Are you satisfied with your health benefits plan? That’s one of the many questions asked of over 2,000 employers, running large and small businesses, by the annual survey from KFF. Approximately 153 million workers and their families receive health benefits from employers in the U.S. Therefore, the survey results offer a window on the current satisfaction (or lack thereof) of health plans, whether by self-insured entities or as part of a comprehensive benefits package offered by non-federal public and private firms.
As you might expect, employers have experienced rising costs for health benefits beyond the rate of inflation over the past several years. While the percentage of costs assumed by employees has remained relatively constant (around 25 percent), the costs of premiums, deductibles, and co-pays have risen. Given the low level of unemployment and the need to retain workers, employers are shouldering most of the increases. This trend affects businesses that fully insure their health benefits and those that contract with health insurance companies and their associated physician networks.
The most striking observation from the survey was the section “Employer Perception of Enrollee Satisfaction.” In the following four categories, employers acknowledge “moderate to high” concern by employees: appointments 49 percent; prior authorization 47 percent; finding in-network providers 26 percent; and affordability of cost sharing 58 percent. These numbers reflect managers’ perceptions of their employees’ concerns without regard to the actual survey results of the employees themselves. It is safe to conclude that such employer perceptions are derived from those employees brave enough to speak out on these issues to management. I would wager that a much higher percentage of workers are not just concerned but unsatisfied regarding issues of access and cost.
Employers who understand the limitations of current models of health benefits administration look to alternative models that shrink the financial drain of intermediaries and promote a better relationship between their members and the health care team. Where employers are willing to think differently about their health plans, the opportunity exists for a better experience for everyone involved—employers and their employees as well as physicians and their teams of distinction. In such models, doctors share the financial risks to achieve desired health outcomes and are compensated accordingly. In such models of value-based care, health team members have access to cloud-based clinical and claims information. Unnecessary prior authorizations are eliminated for medical decision-making. Unlike current benefit programs that expect employees to self-serve their needs, employees who enroll in health plans that have been made over with their interests in mind are assisted by care managers who function as patient advocates. Cost transparency is applied to care facilities and prescription drug benefits. Supporting medical thought leaders to drive reform locally is the backbone of a business model that attracts employers and reduces avoidable costs.
The KFF national survey contains a sample size from which some important conclusions may be drawn for businesses and health care professionals who care for their employees. Many employers perceive the status quo as unacceptable and unsustainable as their health benefit plan costs continue to rise.
It’s time for a makeover. Expect more in 2024.
Paul Pender practiced clinical ophthalmology for 38 years, specializing in the medical and surgical treatment of eye diseases. He completed his residency at the world-renowned Wills Eye Hospital. His honors include a lecture series in his name by the New England Ophthalmological Society and the Secretariat Award from the American Academy of Ophthalmology for his work on webinars for clinicians.
Pender is passionate about patient-centered care. He believes that the patient-physician relationship should serve as the fundamental building block for health care reform. He is an advisor to Vxtra Health, a company committed to collaborating with physicians to earn trust and to reduce health care costs. By limiting the drain on health benefits budgets by intermediaries (health insurance companies, pharmacy benefits managers, and hospital systems), Vxtra Health establishes a path toward a new model of care, based on price transparency and fiduciary responsibility, starting with self-insured middle market employers.
He writes on timely medical issues on his website, his KevinMD author’s page, and other popular social media. He is the author of Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America (2020) and the ebook Standing Up and Speaking Out for Patients and Doctors: First Steps Toward Focused Health Care Solutions (2023).
