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Survey Report

Encouraging higher-value, lower-cost health care network and delivery solutions

Benefits Administration and Outsourcing Solutions|Health and Benefits|Talent|Total Rewards
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April 3, 2020

Some employers are finding that competing organizational priorities and administrative challenges are hindering their efforts to shift to a value-based health care delivery model.

As employers confront the challenge of lowering the cost of health care while improving quality, they increasingly embrace strategies that involve paying health care providers for outcomes or value rather than services. Groundbreaking developments across a range of areas from digital technology to analytics are creating opportunities to rethink how and where health care is delivered, in the process achieving improved results at a lower cost. But some employers are finding that competing organizational priorities (61%) and administrative challenges (50%) are hindering their efforts to shift to a value-based health care delivery model (Table 1). Addressing these obstacles will help employers make progress toward improved network and provider strategies.

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What have been the biggest barriers to your organization acting upon the network and provider strategies?
Table 1. Competing organizational priorities is the biggest barrier for network and provider strategies
1 Competing organizational priorities 61%
2 Administrative challenges 50%
3 Lack of internal resources to support the change 49%
4 Ongoing expenses 35%
5 Initial start-up expenses 26%
6 Difficulty in working with health plans to implement 22%
7 Lack of qualified vendors 15%

Sample: Companies with at least 100 employees
Source: 2019 Willis Towers Watson Best Practices in Health Care Employer Survey

Companies plan to focus on specific clinical conditions — in particular, mental/behavioral health, metabolic syndrome/diabetes, musculoskeletal and cancer — to improve member health and cost savings. To target these conditions, they will focus on evaluating network strategy along with improving navigation and adopting vendor point solutions (Figure 1).

Employers taking action will focus on revising medical benefits (16%); evaluating network strategy (32%); enhancing navigation (43%); and adopting vendor point solutions (37%).
Figure 1a. Mental/Behavioral health: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions
Employers taking action will focus on revising medical benefits (14%); evaluating network strategy (17%); enhancing navigation (27%); and adopting vendor point solutions (40%).
Figure 1b. Metabolic syndrome/Diabetes: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions
Employers taking action will focus on revising medical benefits (9%); evaluating network strategy (21%); enhancing navigation (26%); and adopting vendor point solutions (31%).
Figure 1c. Muscloskeletal: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions
Employers taking action will focus on revising medical benefits (6%); evaluating network strategy (20%); enhancing navigation (28%); and adopting vendor point solutions (19%).
Figure 1d. Cancer/oncology: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions
Employers taking action will focus on revising medical benefits (5%); evaluating network strategy (15%); enhancing navigation (23%); and adopting vendor point solutions (20%).
Figure 1e. Cardiovascular: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions
Employers taking action will focus on revising medical benefits (16%); evaluating network strategy (14%); enhancing navigation (21%); and adopting vendor point solutions (23%).
Figure 1f. Maternity/infertility: Employers will focus on evaluating network strategy, enhancing navigation and adopting vendor point solutions

Employers are focused on a range of value-based services across all stages of care delivery from prevention to return to work (Figure 2).

More employers are planning or considering interventions across health care delivery in 2020 and 2021 based on several actions per category: Prevention (range of 11% to 20%); Network/Steerage (range of 28% to 37%); Surgical care (range of 20% to 29%); and Return to work (17%). Action taken in 2019 ranged from 7% to 61% for Prevention; 9% to 16% for Network/Steerage; 5% to 45% for Surgical care; and was 55% for Return to work.
Figure 2. Employers seek interventions across the delivery of care

Sample: Companies with at least 100 employees
Source: 2019 Willis Towers Watson Best Practices in Health Care Employer Survey

Onsite health promotion activities and health clinics

In an effort to encourage healthy behaviors, a majority of employers (61%) offer onsite health promotion activities, a number that could grow to over 80% by 2021. Over two-fifths of companies (41%) have a national strategy for these activities while 38% employ a narrower market-specific strategy in a single or a few locations (Figure 3). In addition, over half of employers (54%) provide onsite biometric screening and another 11% are considering adding it in the next two years.

Recognizing the growing ranks of employees who have to balance caregiving and work responsibilities, an increasing number of employers offer elder care support services (24% today growing to over 40% by 2021) and childcare support services (26% today growing to 39% by 2021).

Employers are expanding their use of health clinics both onsite (20% today growing to 31% by 2021) and near-site (7% today growing to 22% by 2021). Such clinics make it convenient for employees to get care, which can range from help managing chronic conditions to preventive screenings, without having to take extensive time off from work. In a competitive labor market, onsite and near-site clinics give employers an edge in attracting and retaining top talent. These clinics benefit employers by giving them greater control over costs, and helping avoid unnecessary and costly emergency room visits. Onsite centers can also allow selective referral to higher-value specialists. The majority of companies make targeted use of onsite (76%) and near-site clinics (78%), employing a market-specific strategy in a single or few locations.

