The Silicon Valley Leadership Group is deeply committed to making health care more accessible and affordable to all. Employers, along with the government, are the largest payers of health care costs and a critical stakeholder in the process of negotiating health care reform. While we remain committed to providing health insurance to employees, employers in the Silicon Valley and across the country cannot sustain current levels of premium increases without cost shifting to employees or making their business significantly less competitive or unprofitable.
The Leadership Group is working diligently with state and federal policy makers to ensure that the needs and sensitivities businesses face are considered as Federal Health Care Reform is implemented at the state level.
The Affordable Care Act in California: Impact on Employers
The Affordable Care Act (ACA) put in place comprehensive health insurance reforms that provides healthcare coverage for previously uninsured Americans, those with pre-existing conditions, and Americans who had insurance with inadequate coverage and security.
Covered California, California’s health exchange, a health insurance marketplace where individuals and small businesses can purchase health insurance at federally subsidized rates. With 1.4 million enrollees as of June 30, 2015, California has the most health insurance exchange enrollees of any state. According to the U.S. Census, California’s uninsured rate dropped to 12.4 % (2014), the fifth largest decline among all states. Further, 88% of Covered California enrollees (1.2 million) were able to take advantage of tax credits.
For most consumers within California, premiums will stay the same or decrease after subsidies. In 2015, the statewide average was 4.2%. Some plans are even offering rates 8.5% lower than last year. Rate increases were generally higher in Northern California with – as high as 12.8% in Santa Cruz County, 7 % in Santa Clara County and more than 6% in Alameda and San Mateo counties.Recent Trends in Employer Sponsored Insurance
The Kaiser Family Foundation analyzed recent trends in employer-sponsored insurance. As seen in Exhibit B, average 2015 premiums for employer-sponsored health insurance rose 4% over the 2014 average premiums. During the same period, workers’ wages increased 1.9% and inflation declined by 0.2%. Premiums for family coverage increased 27% during the last five years, the same rate they grew between 2005 and 2010, but significantly less than they did between 2000 to 2005 (69%).
For 2015, average premiums for high-deductible health plans with a savings option (HDHP/SOs) are lower than the overall average for all plan types for both single and family coverage (Exhibit C), at $5,567 and $15,970, respectively. The average premium for family coverage is lower for covered workers in small firms (3-199 workers) than for workers in large firms (200 or more workers) ($16,625 vs. $17,938) .
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In a 2015 survey conducted by PwC, most employers have indicated that the ACA is not a major cost driver. A PNHP survey found that overall, the ACA accounted for a median of 3% of overall operating costs for businesses However, ACA-related costs are hitting smaller employers much harder than larger ones. The chart above shows the following components of the ACA that have had a significant financial effect on their businesses.
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Most companies now offer health coverage that requires employees to pay an annual deductible before insurance kicks in, and the size of that deductible has soared in the past decade. That deductible has climbed nearly seven times faster than wages, on average, over the past five years The average general deductible for workers with single coverage totaled $1,077 this year, compared with only $303 in 2006 (Kaiser Family Foundation).
Changing Consumer Behavior
With the rise in cost-sharing, more consumers have chosen to forego care. The increase from $680 to $1200 within average in-network deductibles have caused an increase in consumers foregoing care.
Companies Seeking Alternative Benefit Designs
Companies like Netflix allocate a certain amount of money (2015: $15K) for your health benefits. If you pick a health plan that costs more than $15K/year, you’ll make up the difference (pre-tax). If you pick a health plan that costs less than $15K/year or forego health benefits altogether, you’ll receive a large portion of that difference back as pre-tax additional income. Further, increasing trends in implementation of wellness programs serves as preventive medicine.
