司人力资源方案.pptx
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美世Mercer美国保险公司人力资源方案.pptx
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RichBaileyFSA,MAAA,FCARichmond,VA,IsitTimeforEmployerstoMoveAwayFromtheTraditionalWaysofProvidingEmployeeBenefits?
November3,2004,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,1,Agenda,TheEnvironmentMedicalTrendsLegislationMarketplaceChangesPopulationDemographicsEmployerOutlookTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,2,Double-DigitIncreaseforSecondYearinaRowPeremployeecostsinexcessof$5,600peryear,3,AnnualCPITrendU.S.healthcarecostsrise,despitecontinuingeconomicrecession,ThegapbetweenCPI-Uandmedicalcarecomponentisincreasing,4,ComparisonofOverallGrowthCumulativemedicalcareCPI89%greaterthanoverallCPIsince1967,DatabasedonJanuary1CPIvalues,5,EmployersCostIncreasesOut-PaceOtherIndicatorsLargestincreasesince1990(allemployers),6,AggregateHealthCareSpending(19802010)Governmentportionofpaymentsincreasing;totalprojectedtobeover$2trillionby2009,Source:
CMS,7,MedicalTrends,PopQuizHowmanyyearswillittakegrossmedicalcoststodouble,assumingnospecificemployerinterventionsornationalhealthcare?
10ormore98765orfewer,8,MedicalTrendsResponsesfromagroupof25actuarieswhohadtimetogettheircalculators,9,Legislation,MedicarePrescriptionDrugsIfmadeintolaw,willhavemajorimpactonretireebenefitsandstrategiesInitialconfusionaside,shouldhavepositiveimpactonretireeplansExpectcostshiftingtonegativelyimpactactiveplansEEOCProposedchangesinADEAregulationsClinevs.GeneralDynamicsWellsFargocaseAppearstoallowpre-funding(andtax-deductibility)ofentireretireeliabilityanILPapproachwontbeexactlysamenumberasFASliabilityfundinginyears2+wouldbelimitedtoservicecostIRSweighingitsoptions,10,ProposalstoIncreaseCoverageAmongEarlyRetireesFewgovernmentprogramsexceptforfinanciallyindigent,COBRAextensionsand/orMedicarebuy-insProhibitionsonpost-retirementbenefitreductionsExpandedpre-fundingforretireemedical,Stillfewviableproductsforpre-65inindividualmarketthatovercomeaccessandaffordabilityissues.,11,ADEAIssuesImpactonretireemedicalcoverage,AgeDiscriminationinEmploymentAct(ADEA)prohibitsdiscriminationagainstpersonsage40orolderintermsandconditionsofemploymentAge-baseddistinctionsinemployeebenefitplansarepermissibleonlyif:
Aspecificstatutoryexceptionapplies,orEqualbenefit/equalcosttestissatisfiedPlanmustprovideequalbenefitsforolderandyoungerworkers,orPlanmustincurequalcostsforolderandyoungerworkersThirdandSixthCircuitCourtsreachdifferentconclusionsEEOCreviewingADEAregulations,12,MarketplaceChangesConsolidationofMajorHealthCareCarriersEmployeroptionsaregreatlyreduced,carriershavemoreclout,13,MarketplaceChangesPBMconsolidationcontinues;threemajornationalPBMsremain,14,PopulationTrendsAgingbabyboomerswillincreasetheelderlyandnearelderlypopulations,15,NegativeTidalWaveofAvailableTalentPoolof“primeworkers”willbedecreasing,16,ImpactofDemographicsonHealthCareCostCostincreaseswithage,17,HealthDeteriorationAcauseandaconsequence,Weeattoomuch-64.5%ofadultsoverweight,Populationwithdiabetesincreasedover50%inlastdecade,*Overweightisroughly10to30poundsoveranidealweight.Obesityisroughly30poundsoveranidealweightSource:
NationalHealthandNutritionExaminationSurvey,45.0%,47.0%,47.0%,56.0%,64.5%,18,IssuesFacingBusinessesTheperfectstorm,Lowambientinflation;highmedicalinflationAdvancesinmedicaltechnologylikelytoleadtohighercosts,difficultdecisionsLegislativeuncertaintyConsolidatingmedicaldeliveryandfinancingsystemAnagingworkforceIncreasedlongevitySlowingeconomyDisappearingover-fundedpensionplansFew,ifany,obviousandeasyalternativestomanaginghealthcarecosts,19,EmployerOutlook,EnvironmentaloutlookspurringemployeractionEmployersacutelyawareoftrendsHeightenedinterestincostsavingstrategies(activeandretiree)Greateremphasisonlongertermcostprojectionsandonthe“bottomline”Projectionresultshaveinduced“fightorflight”responses,20,RetireeMedicalCoverageEmployerscontinuetodropretireemedicalcoverage,21,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,22,TheCatch-22,Reducingemployercosttypicallyimpliesincreasingemployee/retireecostEventuallyrunsagainstemployerssensibilitiesregardingfairness,paternalism(ifpresent),andtheconceptofbenefitsgenerallyExample(FAS106):
“Lowermyliabilitiessignificantlybutdontdoanythingharshtoourretireestheywontacceptit”Totheextentthatretireesrepresentthebulkoftheliability,thisisaverydifficultpropositionOpportunitiesexisttochangeeligibility,design,etc.forfutureretireesIfwedonttakecostoutofthesystem,eithertheemployerortheemployees/retireeswillpaytheincreases,23,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,24,PathsAwayfromTraditionalDelivery:
TwoCamps,EmployersthatbecomemoreinvolvedinChangingemployeebehaviorChangingproviderbehaviorChangingprovidersthattheyworkwithChangingthelawsEmployersthatreducetheirinvolvementbyIncreasingemployeeresponsibilityLimitingemployercostLimitingemployerrisk,25,EmployersBecomingMoreInvolved,CollectivePurchasingHighPerformanceNetworksDirectContractingConsumerAccountabilityLeapFrogLobbyingDiseaseManagement/PreventiveCareWhattheseapproachesshareisaneyetowardreducingcostfromtheemployerssystem,andinsomecases,theentirehealthcaresystem.,26,CollectivePurchasingUseemployerandplanmanagerclouttonegotiatefavorablepaymentarrangements,BackgroundTraditionalnetworknegotiationsarevolumedrivenApproachestoachievelowercostsincludeAggregatedpurchasingtoimprovenegotiatingstrengthCoalitionsFormalalliancesInformalalliancesDirectingcaretomostcost-effectivesourceofqualitycareReviewingeffectiveness,efficiencyand“fit”ofcurrentvendorrelationships;changingasappropriate,27,WhatisaHPN?