38% of employers have a national strategy, 36% have a market-specific strategy in a single or few locations, 23% have a market-specific strategy in many locations, 5% other
Figure 3a. Employers reported use of high-performance networks

Offering rate in 2019 is 16%

71% of employers have a national strategy, 12% have a market-specific strategy in a single or few locations, 13% have a market-specific strategy in many locations, 6% other.
Figure 3b. Employers reported use of centers of excellence

Offering rate in 2019 is 46%

12% of employers have a national strategy, 76% have a market-specific strategy in a single or few locations, 11% have a market-specific strategy in many locations, 4% other.
Figure 3c. Employers reported use of onsite health clinics

Offering rate in 2019 is 20%

18% of employers have a national strategy, 78% have a market-specific strategy in a single or few locations, 3% have a market-specific strategy in many locations, 3% other.
Figure 3d. Employers reported use of near-site or multiemployer health clinics

Offering rate in 2019 is 7%

41% of employers have a national strategy, 38% have a market-specific strategy in a single or few locations, 19% have a market-specific strategy in many locations, 8% other.
Figure 3e. Employers reported use of onsite/worksite health promotion activities

Offering rate in 2019 is 61%

Sample: Companies with at least 100 employees
Source: 2019 Willis Towers Watson Best Practices in Health Care Employer Survey

Telebehavioral health services

Employers are increasing their focus on mental health by offering coverage for telebehavioral health services. While slightly more than half of companies (54%) offered this coverage in 2018, almost three-quarters (73%) do so today, and this number is expected to rise to 89% by 2021.1

Centers of excellence

COEs (growing from 45% today to 74% by 2021) are reaching a critical mass of employees. Roughly three-quarters of employers (71%) employ a broad, national COE strategy. Most companies currently work with their health plans to establish COEs. While a small number of employers (5%) contract with a carve-out provider for COEs, the prevalence of this practice is expected to jump to 25% by 2021.

High-performance networks

Employers expect that their use of HPNs, which provide access to a narrow network of higher-value and lower-cost providers, will expand significantly from 16% today to 52% by 2021 (Figure 4). As the use of HPNs grows, more employers will reduce the employees’ share of premiums or point-of-care costs. Currently, a mere 9% of companies that offer HPNs reduce these premiums and costs, but by 2021 that figure could rise to 38%.

No one approach to HPN strategy dominates, with 38% of companies employing a national strategy and 36% a market-specific strategy in a single or a few locations.

Expert medical opinion programs

Another growing trend is the use of expert medical opinion programs, which helps ensure best-in-class care and better health outcomes. Less than a quarter of employers (22%) offer this service today, but its prevalence is expected to more than double in two years.

Employer interest is growing: 16% in 2019 to an anticipated 52% in 2021
Figure 4a. Growing attention among employers to offering high-performance programs
Employer interest is growing: 45% in 2019 to 74% in 2021.
Figure 4b. Growing attention among employers to centers of excellence within the health plans
Employer interest is growing: 22% in 2019 to 51% in 2021
Figure 4c. Growing attention among employers to offering expert medical opinion programs
Employer interest is growing: 9% in 2019 to 38% in 2021.
Figure 4d. Growing attention among employers to reduce employee share of premiums or point-of-care costs for high-performance network plans

Note: *“Planning for 2020”; ^“Considering in 2021”
Sample: Companies with at least 100 employees
Source: 2018 and 2019 Willis Towers Watson Best Practices in Health Care Employer Survey

Vendor/carrier strategy

Employers continue to select vendor partners, including insurance carriers, based on a broad set of priorities (Figure 5). Almost all employers (95%) select carriers based on the competitiveness of their network access and of their negotiated provider discounts. Companies also value the effectiveness of the vendor's use of data, analytics and reporting as well as the integration of data, systems and/or customer service across medical, pharmacy and/or mental/behavioral health.

Companies' priorities for selecting health insurance carriers range from competitiveness of negotiated provider discounts and the vendor's network access (both 95%--
Figure 5. Companies examine a broad set of priorities when selecting health insurance carriers

Sample: Companies with at least 100 employees
Source: 2019 Willis Towers Watson Best Practices in Health Care Employer Survey

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Best Practices: health care delivery
  • Use high-performance networks to deliver higher value at lower cost.
  • Offer onsite or near-site health clinics.
  • Provide coverage for expert medical opinion programs.
Best performers 58%, High-cost companies 38%, Best performers’ lead +20%
Figure 6a. Best performer advantage

Use COEs within health plans

Best performers 84%, High-cost companies 66%, Best performers’ lead +18%
Figure 6b. Best performer advantage

Offer coverage for telebehavioral health services

Footnotes

1. Ibid., 1.


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