With just days into the New Year and two weeks until the presidential inauguration, uncertainty over the future of the Affordable Care Act (ACA) is growing. In response, the National Business Group on Health (NBGH) has released a list of six health care benefit trends to keep an eye on in 2017, catered to corporate human resources and finance executives.
The non-profit association, which holds 420 large U.S. employers, questions the fate of the ACA, pharmacy pricing and proposed health plan mergers, among others.
The first trend asks if 2017 will see the ACA being repealed and replaced under the Trump administration. While the association notes how public exchanges have experienced heightened average premium surges and less insurance options, a repeal of the ACA may result with insurers leaving the exchanges to evade being the ‘last man standing,’ according to NBGH. Since the group believes tax on employer plans; employer mandate; and reporting and administrative requirements should be ceased, there will be close monitoring on its repeal.
Furthermore, the second trend raises questions on President-elect Trump’s appointment of Representative Tom Price (R-Georgia) as secretary of the Department of Health and Human Services (HHS), and whether different payment options to the present fee-for-service system will continue to be prioritized. The association emphasizes the public- and private-sector’s need to turn to value-based payments in order to transform health care delivery; and mentions how a repeal of the ACA and changes in accessibility without delivery reformation will not address existing high costs or long-term affordability of health care.
“We’re seeing an increased focus on opportunities looking to positively impact health care delivery,” says Steve Wojcik, vice president of Public Policy at NBGH. “Focusing on the delivery side, whether it’s expanding centers of excellence, looking at accountable care organizations, primary care medical home, offering telehealth, and offering tools to help employees shop for more effective, more efficient providers when they do need a service.”
On the fate of proposed plan mergers for 2017, such as Aetna/Humana and Anthem/Cigna, NBGH weighs arguments pro and con for the partnerships in the third trend. According to the association, arguments for the merges include greater influence in negotiating with providers; accelerating the move to alternative payment models; and reducing overall costs. However, those against the merge argue this would result in a gradual change and innovation prevention.
Due to increased prices on generic, compound, brand, and specialty medications, the fourth trend focuses on advanced risk-sharing and value-based pricing models in 2017 for pharmaceuticals. NBGH mentions that while only 2% of the population consumes specialty drugs, expenditures continue to surge the fastest in health care spending, making specialty medication the top driver of overall health care costs for many employers. The association describes the current pricing model as “antiquated,” “unsustainable,” and “unaffordable,” and has stated how politicians and the public have criticized the model.
“There’s more aggressive utilization management and other changes establishing specialty pharmacy tiers to make sure plans are spending on specialty pharmacy medications as wisely as possible, for people that need it, as opposed to possibly trying to control the waste and unnecessary use for these very expensive medications,” says Wojcik.
Support services for consumer engagement and rising employer interest in workforce well-being cover trends five and six, both stepping in among the aims for 2017.