HighPerformanceNetwork:
Ahealthplanperformanceimprovementmethodthatsteerscaretoprovidersthatmeetspecificefficiencyandqualitycriteria,28,RationaleforHPNs,NewmanagementapproachesareneededinthiseraofcostaccelerationPatientsandphysiciansarethekeydriversofhealthcarecostsButtheyhavelimitedornoincentivetocareaboutcostsTheheartoftheHighPerformanceNetworkconceptistochangetheproviderselectionbehaviorofpatientsand/orphysicians,29,HighPerformanceNetworksNetworkmodels,LimitedNetworkAsubsetofanexistingprovidernetworkcomprisedofhighperformingprovidersTieredNetworkEmployeecopay/coinsurancedifferentialstoencourageuseofhighperformingprovidersPhysicianPartneringAnarrangementwith(typically)primarycarephysicianstoenhanceefficiencyConsumerDrivenDeploymentofperformanceinformationtoconsumerstoimproveproviderselection,30,DirectContracting,LargeemployerswithsignificantmarketpresenceMaybeabletoachievesignificantsavingsbycontractingdirectlywithhealthcareprovidersMayneedgroupofregionalemployerstoachievecriticalmass,31,PromoteConsumerAccountabilityHelppatientsbebetterconsumersofhealthcare,BackgroundIfhalfofcostisduetolifestyleandhalfofchronicpatientsdonotfollowtreatmentplan,whatcanwedo?
GetmembersattentionmakethemawareofconsequencesApproachestoencourageconsumerinvolvementincludeCoordinatedhealthpromotion,diseasepreventionandeducationalprogramsTyingemployeecostincreasetotrend“Definedcontribution”healthplansConsumerdirectedhealthcareRe-introductionofcoinsurance,32,EffortstoImproveQualityofCareinHospitalsLeapfroginitiative,TheLeapfrogGroup:
BackgroundFormedinresponsetoInstituteofMedicinestudyoferrorsinhealthcareGoal:
Majorgainsinpatientsafety,customerserviceandhealthcareaffordabilitySponsoredbyBusinessRoundtableEmployersinLeapfrogGroupusepurchasingpowertoencouragehealthcareproviderstoadoptpatientsafetystandardsLeapfrogstandardsinclude:
ComputerizedsystemsinhospitalstoimprovetheaccuracyofphysiciansprescriptionsandminimizemedicationerrorsStaffingofintensivecareunitsbyphysicianstrainedincriticalcaremedicineReferralofpatientsrequiringcertaincomplexprocedurestohospitalsofferingthebestresults,33,Lobbying,SomeemployersmakingpresencefeltonCapitolHillManyhavebeenactiveforyearsandarerecognizedasimportantvoicesSomelargeassociationshavesimilargoalsandrepresentlargevotingpopulations,34,PreventiveCareandDiseaseManagementAcrosstheHealthCareContinuumProgramsshouldbetailoredtotheneeds,35,EmployersBecomingMoreInvolvedSummary,Typicallythelargeremployers“Fighting”tochangethewayhealthcaredeliveredtoownemployeesGoalistoproducebetteroutcomesAndlowercost,36,EmployersBecomingLessInvolved(Camp2),Employersdesireto“knowtheircost”Dollar-basedplans(oftenaccount-based)ReimbursementplansAccessOnlyplans“CappedPlans”typicallyretireemedicalWhattheseapproachesshareisaneyetowardreducingemployercostattheexpenseofemployees/retirees,37,Account-BasedApproaches,DefinesemployerscommitmentasadefineddollarcontributioninsteadofadefinedmedicalbenefitCommitmentcanbemonthly,annual,aggregateCommitmentcanbebasedonretiree-onlyorrecognizedependentsAmountsavailableforhealthcareonly;employercontributionsaretax-freetotheretireeanddeductibleforemployerunderSections105,106and162ofIRCCanbefundedorunfundedForMed
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