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Large employers cite specialty drugs, high-cost patients among biggest cost drivers

Increases to health benefits expected to remain steady at 6 percent in 2017; employees will see 5 percent premium hike.

Susan Morse, Senior Editor

For the first time, most employers consider specialty pharmacy as the highest driver of healthcare costs.

According to an annual survey released Tuesday by the National Business Group on Health, 80 percent of 133 large employers placed specialty pharmacy as one of the top three highest cost drivers, followed by high cost claimants, at 73 percent, and specific diseases and conditions at 61 percent.

Nearly a third, 31 percent, said specialty pharmacy was the highest driver of health costs. That compares to only 6 percent who cited specialty pharmacy as the number one driver two years ago.

Telehealth will grow its reach, as 90 percent of employers will make telehealth services available to employees in states where it is allowed next year, a sharp increase from 70 percent this year, the survey found.

By 2020, virtually all large employer respondents will offer telemedicine. Use by employees remains low, but is increasing steadily.

[Also: Hospitals contract with large employers and offer free surgery]

Among the biggest changes expected for 2017 is the use of Centers for Excellence, a team approach to best practices.

The use of Centers of Excellence will grow from 79 percent this year to 85 percent in 2017, according to the survey. The largest increases will be for bariatric surgery - up 15 percent - transplants, and fertility treatments, both up by 8 percent.

Next year, eight in 10 respondents plan to offer nurse coaching for care and condition management; 72 percent will offer nurse coaching for lifestyle management; and nearly two-thirds, 65 percent, will provide employees with self-service decision-making tools to help them become better healthcare consumers.

Overall large employers said they expect increases to health benefits to remain steady at 6 percent in 2017. This is identical to the increase they would have experienced in each of the past two years had they not made changes to their plan design, the National Business Group on Health said.

[Also: 'High cost claimants' are biggest driver of healthcare costs for many employers, study shows]

"While employers have been able to keep increases in check for the past few years, costs are still running at more than twice the rate of inflation and general wage increases, thereby threatening affordability," said Brian Marcotte, president and CEO of the National Business Group on Health.

Many employers expect to hold increases to 5 percent by making some changes to their plans, he said.

However, for 2017, employer focus is shifting away from plan design to optimizing how healthcare is accessed and delivered, according to Marcotte.

The survey also revealed that employees will not see major cost increases during this year's open enrollment season. As in 2015, employees should expect about a 5 percent increase in premium contributions and minimal changes to their plan design.

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"Interestingly, current estimates have health insurance premiums for the average public exchange plan increasing by at least 10 percent, about twice what large employers are projecting for next year," Marcotte said. "This is a clear indication that the employer-based health care model continues to be the most effective way to provide health insurance coverage to employees and their families."

The Large Employers' 2017 Health Plan Design Survey is the industry's first look at health benefit costs and plan design changes for 2017. It is based on the responses of 133 large employers, according to the nonprofit association representing 425 members.

The survey found more employers are focused on expanded telehealth services, Centers of Excellence options and optional selective network choices, Marcotte said.

The survey found that 84 percent of employers will offer a Consumer-Directed Health Plan in 2017, up from 83 percent this year. More than one-third of employers, 35 percent, will only offer CDHPs to employees in 2017, a slight increase from 33 percent this year.

Spousal surcharges are leveling off. One in three employers, 33 percent, will have surcharges in place for spouses who can obtain coverage through their own employer, roughly the same as this year.

A few employers will exclude spouses when other coverage is available through an employer.

Twitter: @SusanJMorse

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