U.S. employers are becoming increasingly dissatisfied with their health insurers, finds a recent PricewaterhouseCoopers study.
Many have taken a hard hit from the recession and are looking more critically at the services their health insurers offer, while demanding more information technology and strategies to help reduce waste in health care spending and better engage employees in managing their health.
In the study, "What employers want from health insurers in 2010: Better information, more value," the consulting firm found that overall satisfaction with health insurers by large employers has decreased to 59% from 64% in 2008. The view of carriers was even less flattering among small businesses, which registered an overall satisfaction scored that remained steady at 52%.
Employers of all sizes, however, are cost-shifting to employees in continuation of recent expense trends. Fully 60% of the 250 employers surveyed said they would further increase cost-sharing for health care with their employees in the year ahead.
In part, the cost-shifting might be simple frustration over a perceived lack of options.
"[Employers] feel they don't have adequate data to make decisions around their health plans, future changes and technology. They continue to look at cost-sharing strategies, but at the same time [they] are really focusing on improving the population health as well as trying to make their members better consumers of health care," says Kathryn Stein, a managing director in PricewaterhouseCoopers' health industries.
Claims processing, administrative fees and provider discounts remain among the most important basic service offerings for large and small employers, though wellness programs surpassed provider discounts as the more important offering among large employers.
While wellness programs are prevalent among employers, HR professionals are frustrated by the low level of employee participation, which hovers at around 50%. Further, many employers are finding that simple financial incentives such as cash, gift certificates and annual premium savings are no longer working as a way to drive up participation. Still, it is promising that 71% of companies surveyed now offer wellness programs, and 67% offer disease management programs.
Instead of financial incentives, many employers are engaging employees' physicians as a mode to carry their message to patients in the most efficacious way.
"Trying to get the physician involved is a new and involving way that employers are trying to address this issue. Instead of having a letter from the insurance company ... people will be more motivated to read the letters and participate if their physician is involved," suggests Stein.
Employer interest in personal technology tools, such as personal health records and online comparison tools, is gaining. Nearly half of all employers say that it is important that insurers offer these tools, but less than half are satisfied with the services they're receiving.
"Many large employers are using an outsourced data warehousing vendor to take the data from their insurance companies and carve out service vendors and merge it into one database [to get] better answers about their population's health and their cost," comments Stein on how employers are supplementing health insurer services to more fully glimpse the needs and demographics of their population.
"Employers recognize that it's better to manage the health of their workforce than to manage the cost of illness, and they want their health plan to help manage the entire health continuum" says Paul Veronneau, principal and U.S. healthcare payer leader, PricewaterhouseCoopers. "There is only so much insurers can do to manage health and cost through provider discounts or on the back end of a claim. This is an opportunity for health insurers to look beyond traditional strategies and get more aggressive about health care quality and value," he adds.
The survey provides several key recommendations for insurers and can be accessed at the PricewaterhouseCoopers' Health Research Institute Web site, www.pwc.com/us/en/health-research-institute/index.jhtml, where more detailed information from the survey can be found.
The recession and high unemployment continue to take a toll in terms of declining membership, as the nation's leading health insurers saw membership fall through the third quarter of 2009.
Between September 2008 and September 2009, the top eight carriers saw an aggregate decline of 1.7 million members, or 1.3%. Losses continue to be experienced in both the fully insured and ASO segments, according to Mark Farrah Associates, a leading provider of market data and intelligence solutions. ASO enrollment decreased by 1.1%, and risk enrollment declined 1.6% for those plans.
The eight leading companies reported a combined loss of 860,000 members between the third and fourth quarters of 2009. Humana and Health Care Services Corp., which includes Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas, were the only organizations among the top eight plans to see enrollment gains in the third quarter. Humana was also among the few plans that saw year-to-date profit margin improvement compared with 2008.
In MFA's latest "Healthcare Business Strategy" report, the firm reviewed enrollment and financial trends among eight top health insurers: Aetna, CIGNA, Health Care Service Corp., Health Net, Humana, Kaiser Permanente, UnitedHealth Group and WellPoint. These eight health plans cover nearly 60% of the total U.S. insured population.
Associate Editor Elizabeth Galentine contributed to this report.
Consumers unhappy with health insurers, too
A 2009 Consumer Reports survey finds that dissatisfaction with health insurers extends to employees as well.
Although HMOs scored better than PPOs on billing and customer service, there was little difference between the two in terms of access to care. Of HMO members who were ill, 15% had problems getting care, compared with 14% of PPO members.
People in PPOs had more trouble with their bills. Eleven percent said they were sent statements they were not obligated to pay, compared with 6% of HMO members. Sixteen percent of PPO members complained that their plan took a month or more to reimburse them for bills they'd paid; only 5% of HMO members had to wait that long. Sixty-two percent had to call a plan rep to check up on a bill or claim, versus 27% of HMO members.
Dealing with bills was the most problematic for people who needed their plan the most. Overall, 24% of people in PPOs had a billing problem, but that jumped to 33% among people who were ill. Only 11% of HMO members found dealing with bills a pain. But if they reported being seriously ill, that number rose to 14%.
Source: Consumer Reports, 2009.
