by Maria K Todd, MHA PhD
CEO & Founder
Mercury Healthcare International
How much can you save if your plan is appealing to participants?
Telephone and video visits tend to range between $40-$65 versus the average $125 for a traditional office visit. When employers permit the telemedicine service to be used "first dollar" (meaning before annual deductibles have been satisfied) the utilization may increase even more - especially for non-acute visits. But the biggest potential savings is when the ED is avoided as an after hours "port in the storm". The average ED visit costs an employer-sponsored health benefit plan between $1300 and $1600 per visit. Many of those telephone and video visits can be had for the cost on one emergency department visit that doesn't result in admissions to inpatient or observation areas.
Call on Mercury Health Travel if you'd like to arrange a second surgical opinion program, a telehealth program or synchronous or asynchronous telemedicine program for your company. Most programs charge employers a per-employee/per-month fee of as much as $8 PEPM in addition to the time and charges for each call. We charge no PEPM fee. Our model is more cost effective. We set up your program for a modest one -time consulting fee and then you pay the providers directly at a contracted rate for calls with no middleman fees, commission payments, or other service or administration fees. Claims can go directly through your TPA or ASO or our Kansas-based, partner TPA will help you with your special carve-out program. As our technology and services partner, we don't collect any finders fees or commissions from them if you select them. Our loyalty and advocacy is to our clients.
What else are employers planning for 2017?
Retail /Walk-in Clinic Coverage
A large number of employers already pay for visits to a retail clinic as another lower-cost and convenient option for their health plan members. Such a visit typically costs about $60 before the annual deductible is met. This trend is expected to increase exponentially as many employees face challenges obtaining appointments when they need them.
The total health benefit cost per employee is expected to rise by 4-6% next year. Many plans intend to explore cost-containment measures such as plan design changes, telemedicine and domestic medical tourism. Those that do not initiate any changes estimate that cost would rise by about 7-10%.
Price transparency tools
The percentage of employers with 20,000 or more employees that provide transparency tools through a specialty vendor nearly doubled to 28% from 15% two years ago, while an additional 62% of respondents report that their health plan provides some type of transparency tool.
But transparency tools get mixed reviews. Many who placed tremendous hope in them are expressing disappointment because the data is not available to enable platforms to provide accurate and correct prices. Transparency that isn't accurate is viewed as bait and switch and participants who spend time looking for cheaper alternatives and then face bait and switch at the reception desk end up outraged and feeling like they wasted their time. The outrage inflames further when they find that because of false information they actually paid more despite their efforts to use the system and attempt to save money.
Fitness and Wellness Programs
The number of plan participants now wearing a fitness tracking device or using an app has increased but wellness plans are still suffering from lackluster effectiveness in plan savings. The typical off the shelf program runs about $75-90 per year but the program fails to get satisfactory or expected ROI year after year.