Organizations in both the public and private sectors are confronting the operational implications of healthcare reform fueled by mandates and continually rising health costs as executives across industries analyze their options. Many are realizing that their most significant opportunities for taking control of healthcare management challenges lie within their own business processes and IT environments and may require them to transform the way they do business.

Health insurance brokers traditionally have played the role of linking business customers with insurers, leveraging their resources to find the most cost-effective solutions for those businesses and their employees. The centerpiece of that strategy has been healthcare cost control, either by steering employers toward less expensive plans, cutting benefits, or by increasing employee contributions. However, as steam picks up behind the concept of Healthcare Performance Management (HPM), the competitive imperatives in the broker industry will change dramatically.

In an ever changing healthcare landscape, U.S. companies, which bear a majority of employee health care insurance premiums, have been taking measures to control expenditures. Many companies have decided to increase employees' share of costs, but have failed to meet the broader need of improved health care. This white paper looks at the addition of reward-driven wellness programs to help decrease absenteesim, increase overall health of workers and reduce high-risk cases. Collectively, these outcomes have led to a reduction in company health plan expenditures.

Active management of healthcare delivery and healthcare cost control has not typically been seen as an integral part of the mission for human resource (HR) departments. But changing times — and skyrocketing costs — have pushed Healthcare Performance Management (HPM) center stage for companies that want to boost productivity, while investing benefit dollars in better health outcomes for their employees. The key for organizations seeking to stay ahead of the curve may well lie in changing the game. Rather than simply paying out rising medical and pharmacy claims, employers increasingly are addressing health benefits challenges in a more holistic manner by investing in a more comprehensive strategy for employee health.

Soaring healthcare costs combined with the economic downturn pose a significant challenge for employer-sponsored health plans that cover medical costs for 61 percent of the US population. This report provides an overview of the data and tools needed by employers to interpret relevant plan data, find the problems and determine solutions. It also addresses the basic obstacles and “hidden” barriers to employer healthcare control and the opportunities to overcome these barriers with collaboration between employers and gatekeepers for improved health plan performance.

Comparative effectiveness research (CER) holds great promise for improving the quality of health care and patient outcomes. The CER symposium hosted by The Lewin Group’s Center for Comparative Effectiveness Research on June 15, 2010, extended beyond a discussion of the challenges associated with CER implementation, engaging experts in a dialogue about real solutions to these challenges, in particular with regard to data sources and analytical methods and tools. Experts from a variety of fields probed pertinent clinical, methodological and social issues and shared progress and new ideas for continuing to advance the resources for and state of the art of CER.

The grandfather clause is a provision in the Patient Protection and Affordable Care Act that seeks to keep a key promise made to citizens by the Obama administration: “If you like your healthcare plan, you can keep your healthcare plan.” In this report, we examine the grandfather clause, the new HHS rules that will govern its implementation and the likely impact on employer health plans, as well as whether or not the benefit of retaining grandfather status outweighs making certain plan design changes and how HPM technology can help them operate more cost-effectively.

Over the last two decades, the Towers Perrin Health Care Cost Survey has identified key trends in health care — examining cost drivers, enrollment patterns, plan design, population health, prescription drugs, retiree medical and other topics on an annual basis. During this period, health care has changed dramatically, in ways that have challenged the industry to evolve and innovate. This paper highlights the importance of the challenges we face and the value of the opportunities employers and employees can choose to embrace today and in the years ahead.

This white paper reviews the many hurdles faced by healthcare providers and healthcare payers in a down economy and explains how performance management solutions—such as those from IBM— can provide the kind of deep information and insight that decision-makers need to lead their organizations through critical challenges.