最大化零售业的健康福利计划

© Oliver WymanA $90 billion market opportunity is emerging across the food retail landscape.Healthy benefitsprograms, which allow different health paying entities toallocate funds for consumers to spend on health and well-being, are quicklyexpanding in commercial and government insurance programs. Oliver Wymanand FMI partnered to provide examples of the kinds of programs that arepublicly or privately funded, which benefits are included, and provideretailerswith actions so they can fully take advantage of this growing market andharness its full potential.WHAT IS THE HEALTHY BENEFITS SPACE?Employers, consumers, and state and federal governments are grabbling with rising healthcarecosts. By 2031, total healthcare spending in the US is expected to outpace average grossdomestic product growth. By 2031, healthcare spending is expected to account for 19.6%of GDP. Employers anticipate a 5.4% rise in per-employee costs this year, according to datafrom Mercer. One tool that employers, as well as Medicare and Medicaid, have adopted tocontain costs is investing in health and wellness programs. Consumers have also flocked tothese offerings as they aim to take more control over thewell-being.These initiatives, funded by both public and private sources, are designed to drive consumerspending towards health-related items that can be found across many grocery aisles,representing a substantial retail-centric opportunity. We project that between employer-sponsored initiatives, government programs, and other nascent programs, there’s nearly$90 billion of spending available to retailers in thehealthy benefitsspace.This presents retailers with a significant chance to benefit from these programs bydevelopinginnovative business models to tap into these funds while supporting their growth.WHO ARE THE FUNDERS OF HEALTHY BENEFITS PROGRAMS?Healthy benefitsprograms are supported through funds that are typically allocated to accountsaccessible via restricted or filtered payment cards. These cards necessitate uniqueconnectionswith retailers’ point of sale (POS) systems, which present a significant challenge for retailersthat wish to fully implement these programs and enhance consumer awareness and accessto services. © Oliver WymanThe funding landscape forhealthy benefitsprograms encompasses a wide array of players:Government agencies in partnership with health payersMedicare Advantage (MA) plans are the fastest-growing restricted spend segmentand provide members with health and wellness supplemental programs that promotepreventative care, wellness activities, and overall health improvement. We estimate thatthere’s $30 billion of spending here, with a 29% compound annual growth rate over fouryears. These plans are increasingly bolstering their supplemental benefits to remaincompetitive, adding such services as dental, vision, and hearing. Beyond that, over-the-counter health product, which aren’t covered by traditional Medicare, have become tablestakesbenefits. © Oliver WymanMedicaid 1115 state waivers expand the scope of covered benefits beyond traditionalmedical services and enable programs that incentivize members to engage in healthierbehaviors, especially those driven by social determinants of health (SDOH). These healthybenefit waivers have been approved for use in 19 states and cover various food-basedinitiatives which include screenings and referrals to nutrition programs, nutrition education,and Food as Medicine services that directly provide nutritious foods that support health.However, Medicaid 1915(c) waivers are less flexible, only covering home-based care as isrelevant, with some coverage for meal-delivery services permitted (so long as it does notconstitute a full nutritional regiment). © Oliver WymanEmployer-supported programsEmployers and their employees are moving to fundhealthy benefitsprograms throughcontributions to Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), andHealth Reimbursement Agreements (HRAs). This segment totals roughly $55 billion inavailable spending, with a 5% CAGR over five years. Individual employees open an HSA inconjunction with enrollment in a high-deductible health plan and enable the employee topay for categories of medical expenses not covered until the insurance plan deductible ismet. Some employers choose to match employee’s contributions to an HSA. FSAs may beoffered by an employer for employees to allocate pre-tax dollars — most notably thesefunds are use it or lose it while HSAs can accrue over time. Both HSAs and FSAs can benefitfrom additional flexibility in terms of covered products when employees receive a Letter ofMedical Necessity (LMN) from their provider. LMNs enable consumers to use their HSA orFSA funds to cover vitamins, supplements, food, among other expenses outside of standardmedical expenses, visits to licensed practitioners, prescription drugs, and OTC items. HRAsare arrangements where an employee will pay for a medical expense then submit a receiptfor