Tips for navigating changing health care industry

Attorney Andrew Eills  contributed to this recent NHBR Ask the Experts article.  The full article can be found here.

As New Hampshire businesses know too well, the cost and delivery of health care is an evolving landscape that presents more questions than answers. Medical industry professionals can help businesses understand the most significant changes and how to navigate them. This week, we sought insight from some of the state’s leading experts.

Our panel: Andrew B. Eills, shareholder in Sheehan Phinney’s Healthcare Group,; Caitlin McCormick, vice president of sales and account management, UnitedHealthcare of New England,

Caitlin McCormick, VP of sales and account management, UnitedHealthcare

Q: We know the health care system is complicated. Tell us what UnitedHealthcare is trying to do to help with that?

A: We consistently invest in ways to simplify the health care system to provide more affordable, supportive care. So, if you think the health care system is too complicated and due for an overhaul, you may be pleasantly surprised by our latest innovative plan called Surest — a health plan designed to help simplify care with upfront pricing. This is a common-sense approach created by listening to what people want and then giving it to them. When people hear the details, they often ask, ‘So, what’s the catch?’ I’m happy to say there isn’t one.

Q: What’s different with the Surest health plan?

A: For starters, your benefits work for you immediately. There’s no deductible to chip away at and no co-insurance to worry about paying weeks after receiving care. With most traditional plans, these charges can be financial barriers to care for some members, and they’re often just confusing. We removed them from the plan to simplify things.

Q: You mentioned “upfront pricing.” Is that what the industry is calling “transparency?”

A: The type of technology that offers price transparency for rideshare trips, vacation rentals and so many other areas of life is making its way to health care. Not only that, but health care quality data is also becoming more easily available, helping people comparison shop for medical care and services.

The Surest plan, that I mentioned, makes health benefits more transparent and easier to use, helping people to make more informed health care choices — with the aim of lowering the total cost of care. It lists a single, all-in price for hundreds of services. Members can review and consider their options before deciding on care. This upfront pricing also helps avoid billing surprises that, with a traditional health plan, might show up weeks or months after a service or procedure.

Q: What is driving this trend in transparency, and where else are you seeing more of it?

A: Lawmakers mandated some transparency changes in the No Surprises Act and other legislation, including required disclosures by health plans and hospitals. Unfortunately, some organizations are not meeting these requirements or presenting the information in ways that are not easy to understand. UnitedHealthcare is helping address these issues through multiple initiatives that make quality and cost information more actionable and personalized.

We know health care quality and cost can vary significantly even within the same city, which is why we offer members resources to review quality information and cost estimates for more than 820 common medical services. By providing this information online, via our mobile app and through our customer care advocates, we are making it easier for them to check on costs and make more informed decisions.

For many people, surprise medical bills top the list of affordability concerns. So, we want to empower our members with timely information that could help them improve their health and perhaps save them money in the process.

Q: What other innovations are coming to the health care market?

A: Historically, the choice in health care funding for a smaller business has been between the higher-cost predictability of a fully insured plan and the potential savings, albeit with risks, of self-funding.

Now there’s an alternative level-funded health plan which is growing in popularity with smaller groups. Use of these plans is on the rise. According to a recent survey, 42% of small firms report that they have a level-funded plan, a steep increase from previous years. A level-funded plan is an option for employers that want to move away from fully insured health care but are not yet ready to completely self-insure. Health insurers have designed level-funded plans to offer two main upsides: predictability and potential savings, including through a possible surplus refund.

For small business owners seeking a health plan designed with affordability in mind, an alternative like level-funding may be a solution.

Q: Another trend we see is a big demand from employees to get better access to behavioral health. What are insurers doing to address that?

A: An estimated 1 in 3 Americans lives in an area with a shortage of mental health professionals. Of those areas, two-thirds are in rural or partly rural regions of the country.

Demand for behavioral health support has increased and so has the need for alternative ways to access it. This can be especially true for employees who work outside of urban centers.

