How Research Can Drive Healthcare Value for EmployersPaul Fronstin, Ph.D.Director, Health Research and Education Program@pfronstinSeptember 20, 2019

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Paul FronstinDisclosures

Relationship Company(ies)

Speakers Bureau

Advisory Committee University of Michigan V-BID Center

Board Membership National Alliance of Healthcare Purchase Coalitions; Emeriti Consortium for Retirement Health Solutions

Consultancy

Review Panel

Honorarium

Ownership Interests

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About the Employee Benefit Research Institute (EBRI)Nonpartisan tax-exempt membership

organization created in 1978. Our mission is to contribute to sound

employee benefit programs and public policy through independent, objective, fact-based research and education.We bring together all facets of the

employee benefits ecosystem, resulting in well-informed publications and events, along with unparalleled networking experiences.

info@ebri.org

Employee Benefit Research Institute (EBRI)

Twitter@EBRI

LinkedInEmployee Benefit Research Institute

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Employers Will Make Health Plan Design Decisions Based on Sound Research• HSA-plan affected lower

income workers disproportionately:

• Specialist visits• Flu vaccines• Breast cancer screenings• Emergency department

visits• Inpatient admissions

• Findings resulted in employers front loading HSA for lower income workers

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• Rising HSA balances resulted in higher use of health care services

• Primary care visits• Specialist visits• Chiropractic visits• Physical therapy• Psychotherapy• Blood tests, X-ray, CT scan, MRI

• Employers discussing raising deductibles, adding higher deductible plan as a choice, education around benefits of long-term savings

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Sometimes Employers Get Caught Up in the Hype: Employer Interest in HSAs in 2004Likelihood of Offering a High-Deductible Health Plan with an HSA

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Then They Don’t Follow ThroughPercentage of Employers Offering HSA-Eligible Health Plan/HRA, by Firm Size, 2010–2016, with Projections Through 2019

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The Hype Around Private Health Insurance Exchanges: Sometimes They Don’tConsultant Estimated

EnrollmentBy

Year

EBRI 5-6 million (5%) 2015

Accenture 40 million 2018

Oliver Wyman 39.1 million 2018

Goldman Sachs 35 million 2019

EBRI 13-15 million (10%) 2020

Consumerdriven, LLC &HSA Consulting Services, LLC

75 million 2020

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What Happened? Still Too Many Unanswered Questions• Are expenses more predictable?• Will it increase competition?

• Will increase choice be positive for consumer?

• Will employees shop intelligently and choose highest value plan?

• What happens to wellness programs?

• Will it reduce administrative costs?• Do lessons learned from retirement

benefits apply?• Does employee choice add costs?

• How does moving to fully-insured model save money?

• If plans are standardized, how do they compete?

• Does risk-adjustment mitigate need to compete?• Why would insurers invest in people if they can

easily move to another plan during open enrollment?

• If employers aren’t pooled, what does it mean to be in an exchange?

• If employers self-insure, what does it mean to be in an exchange?

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Thank You!Paul Fronstin, PhDDirector, Health Research and Education Program@pfronstinSeptember 20, 2019