MERCER为美国保险业协会做的HR分析报告.ppt
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MERCER为美国保险业协会做的HR分析报告.ppt
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RichBaileyFSA,MAAA,FCARichmond,VA,IsitTimeforEmployerstoMoveAwayFromtheTraditionalWaysofProvidingEmployeeBenefits?
November3,2004,1,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,2,Agenda,TheEnvironmentMedicalTrendsLegislationMarketplaceChangesPopulationDemographicsEmployerOutlookTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,3,Double-DigitIncreaseforSecondYearinaRowPeremployeecostsinexcessof$5,600peryear,4,AnnualCPITrendU.S.healthcarecostsrise,despitecontinuingeconomicrecession,ThegapbetweenCPI-Uandmedicalcarecomponentisincreasing,5,ComparisonofOverallGrowthCumulativemedicalcareCPI89%greaterthanoverallCPIsince1967,DatabasedonJanuary1CPIvalues,6,EmployersCostIncreasesOut-PaceOtherIndicatorsLargestincreasesince1990(allemployers),7,AggregateHealthCareSpending(19802010)Governmentportionofpaymentsincreasing;totalprojectedtobeover$2trillionby2009,Source:
CMS,8,MedicalTrends,PopQuizHowmanyyearswillittakegrossmedicalcoststodouble,assumingnospecificemployerinterventionsornationalhealthcare?
10ormore98765orfewer,9,MedicalTrendsResponsesfromagroupof25actuarieswhohadtimetogettheircalculators,10,Legislation,MedicarePrescriptionDrugsIfmadeintolaw,willhavemajorimpactonretireebenefitsandstrategiesInitialconfusionaside,shouldhavepositiveimpactonretireeplansExpectcostshiftingtonegativelyimpactactiveplansEEOCProposedchangesinADEAregulationsClinevs.GeneralDynamicsWellsFargocaseAppearstoallowpre-funding(andtax-deductibility)ofentireretireeliabilityanILPapproachwontbeexactlysamenumberasFASliabilityfundinginyears2+wouldbelimitedtoservicecostIRSweighingitsoptions,11,ProposalstoIncreaseCoverageAmongEarlyRetireesFewgovernmentprogramsexceptforfinanciallyindigent,COBRAextensionsand/orMedicarebuy-insProhibitionsonpost-retirementbenefitreductionsExpandedpre-fundingforretireemedical,Stillfewviableproductsforpre-65inindividualmarketthatovercomeaccessandaffordabilityissues.,12,ADEAIssuesImpactonretireemedicalcoverage,AgeDiscriminationinEmploymentAct(ADEA)prohibitsdiscriminationagainstpersonsage40orolderintermsandconditionsofemploymentAge-baseddistinctionsinemployeebenefitplansarepermissibleonlyif:
Aspecificstatutoryexceptionapplies,orEqualbenefit/equalcosttestissatisfiedPlanmustprovideequalbenefitsforolderandyoungerworkers,orPlanmustincurequalcostsforolderandyoungerworkersThirdandSixthCircuitCourtsreachdifferentconclusionsEEOCreviewingADEAregulations,13,MarketplaceChangesConsolidationofMajorHealthCareCarriersEmployeroptionsaregreatlyreduced,carriershavemoreclout,14,MarketplaceChangesPBMconsolidationcontinues;threemajornationalPBMsremain,15,PopulationTrendsAgingbabyboomerswillincreasetheelderlyandnearelderlypopulations,16,NegativeTidalWaveofAvailableTalentPoolof“primeworkers”willbedecreasing,17,ImpactofDemographicsonHealthCareCostCostincreaseswithage,18,HealthDeteriorationAcauseandaconsequence,Weeattoomuch-64.5%ofadultsoverweight,Populationwithdiabetesincreasedover50%inlastdecade,*Overweightisroughly10to30poundsoveranidealweight.Obesityisroughly30poundsoveranidealweightSource:
NationalHealthandNutritionExaminationSurvey,45.0%,47.0%,47.0%,56.0%,64.5%,19,IssuesFacingBusinessesTheperfectstorm,Lowambientinflation;highmedicalinflationAdvancesinmedicaltechnologylikelytoleadtohighercosts,difficultdecisionsLegislativeuncertaintyConsolidatingmedicaldeliveryandfinancingsystemAnagingworkforceIncreasedlongevitySlowingeconomyDisappearingover-fundedpensionplansFew,ifany,obviousandeasyalternativestomanaginghealthcarecosts,20,EmployerOutlook,EnvironmentaloutlookspurringemployeractionEmployersacutelyawareoftrendsHeightenedinterestincostsavingstrategies(activeandretiree)Greateremphasisonlongertermcostprojectionsandonthe“bottomline”Projectionresultshaveinduced“fightorflight”responses,21,RetireeMedicalCoverageEmployerscontinuetodropretireemedicalcoverage,22,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,23,TheCatch-22,Reducingemployercosttypicallyimpliesincreasingemployee/retireecostEventuallyrunsagainstemployerssensibilitiesregardingfairness,paternalism(ifpresent),andtheconceptofbenefitsgenerallyExample(FAS106):
“Lowermyliabilitiessignificantlybutdontdoanythingharshtoourretireestheywontacceptit”Totheextentthatretireesrepresentthebulkoftheliability,thisisaverydifficultpropositionOpportunitiesexisttochangeeligibility,design,etc.forfutureretireesIfwedonttakecostoutofthesystem,eithertheemployerortheemployees/retireeswillpaytheincreases,24,Agenda,TheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:
TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics,25,PathsAwayfromTraditionalDelivery:
TwoCamps,EmployersthatbecomemoreinvolvedinChangingemployeebehaviorChangingproviderbehaviorChangingprovidersthattheyworkwithChangingthelawsEmployersthatreducetheirinvolvementbyIncreasingemployeeresponsibilityLimitingemployercostLimitingemployerrisk,26,EmployersBecomingMoreInvolved,CollectivePurchasingHighPerformanceNetworksDirectContractingConsumerAccountabilityLeapFrogLobbyingDiseaseManagement/PreventiveCareWhattheseapproachesshareisaneyetowardreducingcostfromtheemployerssystem,andinsomecases,theentirehealthcaresystem.,27,CollectivePurchasingUseemployerandplanmanagerclouttonegotiatefavorablepaymentarrangements,BackgroundTraditionalnetworknegotiationsarevolumedrivenApproachestoachievelowercostsincludeAggregatedpurchasingtoimprovenegotiatingstrengthCoalitionsFormalalliancesInformalalliancesDirectingcaretomostcost-effectivesourceofqualitycareReviewingeffectiveness,efficiencyand“fit”ofcurrentvendorrelationships;changingasappropriate,28,WhatisaHPN?
