Mercer s National Survey of Employer-Sponsored Health Plans 2007

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1 February 21, 2008 s National Survey of Employer-Sponsored Health Plans 2007 Bob Boyer, Indianapolis Services provided by Health & Benefits LLC

2 Welcome!

3 About the survey Largest and most comprehensive annual survey Established in 1986, national probability sample used since ,945 employers participated in 2007 All employers with 10 or more employees are surveyed; size groups examined separately in this presentation include: - small employers employees - large employers 500+ employees - jumbo employers 20,000+ employees 2

4 Top Stories

5 Top Stories CNN News Poll January, 2008 Which of the following issues will be most important to you when you decide how to vote for President? 10% 9% 2% 18% 25% 35% Economy Iraq Health Care Immigration Terrorism Other 4

6 Cost growth remains flat Annual change in total health benefit cost from % 12.1% 10.1% 11.2% 10.1% 8.0% 6.1% 7.3% 8.1% 7.5% 6.1% 6.1% 6.1% 5.7%* 2.1% 2.5% -1.1% 0.2% Note: Results for are based on cost for active and retired employees combined. The change in cost from is based on cost for active employees only. * Average increase projected for 2008 after changes to plan design 5

7 Cost rises by 6.1% in 2007 and by just 5.1% for large employers Average total health benefit cost per employee % $7,983 $7, % $7,608 $7, % $8,229 $7, All employers employees 500+ employees 6

8 Cost growth has been flat since 2005 Total health benefit cost change vs. workers earnings and general CPI 20.0% 18.6% Workers' earnings Annual change in total health benefit cost per employee 18.0% 17.1% Overall inflation 16.0% 16.7% 14.7% 14.0% 12.1% 12.0% 11.2% 10.0% 10.1% 10.1% 8.0% 8.0% 8.1% 7.3% 7.5% 6.0% 6.1% 6.1% 6.1% 6.1% 5.7%* 4.0% 2.0% 0.0% -2.0% 2.1% -1.1% 2.5% 0.2% * Projected Source: Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April) ; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April)

9 Slowdown in underlying trend suggests utilization may be falling Increase in cost predicted for upcoming plan year 10.0% 9.8% 9.0% Before changes* After changes* 7.9% 6.6% 6.7% 6.1% 5.7% * Includes changes in carrier, contribution strategy or plan design. 8

10 Employee cost-shifting continues in 2007 among large employers PPO average in-network deductibles Individual Family $689 $703 $765 $833 $882 $995 $1,022 $1,134 $277 $291 $302 $343 $366 $413 $426 $

11 Employers will continue to shift cost in % employees 500-4,999 employees 28% 39% 31% 36% 40% Will raise employee contribution percentage Will raise deductibles, copays, or other cost - sharing features Will not shift cost 10

12 Employer cost management activities helping to slow increases Large employers Use strategy Use strategy and believe it has been successful* Don t use strategy Health management 80% 20% Consumerism 52% 48% * in efforts to control health benefit cost or improve workforce health and productivity Source: s National Survey of Employer-Sponsored Health Plans 11

13 Employer cost management activities helping to slow increases Large employers Use strategy Believe it has been very/ somewhat successful* Too soon to tell Health management 80% 63% 33% Consumerism 52% 62% 29% Data warehousing 24% 59% 39% Collective purchasing 21% 84% 13% Evidence-based plan design 20% 57% 39% Performance transparency 12% 28% 63% High-performance networks 11% 54% 44% * in efforts to control health benefit cost or improve workforce health and productivity 12

14 Use of specific health management programs Large employers Health website Case management Nurse advice line Health risk assessment End-of-life case management Health advocate services Targeted behavior modification Large employers 78% 76% 67% 56% 42% 38% 30% Jumbo employers 90% 91% 85% 78% 51% 47% 51% 13

15 Return on investment in health management Large employers All large Jumbo employers employers Provide disease or care management programs through specialty vendor/ request optional services from health plan vendor 25% 30% 55% 62% Have attempted to measure return on investment (ROI)* 21% 21% 45% 55% Of those that have measured ROI, % of employers that are satisfied with ROI 73% 71% Use incentives to encourage employees to use disease or care management programs* 13% 23% 23% 38% *Among employers that offer disease or care management programs 14

