MERCER為美國(guó)保險(xiǎn)業(yè)協(xié)會(huì)做的絕密HR報(bào)告

RichBaileyFSA,MAAA,FCARichmond,VAIsitTimeforEmployerstoMoveAwayFromtheTraditionalWaysofProvidingEmployeeBenefits?

November3,2004AgendaTheEnvironmentTheCatch-22PathsAwayfromTraditionalDelivery:TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics1AgendaTheEnvironmentMedicalTrendsLegislationMarketplaceChangesPopulationDemographicsEmployerOutlookTheCatch-22PathsAwayfromTraditionalDelivery:TwoCampsOpportunitiesAlongPath2TheAnswerAdditionalTopics2Double-DigitIncreaseforSecondYearinaRow

Peremployeecostsinexcessof$5,600peryear-2.9%+6.2%+7.3%+8.1%+11.2%+14.7%Source:2002Mercer/FosterHigginsNationalSurveyofEmployer-sponsoredHealthPlans3AnnualCPITrend

U.S.healthcarecostsrise,despitecontinuingeconomicrecessionThegapbetweenCPI-Uandmedicalcarecomponentisincreasing4ComparisonofOverallGrowth

CumulativemedicalcareCPI89%greaterthanoverallCPIsince1967DatabasedonJanuary1CPIvalues5Employers’CostIncreasesOut-PaceOtherIndicators

Largestincreasesince1990(allemployers)Includesmedical,dentalandpharmacySource:2002Mercer/FosterHigginsNationalSurveyofEmployer-sponsoredHealthPlansResultsforEmployerswith500ormorelives6.9%18.6%16.7%17.1%12.1%10.1%8.0%-1.1%0.2%6.1%7.3%8.1%11.2%14.7%2.1%2.5%-2.00%0.00%2.00%4.00%6.00%8.00%10.00%12.00%14.00%16.00%18.00%20.00%1987198819891990199119921993199419951996199719981999200020012002EmployersCPI-MedicalCPI-AllItems6AggregateHealthCareSpending(1980–2010)

Governmentportionofpaymentsincreasing;totalprojectedtobeover$2trillionby2009Source:CMS7MedicalTrendsPopQuizHowmanyyearswillittakegrossmedicalcoststodouble,assumingnospecificemployerinterventionsornationalhealthcare?10ormore98765orfewer8MedicalTrends

Responsesfromagroupof25actuarieswhohadtimetogettheircalculators9LegislationMedicarePrescriptionDrugsIfmadeintolaw,willhavemajorimpactonretireebenefitsandstrategiesInitialconfusionaside,shouldhavepositiveimpactonretireeplansExpectcostshiftingtonegativelyimpactactiveplansEEOCProposedchangesinADEAregulationsClinevs.GeneralDynamicsWellsFargocaseAppearstoallowpre-funding(andtax-deductibility)ofentireretireeliabilityanILPapproachwon’tbeexactlysamenumberasFASliabilityfundinginyears2+wouldbelimitedtoservicecostIRSweighingitsoptions10ProposalstoIncreaseCoverageAmongEarlyRetirees

FewgovernmentprogramsexceptforfinanciallyindigentCOBRAextensionsand/orMedicarebuy-insProhibitionsonpost-retirementbenefitreductionsExpandedpre-fundingforretireemedicalStillfewviableproductsforpre-65inindividualmarketthatovercomeaccessandaffordabilityissues.11ADEAIssues

ImpactonretireemedicalcoverageAgeDiscriminationinEmploymentAct(ADEA)prohibitsdiscriminationagainstpersonsage40orolderintermsandconditionsofemploymentAge-baseddistinctionsinemployeebenefitplansarepermissibleonlyif:Aspecificstatutoryexceptionapplies,orEqualbenefit/equalcosttestissatisfiedPlanmustprovideequalbenefitsforolderandyoungerworkers,orPlanmustincurequalcostsforolderandyoungerworkersThirdandSixthCircuitCourtsreachdifferentconclusionsEEOCreviewingADEAregulations12MarketplaceChanges

ConsolidationofMajorHealthCareCarriers

Employeroptionsaregreatlyreduced,carriershavemorecloutUnitedHealthcareHealthSourceProvidentCIGNAEquicorMetrahealthUSHealthcareAetnaTakeCareFHPPacifiCareHealthSourceCIGNAAetnaUSHealthcareNYLCarePrudentialHealthCareFHPPacifiCareProvidentTransamericaEquitableHCAMetropolitanPartnersAetnaGSDHPLincolnNationalHPsTakeCarePacifiCareHealthPlanofAmericaWellPoint/BlueCrossofCaliforniaHancockMassMutualTravelersUnitedHealthcareAetnaPacifiCareHealthSystemsWellPoint/BlueCrossofCaliforniaCIGNABCBSofGeorgiaMultipleBCBSPlansFewerMajorBCBS13MarketplaceChanges

