Employer's Role In Health Care Delivery

[JDinger]

What do people think about the role of employers in health care delivery?

Should employers be required to provide health insurance? Should they incentivize people to "stay well"? In what ways should health care providers support employers and their role in the health care community?

Any sustainable models out there?

Curious what people think...

[Dan Simpson]

Employers currently finance about 35% of the cost of healthcare, so it appears they are a key part of how we fund healthcare. Government supports over 45% of the cost of healthcare.

We could look at the Mass and California models to where the employer has the option to either a) provider HC coverage or B)pay into a state fund that stretches the risk pool and provides HC to uncovered individuals. Also, since our economy is driven by small to medium size businesses, and people change jobs a lot, the portability of HC may be as important as who's funding it. Maybe we need an mandatory employer-sponsored HSA model, with mandatory prevention/wellness benefits. One proposal I read suggested that companies be freed from this direct responsibility - by turning insurance dollars into higher salaries - to allow employees to invest more and buy the plan they want.

Regarding the "stay well" component, I believe that any model we look at needs to contain this - whether it's employer sponsored or not... the future of healthcare needs to be prevention and wellness centered.

[Michael Swan]

This is an interesting question for two reasons, or more accurately two observations:

First, over 50% of employers who provide health insurance to their employees are self-insured. One would think that they would be intricately involved with this process at this point.

Second, that so few have adopted disease management/health management processes.

I think part of the reason is that there hasn't been a coherent mechanism for employers to do health/disease management. I venture a guess that most simply don't find this concept in their area of expertise and just rely on payers to do it for them.

So perhaps the sustainable model is one that brings a turnkey operation into the company. Another interesting observation is that companies also have expense for lost time, which is all part of the cost of 'health care costs'. Again, perhaps the model that works is one that takes into consideration lost time as well, and answers the question 'how to we return this employee to health in the shortest and least expensive manner?'

[Arthurwlane]

Employers are the ultimate payer for a vast majority of people in the US. It is in the employer’s best interest to make sure that their employees are healthy and attentive at work. I think the employer has the best position in the market to offer incentive both financial and non financial. Incentives are probably the most effective tool that can be used to modify a person’s behavior. Using incentives can help move an unhealthy person to a healthier person. An example would be paying a person to stop smoking, lose weight or become compliant with a providers care plan.

However this is just one side of the incentive proposition. The other side is the provider. I think that we should also use incentives to lead the provider to deliver improved health outcomes. If we could get providers to follow the accepted standards of care for patients that suffer from chronic illness we would theoretically improve the health of the patient which in some cases would decrease the healthcare expense for the patient.

The patient and the provider is the key relationship in the healthcare value chain. Both of them need to have their behaviors modified to achieve a more optimal end result.

[vibhu gauba]

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Regards
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