One solution may be the network of online services that expanded during the COVID-19 pandemic and continues to grow today, including: Self-help apps, virtual coaching, virtual therapy, substance use cessation tools.

These virtual services and technology-enabled solutions have all become more widely available over the last couple of years — and that’s a good thing.. Telehealth has clear benefits: It’s convenient, affordable and allows users to get care where and when they need it.

These virtual services may continue to help people: access quality care, stay consistent with treatment, afford services and avoid stigma-related issues. The privacy of virtual services accessed at home may make more people feel comfortable reaching out for help.

A final thought: While access to care is vital, it can’t be effective if employees don’t know about it. For instance, many companies offer an employee assistance program that includes no-cost help for managing stress, anxiety, depression and substance use.

However, EAP services often go unused, in part, because employees aren’t aware of them. Don’t just create the opportunity for employees to address mental health, make sure they know the help is available — and who to call if they need help navigating the complexity.

Andrew B. Eills, shareholder, Sheehan Phinney’s Healthcare Group

Q: How would you describe the current state of health care access and delivery in New Hampshire?

A: Briefly, “good,” especially compared with a number of other states. That said, there is room for improvement and New Hampshire’s “health care providers” (a fancy term for hospitals, community health clinics, nursing homes, private physician groups, community mental health centers and home health agencies) would be the first to admit that more can be done to ensure that all citizens have easier access to care when and where it is needed.

Q: What are a few flash points that you see in the medical profession, and how do they affect patients?

A: Every single New Hampshire provider will tell you that staffing, particularly in nursing homes but also throughout the industry, has been and remains a huge test. The pandemic brought on by COVID-19 exacerbated the challenges in recruiting and retaining the number of staff necessary to operate efficiently and safely.

The forces affecting the ability of health care facilities to recruit and staff include the difficulties in finding affordable housing for workers and alternative or competing jobs that pay more outside of health care. While physician staffing appears to have been more stable than staffing for other areas, such as nursing, recruitment in New Hampshire remains a challenge, especially in the north Country.

Obviously, lack of staff may mean delays in the availability of patient visits or longer waiting times for procedures. Every provider wants stability in their staff numbers in order to provide excellent care and to train the next generation of medical workers.

Throughout the country, physician burnout is a subject on the front burner in every C-suite. A number of factors are at play. One, the COVID pandemic seems to have had the curious effect of lessening the civility that patients formerly brought to health care institutions.

In our hospital emergency departments, nationwide there has been a remarkable rise in physical and verbal assaults on health provider staff. At the same time, “boarding” patients who need to be in a different environment contributes to stress within hospitals.

And of course, the confluence of patient demands, time spent for and with patients, and requirements built into electronic health records systems increases the pressures providers feel.

Q: The U.S. has higher health care costs relative to other advanced countries. What are the trends in health care cost growth?

A: For U.S. health care, the elephants (plural) in the room are costs and the factors that drive them. Health care spending overall accounts for almost one-fifth of our economy, and other large, wealthy countries spend about half as much per person.

Medicare, which provides health care to those over age 65 and currently serves over 65 million, accounts for 13% of the federal budget and 21% of national health care spending. The U.S. population as a whole is aging, so in the coming years the number of Medicare beneficiaries will increase.

Surprisingly, however, annual Medicare spending per beneficiary actually has trended downward from $13,159 in 2011 to $12,459 in 2023. We don’t know whether this trend will continue or disappear, but efforts to shift care from hospitals to less expensive settings may be a reason, as well as requirements for private health insurance under the Affordable Care Act, which on balance may have led to healthier individuals now on Medicare.

Employer-sponsored insurance, however, has increased faster than inflation and generally has outpaced wage growth. Employers are concerned that cost increases are not sustainable.

At the same time, consumers (aka patients) demand choice and transparency in pricing, as well as certain medical services in their communities, some of which are expensive and require clinical expertise. Our policymakers will have to respond to these conflicting pressures.