xx保险业协会hr分析报告

Rich Bailey FSA, MAAA, FCARichmond, VAIs it Time for Employers to Move Away From the Traditional Ways of Providing Employee Benefits? November 3, 2004Mercer Human Resource ConsultingAgendan The Environmentn The Catch-22n Paths Away from Traditional Delivery: Two Campsn Opportunities Along Path 2n The Answern Additional Topics2Mercer Human Resource ConsultingAgendan The Environment Medical Trends Legislation Marketplace Changes Population Demographics Employer Outlookn The Catch-22n Paths Away from Traditional Delivery: Two Campsn Opportunities Along Path 2n The Answern Additional Topics3Mercer Human Resource ConsultingDouble-Digit Increase for Second Year in a RowPer employee costs in excess of $5,600 per year-2.9% +6.2%+7.3%+8.1%+11.2%+14.7%Source: 2002 Mercer/Foster Higgins National Survey of Employer-sponsored Health Plans4Mercer Human Resource ConsultingAnnual CPI Trend U.S. health care costs rise, despite continuing economic recession The gap between CPI-U and medical care component is increasing5Mercer Human Resource ConsultingComparison of Overall Growth Cumulative medical care CPI 89% greater than overall CPI since 1967Data based on January 1 CPI values6Mercer Human Resource ConsultingEmployers Cost Increases Out-Pace Other Indicators Largest increase since 1990 (all employers)Includes medical, dental and pharmacySource: 2002 Mercer/Foster Higgins National Survey of Employer-sponsored Health PlansResults for Employers with 500 or more lives6.9%18.6%16.7%17.1%12.1%10.1%8.0%-1.1%0.2%6.1%7.3%8.1%11.2%14.7%2.1%2.5%-2.00%0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%16.00%18.00%20.00%1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002EmployersCPI-MedicalCPI-All Items7Mercer Human Resource ConsultingAggregate Health Care Spending (1980 2010) Government portion of payments increasing; total projected to be over $2 trillion by 2009Source: CMS8Mercer Human Resource ConsultingMedical Trendsn Pop Quizn How many years will it take gross medical costs to double, assuming no specific employer interventions or national health care? 10 or more 9 8 7 6 5 or fewer9Mercer Human Resource ConsultingMedical TrendsResponses from a group of 25 actuaries who had time to get their calculators10Mercer Human Resource ConsultingLegislationn Medicare Prescription Drugs If made into law, will have major impact on retiree benefits and strategies Initial confusion aside, should have positive impact on retiree plans Expect cost shifting to negatively impact active plansn EEOC Proposed changes in ADEA regulations Cline vs. General Dynamicsn Wells Fargo case Appears to allow pre-funding (and tax-deductibility) of entire retiree liabilityo an ILP approacho wont be exactly same number as FAS liabilityo funding in years 2+ would be limited to service cost IRS weighing its options11Mercer Human Resource ConsultingProposals to Increase Coverage Among Early RetireesFew government programs except for financially indigentn COBRA extensions and/or Medicare buy-insn Prohibitions on post-retirement benefit reductionsn Expanded pre-funding for retiree medicalStill few viable products for pre-65 in individual market that overcome access and affordability issues.12Mercer Human Resource ConsultingADEA IssuesImpact on retiree medical coveragen Age Discrimination in Employment Act (ADEA) prohibits discrimination against persons age 40 or older in terms and conditions of employmentn Age-based distinctions in employee benefit plans are permissible only if: A specific statutory exception applies, or Equal benefit/equal cost test is satisfiedo Plan must provide equal benefits for older and younger workers, oro Plan must incur equal costs for older and younger workersn Third and Sixth Circuit Courts reach different conclusionsn EEOC reviewing ADEA regulations13Mercer Human Resource ConsultingMarketplace ChangesConsolidation of Major Health Care Carriers Employer options are greatly reduced, carriers have more cloutUnited HealthcareHealthSourceProvidentCIGNAEquicorMetrahealthUS HealthcareAetnaTakeCareFHPPacifiCareHealthSourceCIGNAAetna US HealthcareNYLCarePrudential HealthCareFHPPacifiCareProvidentTransamericaEquitableHCAMetropolitanPartnersAetnaGSDHPLincoln National HPsTakeCarePacifiCareHealth Plan of AmericaWellPoint/Blue Cross of CaliforniaHancockMass MutualTravelers United HealthcareAetnaPacifiCare Health SystemsWellPoint/BlueCross of CaliforniaCIGNABCBS of GeorgiaMultiple BCBS PlansFewerMajor BCBS14Mercer Human Resource ConsultingMarketplace Changes PBM consolidation continues; three major national PBMs remainCPIAPICPNRxNetValue RxDiagnostekPerformHCSHPIDiagnostekValue