Receipt of and Spending on Cessation Medication Among US Adults With Employer-Sponsored Health Insurance, 2010 and 2017.

OBJECTIVE: Studies examining the use of smoking cessation treatment and related spending among enrollees with employer-sponsored health insurance are dated and limited in scope. We assessed changes in annual receipt of and spending on cessation medications approved by the US Food and Drug Administration (FDA) among tobacco users with employer-sponsored health insurance from 2010 to 2017. METHODS: We analyzed data on 439 865 adult tobacco users in 2010 and 344 567 adult tobacco users in 2017 from the IBM MarketScan Commercial Database. We used a negative binomial regression to estimate changes in receipt of cessation medication (number of fills and refills and days of supply). We used a generalized linear model to estimate spending (total, employers', and out of pocket). In both models, covariates included year, age, sex, residence, and type of health insurance plan. RESULTS: From 2010 to 2017, the percentage of adult tobacco users with employer-sponsored health insurance who received any cessation medication increased by 2.4%, from 15.7% to 16.1% (P < .001). Annual average number of fills and refills per user increased by 15.1%, from 2.5 to 2.9 (P < .001) and days of supply increased by 26.4%, from 81.9 to 103.5 (P < .001). The total annual average spending per user increased by 53.6%, from $286.40 to $440.00 (P < .001). Annual average out-of-pocket spending per user decreased by 70.9%, from $70.80 to $20.60 (P < .001). CONCLUSIONS: Use of smoking cessation medications is low among smokers covered by employer-sponsored health insurance. Opportunities exist to further increase the use of cessation medications by promoting the use of evidence-based cessation treatments and reducing barriers to coverage, including out-of-pocket costs.

How to align evidence-based benefit design with the employer bottom-line: a case study.

OBJECTIVE: To illustrate how to use evidence-based benefit design (EBD) by presenting the case study of a major manufacturer. METHOD: Key components of the company's measurement and management approach to EBD are introduced. Descriptive results on the direct and indirect cost and utilization trends of the company's US active workforce during 2002 to 2008 are presented. RESULTS: From 1999 to 2002 aggregated to 2008, health care costs dropped sharply, with 2006, 2008, and projected 2009 reporting decreases even as annualized increases in national expenditures approximated 10%. Annualized rates for hospitalizations, office visits, and prescriptions showed corresponding decreases from 2004 to 2008. From 2002 to 2008, workers' compensation/disability and absenteeism costs decreased 38% and 46%, respectively. CONCLUSIONS: These results support the company's direction in health benefit design although further confirmation is needed. Ongoing quality improvement processes are discussed, as are implications for implementing EBD.

Development of an interactive model of the burden of future coronary heart disease from an employer perspective.

OBJECTIVE: To create a computer-based model for employers to better understand the burden of coronary heart disease (CHD) to their organizations. METHODS: A user-friendly model was developed to allow employers to evaluate the burden of CHD. Inputs include the demographic distribution by age and sex, prevalence of CHD and CHD risk factors, direct and indirect medical costs of CHD events, and discount and inflation rates. The model contains prediction equations derived from National Health and Nutrition Examination Survey data and Framingham Heart Study equations, used with employer inputs to predict future CHD events and expenditures. RESULTS: Interactive graphs are presented for the employer's covered population alongside regional benchmarks. The time horizon and population may be adjusted. CONCLUSIONS: This interactive model illustrates how pragmatic outcomes research can be converted into a transparent model addressing health care budget issues that is readily understood by corporate managers.

Economic cost of Guillain-Barré syndrome in the United States.

OBJECTIVE: This study estimated the annual economic cost of Guillain-Barré syndrome (GBS) in the United States in 2004, including the direct costs of medical care and the indirect costs due to lost productivity and premature death. METHODS: The cost-of-illness method was used to determine the costs of medical care and lost productivity, and a modified value of a statistical life approach was used to determine the cost of premature deaths. Data were obtained from the Nationwide Inpatient Sample, the Medical Expenditure Panel Survey, the Compressed Mortality File, a telephone survey of 180 adult patients with GBS, and other sources. RESULTS: The estimated annual cost of GBS was $1.7 billion (95% CI, $1.6 to 1.9 billion), including $0.2 billion (14%) in direct medical costs and $1.5 billion (86%) in indirect costs. Most of the medical costs were for community hospital admissions. Most of the indirect costs were due to premature deaths. The mean cost per patient with GBS was $318,966 (95% CI, $278,378 to 359,554). CONCLUSIONS: The economic cost of Guillain-Barré syndrome (GBS) was substantial, and largely due to disability and death. The cost estimate summarizes the lifetime health burden due to GBS in monetary terms, and provides some of the information needed to assess the cost-effectiveness of health measures that affect GBS.

Emerging trends in health and productivity management.

Many large U.S. employers have generally embraced a Health and Productivity Management (HPM) perspective to guide their multiple employee health management efforts. In looking ahead there are a number of emerging trends that are helping to shape these efforts. As health promotion professionals assess the implications of these trends on their respective role and function within the worksite, it may provide a very useful process for refining strategies for programming and professional development. The identified trends also have a variety of implications for health promotion vendors and the growth of the health management marketplace.

Between a rock and a hard place: understanding the employer mind-set.

Large and mid-size employers are "between a rock and hard place" when it comes to health benefits: They are both unable to manage their health care costs effectively or simply get out of offering these benefits entirely. Although there is considerable diversity in how employers approach health care, several goals underlie most of their decisions. It is unlikely that the current round of employer-based health initiatives will succeed at managing rising costs. As a result, employers are likely to become more interested than at any time in the past decade in exiting their roles as providers of health benefits.

Employment-based health insurance: past, present, and future.

We review the rise, stabilization, and decline of employment-based insurance; discuss its transformation from quasi-social insurance to a system based on actuarial principles; and suggest that the presence of Medicare and Medicaid has weakened political pressure for universal coverage. We highlight employment-based insurance's flaws: high administrative costs, inequitable sharing of costs, inability to cover large segments of the population, contribution to labor-management strife, and the inability of employers to act collectively to make health care more cost-effective. We conclude with scenarios for possible trajectories: employment-based insurance flourishes, continues to erode, or is replaced by a more comprehensive system.

The costs of mental health parity: still an impediment?

Parity in mental health benefits rectifies unfairness in health insurance coverage and reduces financial risk for those with mental illness. However, increased coverage for mental illness has been seen as creating inefficiencies and increasing total spending, based largely on results from the RAND Health Insurance Experiment conducted in the 1970s. Newer evidence suggests that cost control techniques associated with managed care give health plans alternatives to discriminatory coverage for containing costs. We review both eras of research on mental health insurance and conclude that comprehensive parity implemented in the context of managed care would have little impact on total spending.