PBMconsolidationcontinues;threemajornationalPBMsremainCPIAPICPNRxNetValueRxDiagnostekPerformHCSHPIDiagnostekValueRxRxNetColumbiaValueRxExpressScriptsExpressScriptsNPADPSExpressScriptsPAIDMEDCOAdvancedParadigmAdvanceMedcoIntegratedPrescriptionSolutions(IPS)PCSFoundationMerck-MedcoMerck-MedcoProadvantageSystemedParadigmMerck-MedcoMedcoAdvancePCSMajorInsurersMajorInsurersMPSPCSClinicalPharmacyAdvantage14PopulationTrends

AgingbabyboomerswillincreasetheelderlyandnearelderlypopulationsDataSource:U.S.CensusBureauStatePopulationProjectionsBabyBoomersYearofBirth1946to1964Source:U.S.CensusBureauasofJanuary2000U.S.Population,2000ProjectedPopulationMillions15NegativeTidalWaveofAvailableTalent

Poolof“primeworkers”willbedecreasing

Source:DRI,WorldatWorkJournal,fourthquarter2001PercentChangeinPopulationbyAgeGroup,2000-10-20%-10%0%10%20%30%40%50%60%5-910-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-79The“Echoboom”

ages15-29ShrinkingPoolof

“Primeworkers”

ages30-44Aging“Babyboomers”

ages45-6916ImpactofDemographicsonHealthCareCost

Costincreaseswithage0.000.501.001.502.002.503.0020-2425-2930-3435-3940-4445-4950-5455-5960-6465+AgeRelativeCostbyAgeMaleFemaleAverageemployercost=1.0RelativeCostsByAgeandGender17HealthDeterioration

AcauseandaconsequenceWeeattoomuch--64.5%ofadultsoverweightPopulationwithdiabetesincreasedover50%inlastdecade*Overweightisroughly10to30poundsoveranidealweight.Obesityisroughly30poundsoveranidealweightSource:NationalHealthandNutritionExaminationSurvey45.0%47.0%47.0%56.0%64.5%18IssuesFacingBusinesses

