Managed Care - August 2008 - (Page 28) BOS: That’s right. There’s also common ground in pressing forward to improve the general health and well being of the U.S. population. Health plans have shown that they have an interest in managing health, especially with their fully insured populations. And self-insured employers have that same interest in managing health, because they bear risk, but they are also very interested in improving the productivity of the workforce. The two go hand in hand. MC: Which of the presidential candidates would be more likely to be embraced by large employers today? BOS: There’s not enough clarity yet to create a groundswell of support or abhorrence. Employers have a wait-and-see attitude. There is some concern on the part of employers that the McCain proposal seems to be in favor of individual insurance. On the other hand, some employers are concerned that a mandate such as the one in the Obama proposal would create some problems. It is also unclear how important health care will be in the general election or in the next administration. When Senator Clinton was in the race, we knew as an industry that this was going to be one of the top three priorities of her administration, should she be elected president. Health care reform is not the seminal issue of either of the other campaigns. MC: Does it surprise you that we haven’t been hearing much talk about a single-payer system? BOS: Both candidates are staying away from that. Clearly Senator McCain would not be in favor of that particular type of proposal. He’s coming at it from exactly the opposite direction, which is free market individual insurance. It will be interesting to see how the debates go. MC: In wanting to stick with an employer-based system in general, what opportunities or benefits do employers see? BOS: My perspective is driven by how very large employers are approaching health care, because those are the companies I deal with in my dayto-day consulting work. And what they are interested in right now is using data to identify opportunities to improve the health and productivity of their workforces. They are using health risk questionnaires and medical and prescription drug claim data to identify individuals who are at risk for chronic conditions. They want to get those people into programs before they develop chronic conditions and improve the efficiency of the delivery of care for populations that do have chronic conditions. Global employers are also interested in this. They are moving employee assistance programs and wellness programs overseas to their global populations. There are various types of state-run health care systems around the globe, but employers still are able to affect the health and productivity of their employees overseas, even though they may not be able to deliver health care in the same manner through an employer-sponsored plan as they are in the United States. MC: You’ve been tracking the activities of employers in the United States for years through the National Survey of Employer-Sponsored Health Plans. What are some of the most interesting things you’ve learned? BOS: I’ve been associated with the survey since it started in 1986. One of the things that we saw then and we see now is that what large employers are interested in and how they are trying to improve the health care system ends up trickling down to smaller employers. Because smaller employers are typically fully insured and looking to health plans to provide them with the means to control the risk, the products large employers have initiated become more available in the fully insured market and in the smaller self-insured market over time. The other trend that has continued since 1986 has been that small employers typically provide less generous benefits than larger employers, because they are looking for a less costly environment. MC: Do you ask the same questions every year? BOS: The basics of the survey stay the same: How much are you paying for health care, what does your average plan design look like, and what are you charging your employees for health care? But questions on strategies and tactics are issues that are popular at the moment, and we’ve found that issues are hot for about five to ten years. In 1986, the strategic questions were how worried are you about AIDS and what are you concerned about in relation to HMOs? Push forward ten years and the big issue was, how effective are primary care physician gatekeeper programs? That 28 MANAGED CARE / AUGUST 2008
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