During a Merative-sponsored featured session at Becker’s Hospital Review’s Payer Virtual Forum, two Merative advisors — Leah Kamin, analytic advisor, and Katherine Shanahan, senior pharmacy analytic advisor — discussed how health plans can support employers with strategic decision-making around behavioral health and the management of specialty medications.
Four key takeaways were:
1. Employer groups need help crafting competitive yet cost-effective benefits programs. To attract and retain top talent, organizations need to offer compelling benefits packages. However, identifying opportunities to deliver value (e.g., valued benefits and programs), improve the health of their populations, reduce costs and accurately determine program performance — particularly in behavioral health and the management of specialty drugs — is not clear-cut.
2. Health plans can be consultative partners to employer groups. In addition to offering network discounts and value-based care arrangements, health plans are expected to provide employer groups with reporting by sharing cost and utilization data, and by surfacing actionable insights that help manage and fine-tune benefits programs. Best in class reporting is a top need for employers and a key way to differentiate your offerings to retain existing business as well as win new business,” Ms. Shanahan said. She noted that top-tier employer reporting can help a plan be seen not only as an employer-selected carrier, but also as a strategic consultative partner.
3. Mental and behavioral health services are a primary focus for employer groups. According to the Kaiser Family Foundation Health Benefits Survey 2021, since the beginning of the COVID-19 pandemic, large and medium-sized firms saw 38 and 21 percent increases, respectively, in employees seeking mental health services and seven and five percent increases, respectively, in those seeking substance abuse services.1 In response, 40 percent of firms offering health benefits updated their mental health and substance abuse (MHSA) strategy by expanding ways enrollees can get such services, expanding the number of in-network providers and waiving or reducing cost-sharing.
These factors, along with the differential impact of the pandemic on employee-dependent children and minorities, combined with access challenges and the shift to telemedicine, increased the need for health plans to support employers. “[Insurers] need to think about what this shift means and whether or not continued investment and promotion of telehealth services for mental health should be considered,” Ms. Kamin said. “Analytics that support employers to make these decisions should focus on [whether] the shift to telehealth improves access for certain populations.”
4. Specialty drugs are a major cost driver for employers. The cost of specialty drugs administered in a medical setting, which account for approximately 30 percent of all specialty drugs, can be highly variable within and across markets. But when delivered in an office setting, those same drugs often cost half as much, according to Merative’s MarketScan data.2 By negotiating with providers to either bring down the cost of outpatient hospital specialty drug administration or assist in steering patients to lower-acuity settings, insurers can act as true partners to employers. “Despite health plans offering this type of program, many employers are not aware of this opportunity,” Ms. Shanahan said.
Furthermore, health plans are missing out on the opportunity to show employers value by managing biosimilars. On average, biosimilars cost 15 – 30% less than their comparative brand reference products. Unfortunately, Merative’s MarketScan data has found that only 7% of potential spend has shifted to biosimilars with the remaining 93% still spent on brand reference products. This leaves open enormous cost-saving opportunities that can demonstrate value to an employer.
To stand out as valued partners to their employer clients, health plans need tools that empower them to deliver bespoke analytics experiences while reducing the time they spend on data management so they can engage at a more strategic level.
Merative’s (formerly IBM Watson Health’s) industry-leading analytics technology and deep real-world experience can help health plans transform into such insight-driven consultative partners.
To watch the session on demand, click here.
1 2021 employer health benefits survey. KFF. https://www.kff.org/health-costs/report/2021-employer-health-benefits-survey. Nov. 10, 2021.
2 Merative MarketScan Normative Benchmarks. US Total Actives. 2019.