RxRxNetColumbiaValue RxExpress ScriptsExpress ScriptsNPADPSExpress ScriptsPAIDMEDCOAdvanced ParadigmAdvanceMedcoIntegrated Prescription Solutions (IPS)PCSFoundationMerck-Medco Merck-MedcoProadvantageSystemedParadigmMerck-Medco MedcoAdvance PCSMajor InsurersMajorInsurersMPSPCSClinical Pharmacy Advantage15Mercer Human Resource ConsultingPopulation TrendsAging baby boomers will increase the elderly and near elderly populationsData Source: U.S. Census Bureau State Population ProjectionsBaby Boomers Year of Birth 1946 to 1964Source: U.S. Census Bureau as of January 2000U.S. Population, 2000 Projected PopulationMillions16Mercer Human Resource ConsultingNegative Tidal Wave of Available Talent Pool of “prime workers” will be decreasing Source: DRI, World at Work Journal, fourth quarter 2001Percent Change in Population by Age Group, 2000-10-20%-10%0%10%20%30%40%50%60%5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79The “Echo boom”ages 15-29Shrinking Pool of“Prime workers”ages 30-44Aging “Baby boomers”ages 45-6917Mercer Human Resource ConsultingImpact of Demographics on Health Care Cost Cost increases with age0.000.501.001.502.002.503.0020-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+AgeRelative Cost by AgeMale FemaleAverage employer cost = 1.0Relative Costs By Age and Gender18Mercer Human Resource ConsultingHealth Deterioration A cause and a consequence n We eat too much - 64.5% of adults overweightn Population with diabetes increased over 50% in last decade*Overweight is roughly 10 to 30 pounds over an ideal weight. Obesity is roughly 30 pounds over an ideal weightSource: National Health and Nutrition Examination Survey45.0%47.0% 47.0%56.0%64.5%19Mercer Human Resource ConsultingIssues Facing Businesses The perfect storm n Low ambient inflation; high medical inflationn Advances in medical technology likely to lead to higher costs, difficult decisionsn Legislative uncertaintyn Consolidating medical delivery and financing systemn An aging workforcen Increased longevityn Slowing economyn Disappearing over-funded pension plansn Few, if any, obvious and easy alternatives to managing health care costs20Mercer Human Resource ConsultingEmployer Outlookn Environmental outlook spurring employer action Employers acutely aware of trendsn Heightened interest in cost saving strategies (active and retiree)n Greater emphasis on longer term cost projections and on the “bottom line”n Projection results have induced “fight or flight” responses21Mercer Human Resource ConsultingRetiree Medical Coverage Employers continue to drop retiree medical coveragePercentage of EmployersOffering Coverage to Future RetireesBased on employers of 500 or more lives responding to the2001 Mercer/Foster Higgins Survey of Employer-Sponsored Health Plansn When coverage is offered, retiree premiums and out-of-pocket costs often increase22Mercer Human Resource ConsultingAgendan The Environmentn The Catch-22n Paths Away from Traditional Delivery: Two Campsn Opportunities Along Path 2n The Answern Additional Topics23Mercer Human Resource ConsultingThe Catch-22n Reducing employer cost typically implies increasing employee/retiree costn Eventually runs against employers sensibilities regarding fairness, paternalism (if present), and the concept of benefits generallyn Example (FAS 106): “Lower my liabilities significantly but dont do anything harsh to our retireesthey wont accept it” To the extent that retirees represent the bulk of the liability, this is a very difficult proposition Opportunities exist to change eligibility, design , etc. for future retireesn If we dont take cost out of the system, either the employer or the employees/retirees will pay the increases24Mercer Human Resource ConsultingAgendan The Environmentn The Catch-22n Paths Away from Traditional Delivery: Two Campsn Opportunities Along Path 2n The Answern Additional Topics25Mercer Human Resource ConsultingPaths Away from Traditional Delivery: Two Campsn Employers that become more involved in Changing employee behavior Changing provider behavior Changing providers that they work with Changing the lawsn Employers that reduce their involvement by Increasing employee responsibility Limiting employer cost Limiting employer risk26Mercer Human Resource ConsultingEmployers Becoming More Involvedn Collective Purchasingn High Performance Networksn Direct Contractingn Consumer Accountabilityn Leap Frogn Lobbyingn Disease Management/Preventive Caren What these approaches share is an eye toward reducing cost from the employers system, and in some cases, the entire health care system.27Mercer Human Resource ConsultingCollective Purcha