Last month, benefits brokerage Bernard Health hosted its 7th Annual Health Reform Luncheon, bringing together a panel of local healthcare and workforce experts to discuss group plan sustainability, healthcare consumerism, and political uncertainty.

The panel, which was comprised of Nashville Health Care Council President Hayley Hovious, Healthcare Bluebook Co-founder and SVP Bill Kampine, BernieHR leader Rebekah Michel, and Farm Bureau Health Plans Chief Marketing Officer Randy Wilmore, agreed that the state of health reform was likely to remain uncertain for the foreseeable future.

"I don't know that you're going to see a lot of movement," Hovious said. "When I talk to employers, I'm not getting a sense that they think this is going to get worked out. In terms of planning, it's likely that there will be more people off of the exchanges, which means more people back on your plan."

Wilmore added that until a solution is developed to address high risk patients in the individual market, premium prices are likely to rise. "I think we will see a new class of uninsured due to people who can't afford it," he said. "I don't want to call it a death spiral, but as the prices rise, healthier consumers will stop buying, leaving insurers with sicker populations. The higher premium prices and lack of competition in the individual market is also pushing smaller employers, who initially embraced the exchanges, to return to small group plans, Wilmore said.

However, employers of all sizes have to address the increasingly unsustainable cost of healthcare and insurance. Adjustments to plan design, including narrow networks and HSA-eligible plans, are popular options for reducing costs ... but these strategies do carry some risk.

"We're seeing a lot of interest in narrow networks, but it's brought [to employers] from the healthcare delivery system. Employers need to look carefully. If you're getting a 10 percent discount on a $4,000 procedure, but it should cost much less, the math doesn't work out," Kampine told the audience. "So be careful of what you're encouraging people to do. The narrow network is a very popular item, but it has real implications for employers."

Adopting and optimizing HSA-eligible, or high deductible, health plans is another cost-saving option, but the panel said it requires effective communication. "There's a lot of education that has to go on, but employees embrace it when they see the cost-savings that they are getting," Michel said. "We're seeing employers take the defined contribution approach and contribute toward HSAs and ancillary options. Employees really like this approach because it gives them choices, and everyone wants choices."

Kampine added the need for educating employees on shopping around for cost-effective care. "The single biggest challenge in helping employees be better healthcare consumers is awareness," he said. Hovious agreed, noting, "People have been trained not to be cost-sensitive. You have to educate your population, and it's really important as you see more people move to high deductible plans. For the first time, they're being asked to pay for their care. Nobody knows what anything costs so you're teaching them how to shop. You can't over-communicate this stuff."