mercer為美國保險業協會做的絕密hr分析報告(完整版)

　　

【正文】 ting employer cost – Limiting employer risk 25 Mercer Human Resource Consulting Employers Being More Involved ? Collective Purchasing ? High Performance Networks ? Direct Contracting ? Consumer Accountability ? Leap Frog ? Lobbying ? Disease Management/Preventive Care ? What these approaches share is an eye toward reducing cost from the employer’s system, and in some cases, the entire health care system. 26 Mercer Human Resource Consulting Collective Purchasing Use employer and plan manager clout to negotiate favorable payment arrangements ? Background – Traditional work negotiations are volume driven ? Approaches to achieve lower costs include – Aggregated purchasing to improve negotiating strength ? Coalitions ? Formal alliances ? Informal alliances – Directing care to most costeffective source of quality care – Reviewing effectiveness, efficiency and “fit” of current vendor relationships。 accounts earn interest (., at Tbill rate) or not。 the employee pays the balance in cost. Pure DC Employer pays $Z per employee. Employee must pay balance for whatever plan is picked. The employer contribution is not tied directly to the cost of any plan. Employer Contribution Level DC Health Plans % of Cost No Contribution (wages only) % for Benchmark Plans。 liabilities approximately 189。 $5/month/year of service for 20 years of service) – Fixed or increases annually。Rich Bailey FSA, MAAA, FCA Richmond, VA Is it Time for Employers to Move Away From the Traditional Ways of Providing Employee Benefits? November 3, 2023 Mercer Human Resource Consulting Agenda ? The Environment ? The Catch22 ? Paths Away from Traditional Delivery: Two Camps ? Opportunities Along Path 2 ? The Answer ? Additional Topics 1 Mercer Human Resource Consulting Agenda ? The Environment – Medical Trends – Legislation – Marketplace Changes – Population Demographics – Employer Outlook ? The Catch22 ? Paths Away from Traditional Delivery: Two Camps ? Opportunities Along Path 2 ? The Answer ? Additional Topics 2 Mercer Human Resource Consulting DoubleDigit Increase for Second Year in a Row Per employee costs in excess of $5,600 per year $ 3 , 7 0 3$ 3 , 5 9 4$ 3 , 8 1 7$ 4 , 0 9 7$ 4 , 4 3 0$ 4 , 9 2 4$ 5 , 6 4 6$0$ 1 , 0 0 0$ 2 , 0 0 0$ 3 , 0 0 0$ 4 , 0 0 0$ 5 , 0 0 0$ 6 , 0 0 01996 1997 1998 1999 2023 2023 2023% +% +% +% +% +% Source: 2023 Mercer/Foster Higgins National Survey of Employersponsored Health Plans 3 Mercer Human Resource Consulting Annual CPI Trend . health care costs rise, despite continuing economic recession 0%1%2%3%4%5%6%7%8%9%10%1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2023 2023 2023C P I A l l U r b a n C o n s u m e r s C P I M e d i c a l C a r e? The gap between CPIU and medical care ponent is increasing 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2023 2023 2023CP IMe d i c a l Ca r e 9 .0 % 8 .7 % 7 .4 % 5 .9 % 4 .8 % 4 .5 % 3 .5 % 2 .8 % 3 .2 % 3 .5 % 3 .9 % 4 .6 % 4 .7 %CP I Ov e r a l l 5 .4 % 4 .2 % 3 .0 % 3 .0 % 2 .6 % 2 .8 % 3 .0 % 2 .3 % 1 .6 % 2 .2 % 3 .3 % 2 .8 % 1 .5 %Ra ti o M C/Ov e r a l l 1 .7 2 .1 2 .5 2 .0 1 .8 1 .6 1 .2 1 .2 2 .0 1 .6 1 .2 1 .6 3 .1S o u r c e : . B u r e a u o f L a b o r S ta ti s ti c s4 Mercer Human Resource Consulting Comparison of Overall Growth Cumulative medical care CPI 89% greater than overall CPI since 1967 Data based on January 1 CPI values C P I v s . C P I M e d i c a l C a r e01002003004001967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2023Y e a rStandardized CostM e d i c a l C a r e C P I O v e r a l l C P I5 Mercer Human Resource Consulting Employers’ Cost Increases OutPace Other Indicators Largest increase since 1990 (all employers) Includes medical, dental and pharmacy Source: 2023 Mercer/Foster Higgins National Survey of Employersponsored Health Plans Results for Employers with 500 or more lives % % % % % % % % % % % % % % % % % % % % % % % % % % % % 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2023 2023 2023 Employers CPIMedical CPIAll Items 6 Mercer Human Resource Consulting Aggregate Health Care Spending (1980 – 2023) Government portion of payments increasing。 “flat” or tied to service。 of uncapped plans ? Many caveats – Usually applied only to those retiring postannouncement – Evaluate separately for preMedicare eligible vs. Medicare eligible, or in aggregate – Evaluate per retiree or in aggregate – Definitions of “premiums” and “costs” ? cross subsidy of actives/retirees can cloud calculations ? Need clear definition of how costs and contributions are calculated before cap is hit ? Enrollees will understand concept, but likely won’t be prepared for eventual increases 42 Mercer Human Resource Consulting Employers Being Less Involved Summary ? Focusing on approaches that allow a fixed employer mitment ? Risk transferred to employees/retirees ? In some versions (caps), no immediate impact felt by participants – Communication is critical ? Employers concerned about participant response 43 Mercer Human Resource Consulting The Two Camps Summarized Fight or Flight ? The largest employers seem willing to try to change the world ? Mid sized and smaller employers seem to want to “get out” of the responsibility ? Neither reflects the traditional way of providing benefits Focus on employers reducing involvement, using a generic defined dollar (defined contribution) approach 44 Mercer Human Resource Consulting Agenda ? The Environment ? The Catch22 ? Paths Away from Traditional Delivery: Two Ca