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How a Self-Insured Employer Decreased Costs While Improving Performance

Today we’re speaking with Dr. Steven Goldberg, the vice president of medical affairs, population health, and chief health officer at Quest Diagnostics. He is also a co-author of a recent peer-reviewed case study that analyzed a benefits and wellness program designed by a self-insured employer. 
In the United States, more than 178 million Americans receive insurance coverage through an employer; of these, approximately 60% have insurance from a self-insured employer. Healthcare costs, both medical and pharmacy, for employers and employees continue to increase at a 6% predicted rate in 2019, on top of the 5 to 6 percent annual increases observed since 2014. The increase in healthcare spending has been directly attributed to increased prices for healthcare services, while utilization has remained somewhat consistent.

Today we’re speaking with Dr Steven Goldberg, the vice president of medical affairs, population health, and chief health officer at Quest Diagnostics. He is also a co-author of a recent peer-reviewed case study that analyzed a benefits and wellness program designed by a self-insured employer. The employer, Quest Diagnostics, covers nearly 60,000 lives. The analysis of the program showed that it was able to reduce costs while maintaining program quality and promoting population health. According to the study findings, through proactive changes, physician executive leadership, health plan collaboration, disease-specific population health initiatives, and plan design, Quest Diagnostic's annual healthcare cost trend steadily improved from a year-over-year trend of 5.7% from 2014 to 2015, to 4.6% from 2015 to 2016, to -1.0% for 2016 to 2017, and most recently, 0.3% in the 2017 to 2018 year.

An additional third-party analysis also showed the program to be 11% more efficient than group health programs with comparable benefit and employee contribution.

Importantly, the actuarial value of the plan did not decline, and employee cost share also remained unchanged in 2017 and 2018 versus 2016 for the high-performance network option. Early results in 2018 show improvements in the health status of the health plan membership.

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