16 Use of specific disease management programs Offered to employees enrolled in primary medical plan Diabetes Heart disease/hypertension Asthma Cancer Depression Renal disease Obesity Low back pain Rare diseases Any disease management program Large employers 63% 55% 49% 43% 34% 32% 32% 29% 23% 67% Jumbo employers 83% 78% 75% 46% 36% 31% 30% 47% 27% 86% 15

17 More employers using incentives to encourage participation in health management programs 38% % 19% 23% Large Employers Jumbo Employers 16

18 Use incentives to encourage participation in care management programs offered Large employers Jumbo employers Completing a Health Risk Assessment Participation in a disease management program Participation in a behavior modification program Completing a behavior modification program Any health management programs 29% 11% 22% 16% 23% 40% 17% 33% 17% 38% 17

19 CDHP enrollment reaches 5% of all covered employees Percent of covered employees % 8% 23% 5% % 9% 24% % 10% 25% % 58% 10% 27% % 54% 14% 27% Traditional indemnity plan PPO POS HMO CDHP 18

20 Growth in CDHP offerings slows in 2007 Percent of employers offering HRA- or HSA-based CDHP All employers 2% 6% 7% Small employers 2% 5% 7% Large employers 5% 11% 14% Jumbo employers 22% 37% 41% 19

21 Consumerism initiatives Large employers Jumbo employers Have replaced copays with coinsurance 16% 36% Vary premium contribution based on 5% 16% health status Use evidence-based design 20% 24% Reduced cost-sharing for maintenance drugs 10% 11% Waive/reduce copays for specific, effective drug therapies 5% 6% Waive/reduce copays for specific, effective treatment modalities 3% 4% 20

22 Employers save money with CDHPs Average cost per employee $5,770 $5,970 $6,616 $7,120 $6,932 $7,352 $6,937 $7, CDHP/+3.5% HMO/+7.6% PPO/+6.1% POS/+11.2% 21

23 Comparing HSA, HRA and PPO plan design Large employers HSA HRA PPO Average in-network deductible $1,769 $1,457 $473 % employers contributing to account 65% 100% Average employer account contribution $626* $621 Average gap $1,143 $836 $473 Average cost per employee $5,479 $6,110 $7,429 Average monthly employee premium contribution $69 $65 $89 * Based on employers making a contribution. Including zeros, the average employer HSA contribution is $

24 HSAs vs. HRAs vs. high-deductible PPOs Average cost per employee among large employers $6,944 $5,479 $6,110 HSA-based CDHPs HRA-based CDHPs PPOs with deductible of $1,

25 Enrollee response to HSAs and HRAs Large employer assessment of employee reaction More negative than positive 6% Strongly negative 1% Strongly positive 8% More negative than positive 7% Strongly negative 1% Strongly positive 21% Evenly mixed 32% Evenly mixed 23% More positive than negative 53% More positive than negative 48% HSAs HRAs 24

26 Average enrollment in CDHP over time Among 77 large employers that have offered a CDHP as a choice since % 25% 29%

27 Prescription drug benefit cost slows for a sixth year, but continues to outpace overall cost Cost increase in primary medical plan for large employers 13.8% 16.9% 18.3% 17.8% 16.9% 16.1% 14.3% 11.5% 9.9% 9.3%

28 Use of coinsurance in drug plans Percent of employers requiring coinsurance Generic drugs Formulary brand Non-formulary brand Specialty/biotech/ lifestyle Any drug category Large employers Jumbo employers Retail card Mail-order Retail card Mail-order 8% 6% 34% 25% 10% 7% 40% 24% 12% 8% 41% 25% 2% 2% 5% 2% 20% 15% 55% 39% 27

29 Health coverage eroding among small employers Percent of employers with employees that offer coverage 69% 66% 66% 64% 62% 63% 61%

30 Surprise uptick in retiree medical offerings in 2007, but only among mid-sized employers Large employers 46% Offer coverage to pre-medicare-eligible Offer coverage to Medicare-eligible 41% 40% 38% 35% 35% 31% 29% 28% 29% 29% 31% 28% 23% 21% 21% 21% 19%

