Milliman has studied and published health plan administrative cost benchmarks for over 15 years. Our research has included direct observations of over 100 health plans supplemented with the review of many more statutory reports. Of the many trends and changes that we have observed during this time, one general statistical observation has stood out: health plan administrative costs generally increase at a rate of about 67% of the rate of increase in medical cost inflation. This equates to an annual rate of increase of 6% for the period 2006-2011.
Conceptually, administrative costs, over a period of time, should be affected by:
- Increased efficiency through the use of electronic records and technology
- General salary and cost of goods inflation
- Regulation (positively or negatively)
- Increases or decreases in administrative workload, such as claims, customer services calls, etc.
None of the above appear to be all that closely related to medical inflation. Salary and general inflation should be the primary driver of healthcare administrative cost inflation. But with an annual salary and goods inflation level of around 2%, we must look to some other cause of the 6% annual increase. Certainly, as we consumers collectively continue to expect and demand more medical services and prescription drugs, we can end up creating more administrative burden. But shouldn’t any increase in administrative transactions have been more than negated by the proliferation of advanced technologies and electronic transactions?
This article first appeared at Milliman MedInsight.
The Medicare and Social Security Trustees released their reports on the programs’ financial solvency on April 23. The Social Security report is here, and the Medicare report is here. The Trustees summarized the results on the SSA Web site:
The long-run actuarial deficits of the Social Security and Medicare programs worsened in 2012, though in each case for different reasons. The actuarial deficit in the Medicare Hospital Insurance program increased primarily because the Trustees incorporated recommendations of the 2010-11 Medicare Technical Panel that long-run health cost growth rate assumptions be somewhat increased. The actuarial deficit in Social Security increased largely because of the incorporation of updated economic data and assumptions. Both Medicare and Social Security cannot sustain projected long-run program costs under currently scheduled financing, and legislative modifications are necessary to avoid disruptive consequences for beneficiaries and taxpayers.
These results are not very surprising as they are similar to previous reports. The Trustees strongly recommend action sooner than later:
Lawmakers should not delay addressing the long-run financial challenges facing Social Security and Medicare. If they take action sooner rather than later, more options and more time will be available to phase in changes so that the public has adequate time to prepare. Earlier action will also help elected officials minimize adverse impacts on vulnerable populations, including lower-income workers and people already dependent on program benefits.
As in past years, the Medicare actuary stated that cost projections based on current law may be unrealistic:
While the Part B projections in this report are reasonable in their portrayal of future costs under current law, they are not reasonable as an indication of actual future costs. Current law would require a physician fee reduction of an estimated 30.9 percent on January 1, 2013—an implausible expectation.
Further, while the Affordable Care Act makes important changes to the Medicare program and substantially improves its financial outlook, there is a strong likelihood that certain of these changes will not be viable in the long range. Specifically, the annual price updates for most categories of non-physician health services will be adjusted downward each year by the growth in economy-wide productivity. The best available evidence indicates that most health care providers cannot improve their productivity to this degree—or even approach such a level—as a result of the labor-intensive nature of these services.
The idea of implementing legislative controls of healthcare premium increases has been part of the reform bills for some time, but the idea has become more prominent in recent weeks. While it is tempting to look only at premium numbers when trying to control costs, there are actually a number of underlying factors: unit cost changes, medical inflation, utilization changes, member behavior, plan changes, premium “true-up,” and various leveraging.
This dynamic is discussed in a new briefing paper by Jon Shreve.
David Brooks penned an editorial yesterday about healthcare cost inflation and how the current health reform efforts do not go far enough in addressing this crucial problem. Cost inflation is indeed a big problem—this year’s 7.6% increase is the lowest in years yet is still staggering, amounting to a $1,162 increase in costs for families this year.
How do we reverse the cost curve? A look at the sources of wasteful spending can help clarify the problem and inform a solution. What follows is excerpted from a new report by Helen Blumen and Lynn Nemiccolo.
There are three types of inappropriate care that have a negative impact on quality and efficiency in the U.S healthcare system: overuse, underuse, and misuse of care.
Efficiency, Quality of Care, Reform
Health cost are up 7.4%, but the increase is far more complicated than this single number.
Look first at the hospital components of this cost trend.
- The inpatient cost trend increased from 7.1% to 7.7% this year. Utilization remained flat and the increase was instead driven by unit costs.
- The outpatient cost trend increased from 9.4% to 10.2%, again largely due to an increase in unit costs.
- The physician cost trend decelerated, though physician costs remain the biggest piece of the puzzle.
- Pharmacy costs saw a deceleration in the cost trend but still increased higher than other components of care at 7.9%, with just under 40% of that due to increased utilization. The increased use of generics over previous years complicates this cost trend.
Over-utilization clearly plays a role in the overall cost of healthcare, but as these dynamics illustrate, utilization as a cost driver is a complicated entity.
Cost, Milliman Medical Index, Utilization
An article today in Workforce Management explains the sometimes misleading nature of a reduced cost trend. On the one hand, the 7.4% cost increase in 2009 is the lowest in the history of the Milliman Medical Index, marking the third consecutive year of deceleration.
On the other hand, the increase of $1,162 is the highest since the high-water year of 2006, which saw a 9.6% increase that totaled $1,168.
The total dollar amount of healthcare for a typical family of four has risen so high in five years that any cost inflation, even decelerating inflation, becomes more expensive. So while the deceleration is a good thing, we still have a ways to go before families will notice the difference.
Cost, Milliman Medical Index