Though survey data says that nearly 90 percent of benefits decision makers are very or somewhat familiar with tiered plans and 55 percent are very or somewhat familiar with limited networks, they lack a detailed understanding of how those plans work, based on companion focus groups conducted by Plan-It Marketing. They also lack specific knowledge of tiering methodology and the tier levels of most area providers. Some benefits decision makers are concerned that tiered plans or limited networks would be confusing to employees and could limit access for lower income employees who may be unable to afford the costs assigned to select higher tiered providers.
“We share the concerns of the employer community on cost – and have been aggressive in taking cost out of the health care system through a combination of rate and price reductions and improving care delivery,” said Sandra Fenwick, President and Chief Operating Officer of Boston Children’s Hospital. “At the same time, quality care remains paramount; providers and insurers must work together to be certain families receive the care they need.” Visit www.value.childrenshospital.org/ to learn about how Boston Children’s is working to improve care and make it more affordable.
Public sector employers have been more focused on tiered (currently offered by 54 percent) and limited networks (currently offered by 48 percent), compared to private sector employers (32 percent offer tiered and 28 percent offer limited networks). Both options have been slow to gain acceptance among employees, with only 7-13 percent choosing either option.
The survey also showed that few benefits decision makers had knowledge of pediatric specific healthcare dynamics, with 45 percent not knowing what percentage of their health costs were attributable to pediatric claims. Locally, pediatrics accounts for approximately five to eight percent of an employer’s healthcare expenses.
“As new insurance products come into the market, we need to be sure employers and parents understand what they are buying,” said Fenwick. “Based on the data, it appears employers may be overestimating the impact of pediatric care on their overall health care costs and inadvertently limiting access as a result.”
The results of the survey and focus group were presented at a leadership forum and panel discussion today. Moderated by R.D. Sahl, the panel included Ms. Fenwick, James Roosevelt, President and CEO of Tufts Health Plan and Philip Edmundson, Chairman and CEO of William Gallagher Associates.
Provided by Children's Hospital Boston
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