Employee Benefits: Themes for 2018

Here are the themes I am seeing most often in health and welfare benefits:

Theme: Financial Wellness – Americans are struggling to get ahead, and the middle class is declining. Successful retirement and wealth planning for many people is a simple act of good accounting decisions multiplied over many years. Instant gratification has eroded good decision-making, and large majorities of people have no savings or retirement funds. Smart employers are taking steps to help their people make good decisions and become better stewards. This encapsulates retirement strategy, education, student loan assistance, emergency loan assistance and the like.

Sub-Theme: Student Loan Repayments – Extremely hot benefit right now; it’s one of the most requested benefits by new employees.

Theme: Dependent Care – People are living longer, and in sub-optimal health. Huge portions of the workforce are now having to spend large quantities of time managing the health and care of their dependents and loved ones. Smart employers are looking for ways to relieve this burden and improve the productivity of the workforce.

Theme: Hospital Department Quality vs. Physician Quality – More and more data is becoming available regarding hospital and doctor quality scores. How do we think about it? How is it used? Which firms are stepping forward to help people access quality? If I contract directly with a hospital, am I hurting patient access to the highest-quality providers who aren’t with that hospital? These questions are important and could be addressed with the right sessions.

Theme: Member Steering and Plan Strategy – The best plans are seeking new and improved strategies to steer members. As more cost and quality data becomes available, proper healthcare procurement begins to depend on the firm's ability to steer members. A few firms are leading the way to get exceptional procurement and steerage, and most employers could learn much from them to save millions and get control of (arguably) the hardest budget item in the firm.

Theme: The Care-Knowledge Gap – There is a devastating time period between when a therapy is discovered and when the therapy is available in most major hospitals. This gap has grown to 17 years; thus, the healthcare of 2035 is available today if you can find it. Smart employers and activist entities are working hard to reduce this wait time to save lives and accelerate the improvement of American healthcare.

Theme: Augmented Primary Care – Primary care has had a rough decade. At worst, it has been vanishing, and, at best, it has been acquired and used as a referral source for hospital systems. Smart employers realize that, for them to get control of their spending, they need to partner with primary care doctors whose interests are aligned with the employer and the member. This interest is to keep members healthy by consuming the minimum effective quantity of healthcare services, from professionals operating at the top of their respective licenses, in settings offering the best value. Direct primary care represents the best approach to achieve this objective, and building appropriate technology into these settings can significantly reduce the dependence on the greater hospital system.

Themes Losing Steam: These topics appear (to me) to be losing their luster very quickly:

1. Wellness
2. Medical tourism
3. Price transparency
4. Disease management
5. Private exchanges
6. PBMs and non-specialty Rx