The Business Group on Health, an organization advocating for employers, predicts that healthcare costs will increase by 7.8% in 2025, marking the highest rate of increase in over a decade.
Mercer, a consulting firm, anticipates a 5.8% rise in total health benefit costs per employee in 2025, despite planned cost reduction measures.
On the other hand, consulting firm WTW forecasts a 10.4% growth in global medical costs in 2025.
Employers are facing the significant challenge of rising healthcare costs and are responding by holding their vendor partners accountable, evaluating their health plans and pharmacy benefit manager partners, and seeking more access to medical claims data.
Cheryl Larson, president and CEO of the Midwest Business Group on Health, mentioned in an interview that employers are feeling pressured to address the issue of escalating healthcare costs.
Although employers can take some actions, they ultimately cannot resolve healthcare pricing issues alone. Policy changes at the state and federal levels are necessary.
Various factors contribute to the rise in healthcare costs, with pharmacy costs being a primary driver. Specialty medications, cell and gene therapies, and GLP-1s are among the expensive drugs leading to rising costs.
The National Alliance of Healthcare Purchaser Coalitions survey indicates that drug prices are a significant threat to affordability, with high-cost claims and hospital prices also posing challenges.
Employers are increasingly seeking accountability from their vendor partners for high-quality care and are focusing on improved outcomes, experience, and lower costs.
Employers are also exploring ways to better understand their healthcare costs, including demanding access to their medical claims data and potentially taking legal action against insurance carriers for not providing full access to data. Grainger también demandó a Aetna en mayo por no dar acceso a datos.
Gremminger repitió esto, señalando que los empleadores “necesitan enfocarse en su responsabilidad fiduciaria y jugar duro en la negociación con planes y hospitales, establecer redes más estrechas centradas en el costo y el valor, y eliminar conflictos de interés en los contratos.”
Según Ihrke de WTW, las estrategias de los empleadores dependen de cuánto riesgo quieran retener. Algunos empleadores pueden estar considerando Arreglos de Reembolso de Salud de Cobertura Individual, en los que dan a los empleados una asignación mensual de dinero libre de impuestos para comprar servicios de salud para sus necesidades específicas. Otros pueden estar mirando el diseño del plan y el reparto de costos.
En última instancia, sin embargo, abordar los costos “requiere arreglos de política pública a nivel estatal y federal para impulsar la competencia en el mercado, transparencia, precios justos y asequibilidad,” argumentó Gremminger. Esto incluye prohibir disposiciones contractuales anti-competitivas entre hospitales y planes de salud, exigir a los planes de salud proporcionar la divulgación completa de datos de reclamaciones a los empleadores “sin restricciones o costos adicionales”, y más transparencia de precios para los PBM.
Sin embargo, solo el tiempo dirá si estas estrategias y arreglos de políticas serán suficientes para frenar los costos médicos en el futuro.
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