Theperfectstorm

Lowambientinflation;highmedicalinflationAdvancesinmedicaltechnologylikelytoleadtohighercosts,difficultdecisionsLegislativeuncertaintyConsolidatingmedicaldeliveryandfinancingsystemAnagingworkforceIncreasedlongevitySlowingeconomyDisappearingover-fundedpensionplansFew,ifany,obviousandeasyalternativestomanaginghealthcarecosts19Empl閣oyer征Out原lookEnv睬iro您nme獨(dú)nta贈(zèng)lo饞utl絞ook歐sp躍urr所ing門em辣plo非yer再ac筆tio壓nEmp朋loy帆ers崗ac設(shè)ute鴉ly偵awa損re岡of介tre飼ndsHei辰ght效ene視di頃nte傾res神ti嘉nc獸ost輕sa蛾vin愉gs江tra至teg滿ies粥(a唱cti己ve錢and膚re狠tir罷ee)Grea梯ter筍emph逢asis剖on諒long踩ert止erm動(dòng)cost毀pro賣ject隱ions娃and嗚on枕the午“bot振tom撤line想”Pro技jec憂tio顯nr眼esu回lts樂(lè)ha叮ve轉(zhuǎn)ind做uce源d“叉fig撥ht慨or博fli扛ght吧”r拆esp愉ons壟es20Ret屢ire億eM厘e(cuò)di豎cal捏Co甲ver充ageEmpl固oyer謀sco弊ntin申uet罩odr皇opr壩etir作eem鍛edic姨alc疾over鐵agePercentageofEmployersOfferingCoveragetoFutureRetireesBasedonemployersof500ormorelivesrespondingtothe2001Mercer/FosterHigginsSurveyofEmployer-SponsoredHealthPlansWhencoverageisoffered,retireepremiumsandout-of-pocketcostsoftenincrease21Agen憲daThe廉Envi芝ronm祖entThe壩Catc攔h-22Pat瓦h(yuǎn)s木Awa郊yf胳rom日Tr餅adi母tio盯nal統(tǒng)De靜liv狗ery貪:T羅wo緊Cam蓋psOppo近rtun瓜itie屯sAl格ong腰Path喜2The周Answ罪erAddi銅tion岸alT出opic培s22The土Catc弓h(huán)-22Red費(fèi)uci鑒ng剃emp悅loy斃er怒cos側(cè)tt幟ypi鳳cal斑ly染imp辭lie腰si葡ncr筋eas往ing溉em怒plo酸yee抹/re饒tir網(wǎng)ee摔cos蝦tEve太ntu柴all右yr名uns合ag諷ain飼st終emp廳loy挑er’尺ss錢ens黑ibi頓lit普ies稈re乒gar剪din休gf味air感nes正s,納pat記ern不ali牢sm勸(if媽pr往ese疼nt)搖,a閱nd腥the廢co叨nce架pt老of碎ben也efi蒼ts氧gen醫(yī)era當(dāng)llyExa遷mpl火e(身FAS澇10嚴(yán)6):推“L哪owe穩(wěn)rm孫yl灰iab串ili舟tie市ss緒ign史ifi聞can庫(kù)tly莫bu械td井on’雙td疤oa縮慧nyt堤hin爺gh程ars釀ht壓oo耽ur尊ret攻ire鋪es…押the靜yw付on’畝ta慎cce辰pt脖it”Tot航hee正xten細(xì)tth純atr膏etir廳ees脊repr襖esen鎖tth壓ebu北lko辜fth岡eli液abil紛ity,佛thi松sis墾av谷ery撥diff跪icul愿tpr陜opos獲itio今nOppo父rtun馬itie小sex肯ist約toc安hang杯eel浸igib汪ilit酒y,d矩esig鬼n,飄etc.槐for魔fut臘ure引reti侮reesIfw刊edo嚴(yán)n’t俊take殺cos疫tou幻玉tof腦thesys平tem,ei坊ther污the照emp袋loye珍ror癢the拜emp舍loye委es/r留etir帝ees相will囑pay奏the冒inc須reas丈es23Agen古daThe睬Envi使ronm蠻entThe腸Catc兇h-22Pat惰hs扇Awa順yf掛rom藥Tr磨adi頁(yè)tio史nal買De濟(jì)liv哀ery梨:T布wo箱Cam固psOpp珍ort模uni嫂tie棒sA居lon球gP訊ath結(jié)2The盯An桿swe縣rAdd座iti從ona脈lT走opi喚cs24Path容sAw扇ayf患rom曾Trad揮itio反nal后Deli猜very鏡:Tw產(chǎn)oCa炊mpsEmpl覺(jué)oyer戀sth怨atb傍ecom指emo采rei遍nvol盾ved插inCha格ngi況ng弓emp燥loy妖ee丟beh涌avi藝orCha附ngi因ng皮pro誰(shuí)vid披er脫beh壯a(bǔ)vi爹orChan邁ging狀pro碧vide掩rst盡hat蠅they弄wor氧kwi牌thCha方ngi喬ng叮the飽la栽wsEmpl扣oyer動(dòng)sth昂atr隊(duì)educ遲eth點(diǎn)eir膠invo炭lvem深ent鋒byInc替rea變sin竟ge駱mpl潛oye險(xiǎn)er概esp匪ons劣ibi搜lit輕yLim壯iti災(zāi)ng那emp趨loy姐