DECEMBER - 2022HR TECH OUTLOOK9For employee cost-sharing decisions, there are very few rules for setting payroll deductions, but make sure there is an affordable option for ACA compliance purposes. You will also want to avoid IRS discrimination issues, ensuring you do not favor highly paid employees. Also, look at contribution structures for those covering dependents; how much you charge will influence how many dependents you will cover.Now, back to my earlier point on our collective inability to manage our own personal healthcare. Claim cost is made up of contract terms, utilization, and severity of claims. It is those last two posing some of the biggest challenges. Where and How People Receive ServicesLet's now look at utilization. An easy example is telehealth v. primary care v. urgent care v. emergency room (ER). Plan design can create some steerage through cost-sharing; however, we still see ER visits for non-emergent care.There continues to be a lack of trust around generic medication and not enough time spent researching the cost and quality of healthcare providers and facilities. While plenty of healthcare utilization is appropriate, inappropriate utilization has an impact on overall claim liability. Last, and certainly not least, the severity of claim. If you have a healthy person going for their annual physical with in-range biometrics (weight, blood pressure, cholesterol, blood sugar) and an occasional sickness or accident, their claims are generally not severe. Pair these people with a healthy diet and moderate exercise and we would largely expect them to remain healthy with lower cost claims. While others who are not as healthy may require additional medical services and prescription drugs. These people often are more sedentary and make lifestyle choices that may lead to chronic conditions. In these cases, lifestyle changes may result in these same conditions being mitigated or reversed. Alternatively, ignoring your health and preventive guidelines alongside a less healthy lifestyle may lead to a surprise ­ and sometimes catastrophic ­ diagnosis, e.g., stage 3 cancer versus stage 1, which could be more easily treated. Changing the TidesSo, do you hate the player or hate the game? How do we change the tides? There are solutions to address nearly every common condition. However, the answer is far more evasive; we must find a way to encourage people to prioritize their own health and wellness. We have to find a way to achieve this lofty goal, but we must continue to help employees navigate their own health journey. We must all work together towards improving employees' health which will directly impact employee benefits and improve rates. Kate Genovese is the SVP, employee benefit strategist at Risk Strategies, a leading national specialty insurance brokerage and risk management firm. Genovese's 25+ years of experience are a testament to her passion for employee benefit plans. With her deep knowledge of employer-sponsored health and welfare programs, she helps employers build, maintain, and improve their programs. Administration contract optimization for medical and pharmacy policies can ensure your organization is getting the most value
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