Repealing-Replacing the Affordable Care Act: Considerations for Employers with Self-Funded Plans 

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Over the last several years we have seen employers, especially those with self-funded health plans, evolve in their approach to wellness programs.   Programs have grown from gathering data – e.g., steps on a pedometer, answers to a health risk assessment – to using the information gathered to take a data driven approach to plan design for health plans and their stand alone or integrated wellness programs.  We have also seen employers roll out their wellness programs to spouses, which is a positive trend especially given the latest NIH study which suggests a link between parental obesity and developmental delays in children.  Low hanging fruit, such as targeting more hands on care management for high risk, high cost participants, identifying and implementing mechanisms to promote step therapy and generic drug spend, and removing barriers to managing chronic conditions such as $0 copays for maintenance prescriptions and lower cost office visits, have all been part of our self-funded employers’ toolkits over these past few years as the

Recent Developments in Patient Engagement and Healthcare Cost Initiatives

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In the wake of the recent flurry of commentary on the answer to the question of “What will happen to the Affordable Care Act?” the Commonwealth Fund released a new survey addressing how high-needs patients experience health care in the United States.  The survey underscores what many in the health care sector already know: that a small minority of patients (according to the survey, 10%), account for the majority (according to the survey, 65%), of healthcare spending in the United States.  The survey brings to light the ever-elusive question, the answer to which still remains unclear: how do we as a nation lower healthcare costs and improve population health?

The advent of high deductible health plans has helped employers shift some of the cost burden onto their employees in an effort not only to save money, but more importantly, to have their employees understand healthcare costs and encourage them to be better consumers.  Unfortunately, there is not only a lack of reliable data regarding