31 Employer opinions on health reform initiatives or proposals Pay or play requiring employers to offer a health plan or pay into a fund to provide coverage for the uninsured Individual mandates requiring individuals to purchase health insurance, at specified levels of coverage and cost Extending the age of children entitled to dependent coverage Making section 125 cafeteria plans a requirement to allow all employees (including those not eligible for coverage) to make pretax premium contributions Connector or exchange agencies that provide access to affordable insurance for individuals and small businesses Disapprove/ Strongly disapprove 50% 48% 23% 18% 15% Approve/ Strongly approve 23% 23% 48% 61% 58% 30

32 Should states be encouraged to implement health reform measures as a way to test approaches to universal coverage? Employer opinion Small employers 10% 32% 25% 22% 10% Large employers 4% 25% 30% 30% 11% Jumbo employers 1 6% 27% 39% 27% Stronly agree Agree Neutral Disagree Strongly disagree 31

33 What the largest employers are considering for the next five years Employers with 10,000 or more employees Interested/ very interested Very interested Evidence-based design 81% 20% Facilitating creation of personal health records 63% 21% Building block approach to coverage 38% 6% Off-shoring major surgery 9% 32

34 The trillion-dollar question increasing access for the uninsured Do employers have a role? The high number of uninsured contributes to the fact that the US ranks only 20 th out of 30 developed nations in longevity, while outspending all of them. Uncontrolled cost growth has been a key factor in the problem of the uninsured Employer and health industry initiatives have helped slow cost growth in recent years and continue to show promise Government-led reform needs to build on this progress -- this time around, employers should and will have a seat at the table 33

35 More on Cost and Design

36 Factors that affect average cost per employee Industry $7,593 $7,994 $8,303 $8,453 $8,539 $8,837 $6,729 Wholesale/ Retail Services Manufacturing Financial services Health care Government Trans/ Communic/ Utility 35

37 Factors that affect average cost per employee Region $8,294 $8,299 $8,409 $7,187 South Midwest West Northeast 36

38 Factors that affect average cost per employee Employer size $7,608 $7,614 $8,097 $8,540 $8,726 $8, ,000-4,999 5,000-9,999 10,000-19,999 Number of employees 20,000 or more 37

39 Factors that affect average cost per employee Employer/employee demographics $7,983 $8,831 $9,284 $9,841 All employers Average employee age 43 or higher Dependent coverage election 65% or higher 75% or more employees in unions 38

40 Midwest region type of plan offered Large employers 88% 89% 86% % 11% 11% 12% 11% 6% 34% 27% 27% 15% 15% 8% Traditional Indemnity PPO POS HMO CDHP 39

41 Midwest region average cost per active employee Large employers $8,513 $8,860 $8,039 $7,721 $7,194 $6,915 $7,178 $7,464 Total PPO POS HMO 40

42 PPO cost per employee, by region Large PPO sponsors $7, % + 7.3% + 1.7% $7,846 $7,721 $7,591 $7,717 $7, % $6,793 $6,498 West Midwest Northeast South 41

43 Employee cost-sharing requirements for PPO Large PPO sponsors DEDUCTIBLE (MEDIAN) Require deductible Individual amount (median) Family amount (median) DOCTOR S OFFICE VISIT Require copay Copay amount (median) Require coinsurance Coinsurance amount (median) HOSPITALIZATION Require per-admission copay Copay amount (median) Require coinsurance Coinsurance amount (median) OUT-OF-POCKET MAXIMUM Plan includes maximum Individual OOP max (median) In-network 77% $300 $800 81% $20 20% 20% 23% $250 66% 20% 84% $2,000 Out-of-network 95% $500 $1,200 14% $20 86% 30% 15% $350 89% 30% 86% $3,250 42

44 Midwest region average total benefit cost per employee Large Employers $8,496 $8,888 $6,789 $7,203 $7,942 $8,344 $8,039 $8, Indiana 500+ Kentucky 500+ Illinois 500+ Midw est 500+ Expected average increase in total health benefit cost for 2008: Indiana 500+ Kentucky 500+ Illinois 500+ Midwest 500+ Before making changes* 8.6% 8.0% 9.0% 8.4% After making changes* 5.6% 3.6% 5.9% 6.3% *to plan design or health plan vendor 43

