More employers question need to offer insurance

Whether or not to offer health insurance is a growing question among more employers, a panel of high-profile industry and business officials said Tuesday.

A forum on health-care costs and reform, held by the Winston-Salem Chamber of Commerce, drew 110 attendees.

Keith Kiser, a senior vice president for BB&T Insurance Services, said his group is fielding more questions from employers about the justification for providing health insurance to employees, besides as a carrot to hire and retain quality workers.

"Chief executives and chief financial officers are fully engaged in these conversations these days," Kiser said, considering the cost of providing health insurance typically ranging from $8,000 to $10,000 for each employee.

The 2011 Kaiser Family Foundation study on employer health benefits, out in September, found 99 percent of large companies — 200 or more workers — offer health benefits, but only 48 percent of those with three to nine employees do and 59 percent of those with 3 to 199 workers do.

Three-quarters of small firms (3-199 employees) not offering health benefits believed their employees would prefer a $2 an hour increase in wages rather than health insurance, Kaiser said.

Kiser said the reality that 1 in 5 consumer dollars goes to health-care costs "does keep you awake a night."

The federal health-care overhaul will allow employers to stop providing health insurance — beginning in 2014 — with their employees going into a government-controlled exchange.

However, employers with 50 or more workers that don't offer coverage will be required to pay $2,000 for each full-time employee in its full-time work force. The fee begins if at least one employee enrolls in a plan through a health-insurance exchange and receives a federal subsidy. Two part-time workers are considered as one full-time employee.

The top executives at Blue Cross Blue Shield N.C., Novant Health Inc. and Wake Forest Baptist Medical Center said they empathize with businesses' concerns about health-care costs since they are large employers as well as providers.

"All of us as employers are going to have to look in the mirror and do things that may be uncomfortable," said Paul Wiles, who is retiring as Novant's president and chief executive Dec. 31.

"Employers have to be more active managers with employees and their dependents, having them put more of their own skin in their health-care costs, to live a healthier lifestyle." He said dependents' health-care costs tend to be about 10 percent higher than employees' costs.

Wiles said Novant is preparing to launch a program for its management in which officials would be requested to talk periodically with a health-care navigator.

He said the officials can opt out of the program, but at the cost of paying an additional $45 a paycheck toward their health-care premium. "We are likely to extend it to all employees at some point," he said.

Some businesses have added a similar additional premium cost for employees who use tobacco products.

Dr. John McConnell, chief executive of Wake Forest Baptist, said 80 percent of the center's health-care costs for employees go toward chronic disease management.

Both executives, as well as Brad Wilson, president and chief executive of BCBSNC, touted the patient-centered medical-home concept as a potential cost-saving initiative.

The goal is cutting health-care expenses by expanding preventive care so that patients, especially those with chronic conditions such as diabetes and asthma, don't end up needing more serious, costly care.

It involves health-care officials talking more with patients outside the doctor's office to be sure they're taking care of themselves, and having primary-care physicians assume responsibility for all stages of a patient's medical life — preventive care, acute medical problems, chronic conditions, end-of-life issues.

McConnell said all groups accessing the health-care system need to adopt a preventive mindset for the patient-centered medical-home initiative to succeed. That includes employers, providers and insurers being willing to collaborate more on wellness programs related to chronic-disease management.

Steve Crist, a vice president of sales for BCBSNC, said the insurer has noticed more employers interested in a two-tier insurance option.

In that scenario, employers would provide a defined contribution for each employee's health insurance. Employees wanting a higher level of coverage would pay the extra amount.

"We do see consumers making more buying decisions when they are paying the entire insurance cost themselves," Crist said.