On the supply side, the American healthcare landscape is very thriving and diverse. A recent survey conducted by DELOITTE on fully insured health plans, shows very instructive numbers :
For the 205 responding entities (on a total number of 238), revenue grew by a substantial 65% between 2011 and 2016 while simultaneously seeing their underwriting margin shrink by 55% (3.5 to 1.6%) !
Among these 205 health plans, the 3 largest are, to say it bluntly, faring very well, representing 84%
of the underwriting margins, while only accounting for 34% of the revenues.
92 health plans are reporting losses, many of which not for profit players, who represent 425B$ revenue, make only 3,5 B$ underwriting gains, less than 0.83%.
And yet, insurance premiums are growing more than wages and general price index, due to steadily growing costs of care.
Many Insurers are hence trying to solve two opposite issues at the same time : restore their margins while staying competitive on the market.
CARE2CARE is here to help them address these competing objectives.
Employers have a set of motivations to work for positive change in healthcare:
And it seemed that the efforts deployed by carriers, advisers and employers to curb the spending have produced results in the very last years : its increasing is decelerating since 2011.
| Source: Keiser/HRET Survey of Employer Sponsored Health Benefits 2001-2016 |
CARE2CARE is here to help them address these competing objectives.
EMPLOYER SPONSORED HEALTHCARE : PAYING MORE TO GET LESS ?
But a compelling study by the HCCI (Health Care Cost Institute) in January 2018 sheds a very new light on the story. Based on the claims data from 4 of the most important health insurers in ESI (Employer Sponsored Insurance) and covering 2012 to 2016, its results are very clear :
in almost every type of health service, prices soared and utilization declined :
Two examples : 1.Inpatient utilization shrunk by 12.9%, while prices grew by 24.3% ; inpatient spending grew by 8.3% 2. drugs volume grew by 1.8%, but since prices soared by 24.9%, spending growth hit 27.2% in only 4 years ! |
The conclusion we can draw is that American employers paid more for their workforce to get less. Regarding the level of utilization, this is all the more concerning, since data showed a preexisting record level of unmet care needs due to costs in the United States, especially then it is compared to similar, high developed countries, as it appears in the chart below.
HOSPITALIZATION : AN IMPORTANT SPENDING ITEM AND ITS PROBLEMS
The above mentioned HCCI’s study, produces very precise data on hospitalization, in- and outpatient, representing 56% of the total average spending in 2016, once the related costs of professionnal services have been integrated (see chart below).
| Drugs costs amounted to 1.284$ after taking into account the cost of professional services. They represent 23% of the 2016 global average spending |
In- and Outpatient accounted for 3.038 $, or 56 % of the global average spending per person, after taking into account professionnal services
Surgery represents 29% of the 2016 global average spending |
– Inpatient surgery prices soared by 30%, while utilization declined by 16% ;
– Outpatient surgery prices got up by 19% while utilization declined by 6%.
– Surgery accounted for 29%, in 2016 of the average healthcare spending, (more than prescription drugs : 23%)
– An average episode of inpatient surgery amounted to 41.702 $
Many of the insured people feel probably (very) uncomfortable about them, as do most Americans
d…And it is difficult to find reliable informations on these prices
While there is a trend toward CDHP’s, urging employees to become savvy healthcare purchasers, in order to draw costs down, little pertinent information on costs and quality to help your employees in this purpose is at hand, as established by a recent (April 2017) JAMA survey
To give just some examples : a hip replacement will cost 10.700 $ ; a coronary bypass : 23.700 $ ; a heart valve replacement less than 30.000 $, …
We can examine this in detail with you, comparing the prices you payed your claims, to the prices we can obtain in France ; let us just remind that the scale is 50 to 75% less in France than in the US…
We give more information on the quality of the French healthcare system hereafter
OUR SOLUTION TO THESE ISSUES CONCERNING HOSPITALIZATIONS (OVERVIEW)
Care2Care Medical Travel: Affordable, quality health care, for everyone.
Our proposal, summarized in a few words :
Care2care Medical Travel offers a small network, for high value surgery and treatment in selected facilities, at very competitive prices, in France, a country known for the quality of its Health System and first destination of international tourism, visited by as much as 87 million persons in 2017, among them over 4 million Americans
WHY OUR SOLUTION IS PERTINENT FOR YOUR CLIENTS
First, because surgery is the first spending item in most healthplans, as shown above
Furthermore, the global average spending is highly concentrated on a very small part of their workforce :
– 5% of the people account for more than 50% of the spending ; – the “Top Spenders had 39.409$ in healthcare expenses in 2015; – They exposed high Out Of Pocket expenses (3850$) – hospitalization amounted to 60% of these “Top Spenders” expenses ; |
That’s why we propose you to concentrate on this small group of “Top Spenders” :
With our solution :
– they can get the care they need ;
– te employer gets it’s healthcare budget swiftly and easily under control
GOING FURTHER IN THE RESOLUTION OF THESE ISSUES
Our service is innovative, even “disruptive”: to mitigate the disruption we are offering a preliminary assessment of the implementation of our solution, that can be flexibly adapted to the needs of the workforce:
– Select the conditions treatable using Medical Travel (such as Heart bypass, Heart-valve replacement, Angioplasty, Hip replacement, Knee replacement) ;
– show the benefits of the interested parties : management, employees, service providers
Care2Care secured a strategic partnership with an innovative, transparent, 100% pass-through PBM.
Adding to our expertise in international drug sourcing, we expand our offer to the full pharmacy benefit management.
