Price Waterhouse’s Health Research Institute released their 2018 Top Health Industry Issues report. 2017 was quite a year for healthcare as the industry tried to address controlling healthcare costs in light of the failure of legislative reform along with natural disasters, opioid abuse and cyber security – and all of those issues continue.
With the inability of Washington to make sweeping change, the states have begun to enact initiatives of their own to control cost. This shift has been supported by Washington with the repeal of the individual mandate penalty, loosening up the availability of 1115 waivers to control Medicaid costs and expanding Association Health Plan access through 1332 waivers. Pharmacy costs are definitely under the microscope with state legislatures passing 21 healthcare pricing bills mostly aimed at price transparency and increased utilization management. Meanwhile, change in Washington will continue to be incremental, but very slow.
It is my belief that the uncertainty in healthcare has had a very detrimental impact on the prospect for cost increases in 2018. As 2017 concludes, large claims throughout many of our clients seem to be increasing in both cost and frequency. I believe that uncertainty in the market has led to care deferral and that may have had an impact on the resurgence of large claims. But no doubt pharmacy costs are also a significant contributor. And employers, seeking to mitigate these trends will be open to exploring new options like value-based or reference-based pricing models, since high deductible plans have run their course and won’t be the long-term solution in controlling costs.
Consumers of healthcare are really feeling the pinch of increased cost sharing and they are demanding more transparency and a better user experience. Healthcare is too confusing and as trend increases so will costs to plan participants. In 2018, employers will need to up their game in helping employees to navigate. Tools from insurance carriers and third parties will become easier to use. In particular, price and quality measures will be better able to channel patients to lower-cost, higher-quality providers skilled in their particular medical need.
2018 will be a challenging year for consumers, employers, legislators, voters and yes… benefit consultants.