Editor’s note: Dan Mendelson is the CEO of Morgan Health and Cheryl Pegus is a partner at Morgan Health.
Employers and employees alike adapted admirably to a new way of working throughout the COVID-19 crisis by embracing asynchronous and remote work on a large scale. Now that the acute phase of the pandemic is behind us and more people are returning to offices, employers have an opportunity to take the lessons learned throughout the pandemic to improve health and well-being into 2023 and beyond.
Our focus on improving employer-sponsored health care requires us to put ourselves in the shoes of employees across all income levels, demographics and work environments to understand where there are unmet needs that require a new approach to coverage and care. Many of the questions that we ask ourselves focus on what we would do in the case of a medical emergency — who would we call or where would we go? How would we learn what interventions we need and what they would cost? Can we heal faster, or avoid a serious complication through earlier or easier access to care?
The answers to many of these questions highlight major headwinds that employers need to be mindful of and actively address. For example, the Association of American Medical Colleges projects a shortage of up to 48,000 primary care physicians by 2034 if current trends continue. Physician shortages have a direct impact on the availability and quality of care that employees receive in their local communities — a dynamic that employers will have to contend with through thoughtful benefit design and provider partnerships. In major metropolitan markets, employers may be facing an entirely different subset of access and affordability challenges. The recent release of negotiated prices between hospitals and insurers illustrates the skewed cost dynamics in the commercial market, and the burden they place on employees and employers alike.
Together, we need to solve for these and other complex challenges in order to improve outcomes for the 150 million Americans who rely on employer-sponsored health care. From our vantage point, there are a number of opportunities on the horizon that employers can capitalize on in the next year.
Embrace accountable care strategies to strengthen care delivery
While the employer-sponsored insurance market remains significantly behind the Medicare program in the adoption of quality payment models, employers expect and are increasingly looking to health plan partners and local providers to take greater accountability for patients’ health outcomes.
As a starting point, employers should take inventory of how employees are seeking care — whether they are relying on an emergency room, primary care provider or another resource. By understanding how employees access the health system, an employer can identify opportunities to structure meaningful provider partnerships across local markets with payment tied to improvements of health outcomes. And in cases where employers identify quality or access challenges, a meaningful accountable care strategy can provide infrastructure, payment incentives and targeted support (whether virtual or hybrid care programs) that can begin to positively shift outcomes for employees.
We’ve seen real progress among new market entrants looking to advance accountable care programs for employers of all sizes. Last fall, as part of a new effort to better serve our employees and the broader Columbus community, JPMorgan Chase launched new on-site and near-site advanced primary care centers in partnership with apree health and Central Ohio Primary Care. The joint initiative between apree, COPC and JPMorgan Chase is based on clearly understanding the health needs of Columbus employees and includes payment incentives that are designed to support early intervention, treatment and care and reduce avoidable ER visits. This is just one example of the many programs from employers, like Walmart, General Motors and Microsoft, that mark a paradigm shift in value-based care delivery.
Virtual becoming complementary to, not a replacement for, in-person care
An initial boom in virtual care during widespread lockdowns has now become the norm, and a must-have for patients and employees looking for timely support from their providers. The embrace of all things virtual in health care will continue in 2023 as we see:
- Increased sophistication and integration across virtual care delivery models, as more care and monitoring for chronic conditions can be safely and reliably done in the patient’s home.
- Virtual care supporting health equity goals, by for example, making it possible for patients in medically underserved communities to access care from specialists they may not otherwise be able to see.
- Growing focus on dedicated mental health and behavioral health virtual care programs as core components of comprehensive primary care offerings.
For employers, the adoption of a “virtual first” care mentality can expand access to care. However, employers should view technology as an enabler of care, and ensure in-person access where and when employees need it.
Greater integration of data analytics, transparency tools and care navigation to guide patient care
Perhaps the most promising trend and favorable development for employers and employees is the increased transparency around healthcare pricing and costs. While the slow release of negotiated prices between hospitals and insurers hasn’t fully cleared the black box of healthcare costs, this initial download of data will help power greater insights around provider choice, clinician quality and performance and potential savings.
For many employers, the data offer a first real look at where their healthcare dollars are going. Take for instance our initial internal review of public data files from insurers and hospitals. Our colleagues across JPMorgan Chase’s Benefits team and AI Research identified deeper insights on pricing discrepancy trends, particularly related to prevalent services, like colonoscopies, emergency room visits and MRIs. For example, our analysis found that hospitals in New York City were nearly four times more expensive than other clinics for colonoscopies. Yet, a significant volume of JPMC healthcare spend on specific colonoscopy procedures was incurred for care at those higher-priced hospitals, rather than at more affordable facilities.
Simply having the data is one thing; what employers do with it is another. This is where care navigation providers can take on more active roles in serving as a guide across the health system for patients, and empowering advocates around quality improvements. The benefits of this approach are notable:
- Employers can have a better gauge on which providers, hospitals or health systems are responsible for greater utilization by employees, and compare overall cost — and quality outcomes — based on claims data and public pricing information. This is no small task, but it’s worthwhile so employers may identify potential provider partnerships that can meaningfully tackle cost and quality concerns.
- Integrated care navigation tools can then do a better job of guiding patients in the right direction for in-network and out-of-network care with transparency around relevant provider cost and quality measures. Care navigation companies should come to the table with more rigorous and transparent algorithms used for directing employees to various sites of care, so employers and patients have line of sight on providers delivering the best value for health care dollars.
Healthcare is a complicated and expensive business for employers, providers and patients. Increasingly, thanks to innovation in benefits, technology and data analysis, the value of this significant investment can be correlated to health outcomes. These insights are leading to increased adoption by employers of accountable and advanced primary care solutions — such as integrated virtual care, enhanced behavioral health benefits and transparency tools — that can measurably move the needle on employee health.