Healthcare Innovation: Shaping the Future of Medicine
Enormous technological changes in medicine and healthcare are impacting a variety of stakeholders: patients, medical professionals, researchers, medical students, and consumers. These technological trends are particularly important as they are likely to impact us at one time or another. As of 2015, the trends that have emerged suggest a refined understanding of how data, technology, and design will contribute to healthcare transformation.Institutes for Innovation
As healthcare continues along its perpetual evolution, those in the industry are continually trying to get ahead of the curve and find solutions to the biggest issues facing patient care and delivery today. Some hospitals and health systems have made a commitment to innovation by establishing their own centers and institutes for innovation. The rise of the “innovation center of excellence” has now given way to embed innovation across the organization.
Kaiser Permanente Garfield Innovation Center:
Built in 2006, the innovation center is modeled to look like a real hospital to allow providers to test products in as close-to-reality settings as possible. Once the problem and opportunities for change have been identified, this center is the ideal space to try out new ideas. Teams explore possibilities while participating in hands-on activities such as simulations, technology testing, prototyping, and product evaluations.
David Druker Center for Health Systems Innovation Center:
Launched in August 2010, Sutter Health’s Innovation Center team applies human-centered design and leverages technology to invent, catalyze and deploy breakthrough innovations as a partner in advancing the health and wellbeing of communities. This laboratory develops new healthcare models, technologies, products, service and treatments. Creating scalable solutions that address the pressing health challenges of our time, the team is currently focused on successful aging and lifelong wellness.
Robotic-assisted surgery enhances the skill of the surgeon and allows for less invasive procedures. Advanced robots will be able to perform an operation from continents away, with precision beyond what a surgeon’s hand can do.
Intuitive Surgical: The da Vinci Surgical System enables surgeons to perform delicate and complex operations through a few small incisions. This systems consists of: a designed console where the surgeon sits while operating, a patient side cart where the patient is positioned during surgery, interactive robotic arms, a 3D HD vision system, and proprietary EndoWrist instruments.
Home healthcare services and innovative technology will allow for doctor-patient connectivity where it had not been previously possible, saving both lives and money.
Kaiser members now have two choices for arranging a video physician visit. Patients may contact the health plan call center and be offered a video visit at home with no co-pay, using their smartphone or computer to see a doctor. Next, they may be offered a video visit at one of the clinical decision units.
Further, patient monitoring before, during, and after a procedure can now include autonomous robots, such as iRobot’s RP-VITA (pictured to the right).
Employee wellness programs have been traditionally viewed as recruitment tools or as nice perks. But tax incentives and subsidies under the Affordable Care Act (ACA), as well as demonstrated benefits correlated with healthy employees, have inspired organizations to devote more resources to reinvent their workplace and wellness programs.Impact of Employer Wellness Programs
According to a Kaiser Family Foundation survey, in 2014, 74 percent of all firms offering health benefits in 2014 offered wellness programs. Large firms (200 or more employees) are more likely to offer wellness programs than smaller firms (98% vs. 73%). Large firms that offered health benefits and wellness programs in 2014 collectively employed 44.6 million covered workers.
Workplace wellness programs vary in the services and activities they include, such as onsite flu vaccines, disease management programs, smoking cessation classes, or other fitness and lifestyle programs. Workplace wellness programs also vary in their use of financial incentives, their use of health screenings, and whether programs are offered as part of or outside of the group health plan.
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Many employers offer wellness or health promotion programs to improve their employees’ health. In 2015, 81% of large employers and 49% of small employers reported that they offer employees programs to help them stop smoking, lose weight, or make other lifestyle or behavioral changes. Of firms offering health benefits and a wellness program, 38% of large firms and 15% of small firms offer financial incentives to participate in or complete a wellness program. Of firms with wellness programs, 27% of firms believe that incentives are “very effective” at encouraging employees to participate (Exhibit 1).
Wellness programs are crucial as health plays a significant role in who participates in the labor force. Employers bear productivity losses as illness-related absences is linked to customers’ satisfaction with service or quality. This is testable by measuring the workforce’s health status health risk assessment (HRA) surveys, disability and medical claims reviews or administrative records or sick day absences.