Evidence-based benefit design: toward a sustainable health care future for employers.
ABSTRACT Health care costs for employers are rising much faster than inflation. The common approach to health benefit design of increasing cost sharing has failed to contain costs. Some employers, however, have been successful at mitigating the cost trend or actually reducing health care costs. These employers have in common a dedication to data analysis, a search for cost drivers, and a willingness to adjust their approach to health benefit design to address these cost drivers. This approach has much in common with the movement in clinical practice toward evidence-based medicine. We propose that employers adopt a similar approach toward health benefits termed evidence-based benefit design, which is based on a health and productivity framework focused on direct and indirect costs. Evidence-based benefit design incorporates the relevant literature and employer-specific data that are integrated and regularly analyzed.
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ABSTRACT: To illustrate how to use evidence-based benefit design (EBD) by presenting the case study of a major manufacturer. Key components of the company's measurement and management approach to EBD are introduced. Descriptive results on the direct and indirect cost and utilization trends of the company's US active workforce during 2002 to 2008 are presented. From 1999 to 2002 aggregated to 2008, health care costs dropped sharply, with 2006, 2008, and projected 2009 reporting decreases even as annualized increases in national expenditures approximated 10%. Annualized rates for hospitalizations, office visits, and prescriptions showed corresponding decreases from 2004 to 2008. From 2002 to 2008, workers' compensation/disability and absenteeism costs decreased 38% and 46%, respectively. These results support the company's direction in health benefit design although further confirmation is needed. Ongoing quality improvement processes are discussed, as are implications for implementing EBD.Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 09/2010; 52(10):956-63. DOI:10.1097/JOM.0b013e3181f72ae5 · 1.80 Impact Factor
- Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 06/2011; 53(6):695-702. DOI:10.1097/JOM.0b013e31822005d0 · 1.80 Impact Factor
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ABSTRACT: To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2012; 54(8):904-16. DOI:10.1097/JOM.0b013e318267f1b1 · 1.80 Impact Factor