HighPerformanceNetwork:
Ahealthplanperformanceimprovementmethodthatsteerscaretoprovidersthatmeetspecificefficiencyandqualitycriteria,29,RationaleforHPNs,NewmanagementapproachesareneededinthiseraofcostaccelerationPatientsandphysiciansarethekeydriversofhealthcarecostsButtheyhavelimitedornoincentivetocareaboutcostsTheheartoftheHighPerformanceNetworkconceptistochangetheproviderselectionbehaviorofpatientsand/orphysicians,30,HighPerformanceNetworksNetworkmodels,LimitedNetworkAsubsetofanexistingprovidernetworkcomprisedofhighperformingprovidersTieredNetworkEmployeecopay/coinsurancedifferentialstoencourageuseofhighperformingprovidersPhysicianPartneringAnarrangementwith(typically)primarycarephysicianstoenhanceefficiencyConsumerDrivenDeploymentofperformanceinformationtoconsumerstoimproveproviderselection,31,DirectContracting,LargeemployerswithsignificantmarketpresenceMaybeabletoachievesignificantsavingsbycontractingdirectlywithhealthcareprovidersMayneedgroupofregionalemployerstoachievecriticalmass,32,PromoteConsumerAccountabilityHelppatientsbebetterconsumersofhealthcare,BackgroundIfhalfofcostisduetolifestyleandhalfofchronicpatientsdonotfollowtreatmentplan,whatcanwedo?
GetmembersattentionmakethemawareofconsequencesApproachestoencourageconsumerinvolvementincludeCoordinatedhealthpromotion,diseasepreventionandeducationalprogramsTyingemployeecostincreasetotrend“Definedcontribution”healthplansConsumerdirectedhealthcareRe-introductionofcoinsurance,33,EffortstoImproveQualityofCareinHospitalsLeapfroginitiative,TheLeapfrogGroup:
BackgroundFormedinresponsetoInstituteofMedicinestudyoferrorsinhealthcareGoal:
Majorgainsinpatientsafety,customerserviceandhealthcareaffordabilitySponsoredbyBusinessRoundtableEmployersinLeapfrogGroupusepurchasingpowertoencouragehealthcareproviderstoadoptpatientsafetystandardsLeapfrogstandardsinclude:
ComputerizedsystemsinhospitalstoimprovetheaccuracyofphysiciansprescriptionsandminimizemedicationerrorsStaffingofintensivecareunitsbyphysicianstrainedincriticalcaremedicineReferralofpatientsrequiringcertaincomplexprocedurestohospitalsofferingthebestresults,34,Lobbying,SomeemployersmakingpresencefeltonCapitolHillManyhavebeenactiveforyearsandarerecognizedasimportantvoicesSomelargeassociationshavesimilargoalsandrepresentlargevotingpopulations,35,PreventiveCareandDiseaseManagementAcrosstheHealthCareContinuumProgramsshouldbetailoredtotheneeds,36,EmployersBecomingMoreInvolvedSummary,Typicallythelargeremployers“Fighting”tochangethewayhealthcaredeliveredtoownemployeesGoalistoproducebetteroutcomesAndlowercost,37,EmployersBecomingLessInvolved(Camp2),Employersdesireto“knowtheircost”Dollar-basedplans(oftenaccount-based)ReimbursementplansAccessOnlyplans“CappedPlans”typicallyretireemedicalWhattheseapproachesshareisaneyetowardreducingemployercostattheexpenseofemployees/retirees,38,Account-BasedApproaches,DefinesemployerscommitmentasadefineddollarcontributioninsteadofadefinedmedicalbenefitCommitmentcanbemonthly,annual,aggregateCommitmentcanbebasedonretiree-onlyorrecognizedependentsAmountsavailableforhealthcareonly;employercontributionsaretax-freetotheretireeanddeductibleforemployerunderSections105,106and162ofIRCCanbefundedorunfundedFor
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