er破cos襪tLimi刷ting蔥emp攪loye抹rri群sk25Empl屈oyer它sBe丘comi團(tuán)ngM脂ore鉆Invo勞lvedColl無(wú)ecti疊veP零urch懇asin擾gHig嚴(yán)hP嬸erf壓orm茶anc因eN隆etw賴ork躁sDire擾ctC案ontr爬acti付ngCon鄭sum堆er園Acc組oun執(zhí)tab敗ili塞tyLea曲pF萬(wàn)rogLob今byi敗ngDis卡eas獅eM休ana乘gem愿ent洋/Pr脂eve盡nti聲ve收Car而eWha借tt番hes督ea仗ppr掌oac磁hes瘋sh乏are耽is主an氧ey依et浮owa挪rd著red遷uci旗ng泛cos并tf旱rom笑th結(jié)ee沖mpl楚oye柏r’s固sy他ste稼m,屠and潮in脖so療me阻cas圈es,彈th它ee艱nti狀re稱hea柄lth駱ca夠re異sys使tem彎.26Coll燥ecti嘗veP瓦urch描asin腔gUse足em晝plo偵yer政an居dp非lan趴ma奔nag厚er親clo漁ut矩to旦neg寶oti蛾ate度f(wàn)a蘭vor腫abl素ep益aym嶺ent瓦ar寇ran竭gem防ent護(hù)sBack模grou誰(shuí)ndTra啟dit引ion勤al笑net詠wor旬kn沃ego喊tia好tio盞ns局are釘vo捎lum掌ed房誠(chéng)riv男enAppr額oach尖est艙oac民hiev椒elo編wer爽cost欠sin蠅clud俘eAgg納reg終ate杠dp掛urc跪has踏ing抽to按im穴pro見(jiàn)ve役neg租oti征ati睛ng療str谷eng鏈thCoa方lit攏ion驗(yàn)sFor刪mal遍al爸lia遙nce錦sInf根orm巴al艘all丹ian湯cesDir兆ect榮ing夜ca龜re天to螺mos似tc咐ost還-ef屑fec乒tiv秤es串our黃ce峽of伯qua蹤蝶lit賊yc魄areRev封iew漆ing薪ef鄰fec欣tiv喊ene蒜ss,揪ef件fic仇ien番cy席and蓋“f幟it”遣of腹cu棗rre掌nt受ven糧dor序re鎮(zhèn)lat旺ion遇shi娘ps;遇ch灘ang乖ing桌as每ap竊pro夠pri俯ate27What郵is幼aHP鵲N?High恩Per抽form退ance絨Net飾work裂:Ahe籮alth郵pla回npe古rfor性manc出eim傳prov撓emen倍tme予thod棚tha撒tst旁eers蕩car惕eto休pro勢(shì)vide啄rst閘hat轎meet鞏spe生cifi掀cef朽fici他ency蹦and蠅qua旦lity桑cri館teri歡a28Rati暴onal饞efo婚rHP聲NsNew府mana阿geme雜nta灰ppro云ache資sar食ene壞eded乖in繭this竭era碧of污cost優(yōu)acc鳥eler偷atio鎖nPati黃ents倡and裝phy馬sici模ans損are巧the肯key常driv絞ers鏡ofh危ealt聯(lián)hca攤rec豪ostsBut犁th慨ey輕hav賴el典imi衛(wèi)ted券or般no漂in撤cen播tiv金et斧oc納are綱ab撈out狠co援stsThe熟hear慣tof哀the塵Hig蟲hPe麻rfor頑manc愛(ài)eNe聾twor泊kco暖ncep勢(shì)tis至to演chan旋get巴hep瓦rovi刪der阿sele頸ctio題nbe籌havi申oro毀fpa膊tien摘tsa棵nd/o凝rph淋ysic騎ians29Hig艷hP薯erf咽orm要anc飄eN漂etw撇ork獲sNet憐wor巡壽km猴ode臺(tái)lsLim腿ite拾dN爆etw畜orkAs烏ubs禍et睡of影an商exi擺sti卵ng餅pro框vid怨er解net裙wor名kc披omp同ris娃ed爽of登hig觀hp度erf杰orm壤ing哀pr腸ovi眼der腔sTier公edN閘etwo遷rkEmpl既oyee剛cop眼ay/c拔oins投uran請(qǐng)ced庭iffe族rent多ials防to呼enco鼠urag端eus禍eof室hig越hpe消rfor舟ming新pro顧vide拒rsPhys沫icia鵲nPa雄rtne稀ringAna皂rran豈geme吉ntw慘ith組(typ眠ical斯ly)敗prim爭(zhēng)ary自care佳phy悶sici增ans發(fā)toe旨nhan勿cee晨ffic獵ienc億yCon換sum竄er救Dri佳venDep觀loy被men味to配fp全erf少orm堆a(bǔ)nc遙ei風(fēng)nfo掃rma止tio罰nt綠oc齒ons窄ume踢rs低to絨imp貧rov源ep悲rov治ide骨rs挨ele覆cti匯on30Dire觸ctC掉ontr延acti映ngLarg擺eem蹤蝶ploy擁ers棚with詳sig障nifi蒜cant甩mar么ket兆pres喘enceMay窯be忙ab妄le立to剖ach若iev際es眨ign勇ifi悔can竊ts亭avi嫁ngs排by此co們ntr煌act汁ing旁di返rec故tly墾wi貞th是hea跳lth偷ca圖re蔬pro墳vid魄ersMay番ne愧ed蔽gro紐奉up忌of翅reg索ion喚al盼emp符loy繁ers首to儉ac扯hie明ve岔cri岔tic扁al緞mas具s31Pro造mot怕eC息ons涌ume戀rA捐cco厘unt停abi若lit證yHel云pp雁ati濁ent點(diǎn)sb必eb桶ett打er盞con驢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