Maybe self-insurers can lead the way — my concerns

I agree with Aaron that self-insured companies will be health insurance (and wellness program) laboratories. (His two posts here and here.) They have been already. That’s good, provided some other conditions are met. I raise two of them below, in the form of concerns.

Concern 1: Will employers offer data so their experiences can be analyzed by researchers? It’s wonderful if a company can save money and help its workers be healthier. It’s even better if they can share what they’ve learned to benefit others. The problem is, doing so may help the company’s competitors. That alone is reason for the firm not to share. There may be other costs and factors too.

So, here’s my challenge: Any company making a claim about how well their innovations are reducing health care spending or improving health should offer their data to researchers for scruitiny (appropriately de-identified and with all due precautions, of course).

There is a history of employers making big claims about health care savings that turned out to be overstated. (Safeway is a chief example.) That’s dangerous because it can lead to policy that may not, in fact, be broadly beneficial. In any event, I am among those who prefer to reason based on well-vetted facts, not grand, unverifiable claims. So, show me the data, please. If you believe in your program, there should be no problem demonstrating it works with some independent analysis.

Concern 2: Will employer innovations address the highest cost patients? Many (though not all) of the costliest, sickest patients are not workers. In some sense, large employers have the easiest risk pool to work with. They can cut lots of stuff, and it won’t matter because workers and their families are relatively healthy and young compared to nonworkers and retirees.

What are the long-term consequences of changes to insurance for workers? What happens to workers who become sick and leave the company? Did the health plan work for them or not? Could private cost cutting lead to increased public spending?

I’m not saying companies should not experiment or that their experiments will be necessarily problematic. I just think we need to push hard on some areas so that their innovations can help improve the system for everyone. Experiments are good, but not if you don’t fully observe them. Cost cutting is good, but not when it is cost shifting. Saving health spending is good, but isn’t all that helpful if it is in ways that only address healthy populations.
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