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Perspectives on Essential Health Benefits Workshop Report (2012) / Chapter Skim
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3 Purchaser Perspectives on the EHB
Pages 27-36

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From page 27...
... In September 2010, the Chamber of Commerce polled 590 small businesses 1 and found that "the definition of essential benefits must not be viewed in a vacuum." In presenting some results of that poll, Ms. Malooley asked the committee to view the EHB package as a minimum floor and to allow businesses to have the opportunity to build on those benefits, particularly considering small employer views as a result of passage of the Patient Protec tion and Affordable Care Act (ACA)
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From page 28...
... "We do not want the cost of these plans to force employers to stop offering health care coverage to their employees," Ms. Malooley stated.
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From page 29...
... Over the past five years, insured employers with fewer than 100 employees experienced annual double-digit health care cost growth.4 These increasing costs, he said, resulted from "supply-side components" including increasing physician costs, inpatient facility costs, outpatient facility costs, and prescription drug costs (EngdahlJohnson and Mayne, 2010)
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From page 30...
... Turpin said, "are gravely concerned" that the EHB will be designed to require more generous levels of benefits while "doing nothing to change the underlying cost drivers." With out changing cost drivers, generous benefits will only contribute to higher rates of utilization and cost inflation. Employers, he noted, believe "strategy should drive structure." The structure of the EHB should aim to improve health status and better manage chronic illness, which will also serve to "achieve affordable care." He cautioned that starting with a rich package would "commit the cardinal sin of letting structure drive strategy" because the benefits package would be unaffordable at the outset.
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From page 31...
... HELEN DARLING, NATIONAL BUSINESS GROUP ON HEALTH As president and CEO of an association of large employers, Ms. Darling began by urging the committee to focus not only on the goals of providing comprehensive coverage and promoting evidence-based, effective care, but also on the "equally important triple financial goals" of assuring people affordable coverage, protecting them from catastrophic financial losses when faced with serious illness, and helping them avoid unnecessary costs.
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From page 32...
... These wasted dollars, she said, are spent on unnecessary, redundant, and ineffective care, all of which should be excluded from the EHB package. "We need a constant process of evidence generation and feedback," she said, to manage care and benefit design in a way that ensures patients are protected from wasteful and harmful practices.
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From page 33...
... Step therapy, generic substitution requirements or incentives, generic education programs for plan participants and physicians, a separate deductible for prescription drugs, preauthorization for selected drugs, reduced cost sharing for mail order compared to retail purchase, mandatory mail order of maintenance medications, tiered co-payments, co-insurance rather than co-payments for medications, dose optimization, and quantity-duration protocols for certain medications are all used to manage prescription drug costs. Health improvement programs: Employers offer incentives such as premium discounts to plan • participants who engage in health improvement programs and adopt healthier lifestyles.
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From page 34...
... : Employers require health care vendors to use interoperable HIT • wherever possible or provide personal health records for plan participants. Transparency (cost and quality)
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From page 35...
... PowerPoint Presentation to the IOM Committee on the Determination of Essential Health Benefits by Michael Turpin, Executive Vice President and National Health and Benefits Practice Leader, USI Insurance Services, Washington, DC, January 13.
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Key Terms

  • ehb package
  • health insurance
  • essential health
  • cost sharing
  • plan participants

  • benefit design
  • usi insurance
  • clinical effectiveness
  • learning health
  • plan design

  • prescription drug
  • michael turpin
  • state mandates
  • health improvement
  • population health

  • professional health
  • affordable care
  • employers require
  • chronic illness
  • stop offering

  • compass professional
  • executive vice
  • offer health
  • health information
  • oral health

  • offering health
  • improve health
  • personal health
  • care cost
  • care coordination


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