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 is an ophthalmologist and author of Standing Up & Speaking Out for Patients & Doctors and Rebuilding Trust in Healthcare: A Doctor’s Prescription for a Post-Pandemic America.