45 Midwest region average total benefit cost per employee Large Employers 30% Health Reimbursement Account 24% 22% Health Savings Account 15% 15% 18% 14% 10% Indiana 500+ Kentucky 500+ Illinois 500+ Midw est 500+ Will offer an account-based CDHP in next five years Indiana 500+ Kentucky 500+ Illinois 500+ Midwest 500+ As the only type of plan offered 17% 14% 8% 9% Alongside other medical plan choices 51% 67% 57% 52% 44

46 Midwest region average PPO cost per employee Large Employers $7,743 $8,090 $7,560 $7,541$7,818 $6,880 $7,194 $7,721 Indiana 500+ Kentucky 500+ Illinois 500+ Midw est

47 Employee monthly dollar contributions for CDHP coverage Employers with 500-4,999 employees HSA-based CDHP Employee-only Family No contribution required 14% 6% Average monthly $$ amount $76 $301 Average contribution as % of premium 29% 35% HRA-based CDHP Employee-only Family 8% 2% $67 $285 23% 35% PPO Employee-only Family 17% 6% $90 $338 23% 35% HMO Employee-only 17% $87 23% 46

48 CDHP plan design Sponsors with 500-4,999 employees HRA Employer contribution (median) Deductible (median) Out-of-pocket maximum (median) Employee-only $500 $1,250 $2,200 Family $1,000 $2,500 $4,500 HSA Employer contribution * (median) Deductible (median) Out-of-pocket maximum (median) Employee-only $535 $1,500 $2,650 Family $1,000 $3,000 $5,000 * Zeros not included 47

49 Employer actions for 2008: Results of the 2008 Client Pulse Survey Midwest

50 Basic Strategies - Plan design 2008 medical benefit changes Increased employee cost sharing for medical 39% Increased employee cost sharing for Rx 28% 50% Source: s 2008 Client PULSE Survey 49

51 Basic Strategies - Contributions 2008 medical benefit changes Increased employee s share of plan costs 51% Increased dependent s share more than employees 24% Implemented working spouse rule Increased number of contribution tiers 3% 6% 50% Source: s 2008 Client PULSE Survey 50

52 Basic Strategies Some (very) slowly changing trends Salary-related plan design 3% 0% Salary-related contributions 29% 0% Office visit coinsurance 36% 2% Rx coinsurance 36% 3% Rx out-of-pocket limit 7% 2% Working spouse provision 14% 3% In place in 2007 Added for % 51

53 Advanced plan design Consumer-Directed Health Plans Offer account-based plans (HRA or HSA) 37% 5% Among employers with account-based plans Total replacement approach* 4% 0% Use Health Reimbursement Account design 38% 3% Use Health Savings Account design 62% 11% Company funded HSA* (Average contribution = $546) 46% 8% Exempt preventive Rx from deductible 30% 7% In place in 2007 Added for 2008 *Among employers funding HSA-based CDHPs 50% 52

54 Advanced Strategies - Health management: encouraging employees to be more proactive about their health Percent of respondents offering program Health Risk Appraisal 45% 18% Healthy lifestyle programs 42% 18% Telephonic health advocate/ decision support 29% 6% On-site wellness and prevention 39% 11% Disease management 76% 5% Disability management 28% 1% Complex case management 72% 1% Health information portals and tools In place in 2007 Added for % 65% 7% 53

55 Provide incentives to participate in health management program Among respondents with program, percent providing incentives Health Risk Appraisal 54% Healthy lifestyle programs 47% Telephonic health advocate/ decision support 25% On-site wellness and prevention 35% Disease management 11% Disability management Complex case management 6% 6% Health information portals and tools 14% 50% 54

56 Communication Increasing levels of employee engagement Health care communications outside of annual enrollment 49% 8% Health care portal for employees 37% 6% Branded health care messaging 21% 8% In place in 2007 Added for % 55

57 Advanced strategy changes for 2008: What do they mean? Slow but steady growth of account-based plans Growing evidence that: Necessary care is not neglected Discretionary spending is reduced Objective and endorsed quality measures are still lacking Slow growth of HPN plans Increasing use of measurement to support plan design and health management initiatives Jump in health management data integration Jump in ROI measurement New strategies take time and effort to bear fruit engaging your organization (management and employees) is still the key to success 56

58 Questions

59 Services provided by Health & Benefits LLC

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