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www.HartfordBusiness.com • June 29, 2020 • Hartford Business Journal 9 has been done in several other states. "I think everyone recognizes now that there will be more visibility to the rate of increasing costs," he said. "Historically, that increase has been overwhelmingly driven by unit cost increases and not necessarily by utilization increases." Ironically, fee-for-service healthcare contracts — which have been long maligned by healthcare reformers as a driver of higher costs, but still remain the norm in Connecticut — were likely a blow to providers as billable services dried up starting in March. Kosior said he is unsure whether the experience of the pandemic might push some providers to em- brace alternative payment models, including ones that guarantee a cer- tain level of revenue, but also have downside financial risk if doctors miss quality and cost targets. "The negative financial toll many providers experience today would have been avoided for the most part if they were guaranteed a steady and predictable income stream," he said. Levers to pull Employers — especially those in the fully insured market, where plan customization is limited and a low claims year doesn't necessarily translate into future savings — can only do so much to control rising health insurance costs. One option, made possible last year by the Trump administration, is to give workers a subsidy and send them to the individual market to handle their own insurance needs. That so-called individual coverage Health Reimbursement Arrangement (HRA) is gaining some traction, accord- ing to Gutcheon, the West Hartford broker, but there are downsides. For example, work- ers who collect Obamacare tax credits aren't eligi- ble to participate. Silas Warner, a senior ben- efits consultant at OneDigital Health and Ben- efits' Farming- ton office, said employers — at least his middle- market clients — are unlikely to drop their benefit plans. "Companies with 50-plus workers are still competing really hard for talent," Warner said. Another strategy employers have used over the years is to shift more costs onto their workers through higher premiums, deductibles, co- pays or coinsurance. "I don't have a sense there is much of an employer appetite right now to increase workers' out-of-pocket costs," said John O'Connell, the healthcare practice lead of insur- ance and financial services firm Alera Group Inc.'s Hartford office. However, whether a company will make that choice depends on its financial situation and how com- petitive it needs to be to attract and retain the right workforce, he added. Another possibility is that em- ployers embrace narrow network designs, which have been slow to catch on in Connecticut, as they re- strict where patients can go for care. Ulbrich, the CEO of Ulbrich Stain- less Steels & Special Metals Inc., which has seen a double-digit reduc- tion in new orders in recent months and received a Paycheck Protection Program loan, said he wants to see a greater focus on care quality coming out of this pandemic. He supports health plans that in- centivize employees to go to provid- ers that offer the best service at the most competitive cost. Ulbrich Stainless Steels spends about $10 million annually on health care for its employees, and its self- insured plan has seen relatively mod- est cost increases in recent years that have matched the rate of inflation. Ulbrich said he hopes costs remain stable in the years ahead but he's worried about the market power held by the state's large hospital systems. "The bigger question is, 'how can we get more competition with hospitals and better quality and outcomes,' " he said. Quality Construction + Butler Manufacturing = Repeat Customers www.borghesibuilding.com © 2011 BlueScope Buildings North America, Inc. All rights reserved. Butler Manufacturing™ is a division of BlueScope Buildings North America, Inc. 2155 East Main Street • Torrington, Connecticut 06790 The Belknap White Group, Hartford, CT | 2012 | 15,300 sq. ft. Northeast Beverage, Orange, CT | 2006 | 97,000 sq. ft. Contact us at 860-482-7613 or visit us on the web. FOCUS: INSURANCE Telehealth has its moment, but its future isn't guaranteed If there is one crystal-clear impact that will come out of COVID-19, it's the continued use of telehealth and telemedicine, experts predict. Tweaks by the federal overseer of Medicare that allowed a telephone checkup to be reim- bursed at the same price as an in-person visit spurred commercial insurers to follow suit, and led to a massive increase in what was a mostly niche healthcare service before the pandemic. "Telehealth is here to stay," said Rob Kosior, chief operating officer of Farmington-based health insurer ConnectiCare. "There is a value we see it is delivering, and I think it goes beyond the pandemic." However, the Center for Medicare and Medicaid Services' telehealth reimbursement modifica- tions are temporary, and if the agency walks them back, insurers could do the same, though they can make their own decisions, Kosior said. "We want to make sure that for the service that's being delivered, and how it's being delivered, that reimbursement is actually rational," he said. Rob Kosior, Chief Operating Officer, ConnectiCare ILLUSTRATION | IAN BERRY/CNN