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Hospitals tighten controls on health benefits amidst rising costs, changing industry landscape

Their annual Benefits Survey involved more than 196 hospitals across 86 participating health systems in the eastern United States.

Beth Jones Sanborn, Managing Editor

As hospitals grapple with swelling healthcare costs and a shifting industry landscape, many are implementing stricter rules surrounding their health benefits. That's according to a new survey from Aon's Cammack Health.

Their annual Benefits Survey involved more than 196 hospitals across 86 participating health systems in the Eastern United States. It found that the average annual health care expenditure per employee was $15,541, having risen more than $4000 compared to $11,102 in 2010.

In terms of how hospitals are responding, the survey said 45 percent of hospitals either impose a surcharge or don't cover spouses who have access to their own employer coverage.

[Also: Hospital execs: Beware unexpected costs in merger deals, Deloitte/HFMA report says]

More than three-quarters, or 79 percent, of plans have a higher cost sharing requirement for using urgent care facilities.

"While still priced to steer employees away from the emergency room, these co-pays are beginning to outpace primary care co-pays to help influence choice for the place of service to encourage physician/member relationships," Aon said.

Medication coverage is also affected, with 40 percent of plans involving separate cost sharing for specialty drug tiers, and 12 percent setting charging 100 percent of the discounted price for coinsurance for non-formulary medications, the survey said. Also, 48 percent price incentives to encourage employees to use their own internal pharmacies, Aon said.

[Also: Hospitals can expect $2B less in DSH payments for 2018]

There are also efforts to keep business in-house when it comes to a hospital's employees, with 83 percent using a domestic tier to push employees towards services within their system using incentives like no coinsurance or deductible, which 54 percent and 56 percent of respondents use, respectively, according to the survey.

Free inpatient care is offered by 41 percent of respondents and free and outpatient care is offered by 37 percent. Finally, 24 percent don't charge co-pays for primary care physicians, the survey said.

"These trends align with the overall business objectives of the health care delivery system as health care transforms from volume to value," added Mary Clark, senior vice president of Aon's Health business. "Self-insured, employer-sponsored health plans are key risk populations for systems because they have more control over the data, design and incentives. By retaining care within their own networks and facilities, they have increased their ability to facilitate utilization, cost and quality outcomes."

[Also: Boston Children's Hospital, Cleveland Clinic to partner on pediatric heart care]

Finally, the changing landscape is also influencing hospitals' management of health plans. More than two-thirds participate in a value-based contract with a payer and 53 percent "have at least discussed the concept of partnering to manage health plan members at non-hospital employers." Those potential partnerships include accountable care organizations, clinically integrated networks, and physician hospital organizations.

Twitter: @BethJSanborn

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