Managing Rising Health Benefits Costs for 2023

​With health care benefits costs expected to return to pre-pandemic levels and to continue outpacing overall inflation, employers can take steps to curb their benefits expenses.

HR advisory firm Segal recently projected a 7.4 percent per-person cost increase for open-access preferred-provider plans in 2023, based on responses from almost 80 health insurance providers surveyed during the summer of 2022.

In addition:

• Cost increases for most dental coverages are expected to reach 4 percent, driven by inflation across the U.S.
• The projected annual cost trend for outpatient prescription drugs is expected to be approaching double-digit levels, the highest rate observed since 2015, mostly driven by price increases and new-to-market specialty drugs.
  

While actual 2020 benefits cost increases were negative for medical and dental coverage for the first time since Segal has tracked cost trends, due to deferred and eliminated care from the pandemic lockdowns, 2021 trends experienced a spike in the opposite direction—up 14 percent per covered participant, the highest increase in a decade, Segal reported.

Even when accounting for the spike in 2021, the two-year increases were flat, according to Eileen Flick, senior vice president and director of health technical services at Segal. Actual 2022 cost increase findings from Segal were not yet available.

Other health benefits cost projections for 2023 are in the same ballpark. The nonprofit International Foundation of Employee Benefit Plans reported that in its recent survey of 300 corporate and public-sector employers, respondents projected a median increase of 7.5 percent for medical plan costs.

Coming in slightly lower in their cost predictions, a majority of 455 U.S. employers surveyed in August by consultancy WTW project their health care costs will jump 6 percent next year compared with an average 5 percent increase they are experiencing this year, and most respondents (71 percent) expect little relief in the coming years.

Trends Driving Health Benefits Costs

New prescription drugs, life-saving therapies and deferred care during the pandemic (leading to late-stage diagnoses) are driving up health care costs, according to Tim Stawicki, senior director and chief actuary at WTW.

"The law of supply and demand is also having an impact," said Kim Buckey, vice president of client services at Optavise, a benefits education, enrollment and health care transparency firm. "As more hospitals close, health care workers quit and physicians retire or leave clinical practice, fees for remaining providers increase."

The U.S. Bureau of Labor Statistics says about 3 percent of the health care workforce has quit each month this year. The trend is likely to continue, said Buckey, who cited Elsevier Health's Clinician of the Future study that found 47 percent of U.S. health care workers plan to leave their current role in the next two to three years.

Conversely, Flick highlighted emerging cost deflators helping to hold down costs, such as the increased use of outpatient care including telehealth and urgent care providers as an alternative to emergency rooms. As an alternative to traditional fee-for-service reimbursement of health care providers, value-based reimbursement is becoming more prevalent, tying payments for care to the quality of care provided and rewarding providers for efficiency and effectiveness.

"We're also seeing early data that indicates that the federal No Surprises Act is having its intended effect of lowering out-of-network charges," she said.

Employer Strategies for Controlling Costs

WTW's Stawicki urges HR teams to prepare for the inevitable conversations with their finance teams to reduce health plan spending. "Building connections between HR and finance is a key first step to help educate finance and broader leadership of the headwinds facing employer health care benefit costs in the coming years," he said.

Planning is critical to developing strategies that can reduce costs. This may include virtual primary care networks, revisiting cost-sharing equations, incentivizing employees to seek lower cost care options, alternative payment methods and more.

"Another thing to think about is negotiating and competitive bidding. Many companies haven't done this in four to five years," Flick said. "In some regions, carriers are making big efforts with steep discounts and aggressive management fees."

Cost-Controlling Tips for Employees

HR and company leaders can play a role in educating employees about rising costs and tips for minimizing expenses.

"It's important that employers get the message out about preventive care," Buckey said, which the Affordable Care Act requires insurers to cover in-network at no cost to plan participants. Annual check-ups, for instance, can detect health issues before they become more expensive to treat, she noted.
It's also helpful to remind employees of available tools and resources to help them gain control over their physical, mental and financial health, Buckey advised.

But there is also a concern about unnecessary overuse of health care, so employers should encourage employees to ask questions and use online price transparency tools to make more informed medical decisions.

"I've seen physicians routinely order unnecessary blood panels for things such as Lyme disease where the patient has no symptoms or as part of routine bloodwork," Flick said. "The test for Lyme disease can cost more than $2,000 depending on where the lab is."

People may be afraid to ask how much tests and services cost, Flick noted. Supporting employees in becoming better health care consumers by using transparency tools and encouraging them to ask what they are being treated for, whether the tests are necessary and if less-expensive alternatives are available can help control expenses.

"Open communication with employees is key. Few employees understand or make the connection that the medical services they and their colleagues are using directly influence the cost of the health plan," Stawicki said. "Remind employees of the significant value that employers provide through the health plan. This employer-provided value can run $10,000 or more per enrolled employee, on average."

Katie Navarra is a freelance writer based in New York state.

Related SHRM Articles:

Medical Plan Costs Expected to See Bigger Rise in 2023, SHRM Online, August 2022
IRS Sets 2023 Health Plan Premium Affordability Threshold at 9.12% of Pay, SHRM Online, August 2022