Managed Care - August 2008 - (Page 30) BOS: Each year the major health plans ask us what we see as the next big thing with employers. We don’t advise them for a fee, because that would create a conflict of interest, but we sometimes provide them with aggregated survey data that they can mine on their own to make decisions about product development and where they will have a specific market niche. MC: What trends have you been tracking recently? BOS: One thing we have been measuring is the renewed interest in on-site clinics and on-site pharmacies. This is an important topic, but it has been a cyclical one. The last time it was a big issue was in the ’90s. Health plans need to realize that they are going to be seeing more of these. MC: Does the establishment of these clinics create problems with continuity of care? BOS: If the geography makes sense and it ends up being convenient not only for the employee but also for the family members to participate in the program, it potentially becomes a replacement for the family physician. But it really depends on how the program is designed whether you’re going to have significant continuity-of-care issues. MC: Are employers operating their own clinics and pharmacies? BOS: There are many options. They can build them, contract with the local health care establishment, or contract with a vendor that will manage them. MC: Must there be a certain number of employees in a specific location to make this viable? BOS: It depends on your population. If you have a population that has a tendency toward poor health or is older, this can be effective in much smaller populations. If you have a reasonably healthy population and folks are younger, you need to have a much larger population. The geographic footprint of your employee population is also important. If they are spread out all over the place and people are driving 50 miles to work, they are much less likely to use the services. It takes thoughtful research and planning to decide exactly how this can be effective. MC: What products should health plans be developing to meet the needs of purchasers today? BOS: Any health plan that’s not in the business of consumer-directed health plans ought to be. The 2008 survey is in the field right now, but we are already hearing anecdotal evidence of a growing interest in full-replacement CDHPs. That discussion is happening much earlier than we expected. MC: If you’re surprised, have you come to any conclusions as to why it is happening? BOS: There is more and more evidence that people change their behaviors when these plans are offered, though there is not a consensus. We also believe that the decision whether to offer a consumer-directed health plan has been taken out of the hands of human resources and has risen to the C-suite. At that level, it becomes a philosophical issue: “This is the vision of the organization. This health plan fits the vision of the organization about our employees. Let’s do it and do it well.” MC: Choosing a health plan isn’t always based solely on cost? BOS: At the fully insured level, employers need to have a partnership around cost. They don’t expect health plans to just pass on the cost of risk every year but to manage the risks. Mid-size, self-insured employers also expect health plans to offer them bundled products that look like what larger employers are doing. And the very largest employers are interested in service. They expect health plans to provide them with the kind of data that allows them to look at their risk pool and identify opportunities. Large employers also understand that it’s difficult for them on their own to identify quality providers, and they need to partner with their health plan to be able to get at the quality issues. MC: How do employers feel about the quality of service that health plans are providing now? Is it sufficient? Is it what they expect? Is it deficient? What is the relationship now and what should we expect? BOS: It’s an issue of managing expectations. Some employers have been with the same health plan for decades, and they have built the kind of relationship that can weather changes in management or the way services are provided. Other employers change health plans frequently, and most of the time that change is not based on cost, it’s based on service. That’s different for small employers, who most often change because of cost. MC: Thank you. MC 30 MANAGED CARE / AUGUST 2008
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