The old saying “timing is everything” may even apply to when you eat your meals, according to Michael Pollan, author of In Defense of Food. Skipping breakfast or having an occasional late dinner is fine, but sticking to an earlier eating schedule may contribute to healthier living by helping you maintain a healthy weight. Findings were based on a small study implemented over an 8-week period in which adults had three meals and two snacks between 8 a.m. and 7 p.m., followed by a two week break and eight weeks of a later schedule, which included three meals and two snacks eaten between noon and 11 p.m.
The later eating schedule resulted in weight gain and a negative impact on insulin levels, cholesterol and fat metabolism. The study also showed that when people ate earlier, they stayed satisfied longer, which helped them prevent overeating. Given our hectic schedules, eating later occasionally is hard to avoid. But it will help if you can make an effort to get back to an earlier schedule.
The trend to value-based medical treatment took a significant hit recently when the Trump administration cut the number of hospitals required to participate in the Comprehensive Care for Joint Replacement model and canceled other bundled payment models slated to go into effect on January 1, 2018.
HHS Secretary Tom Price has been a consistent critic of the mandatory payment model created by CMS Director Patrick Conway. Price’s announcement came shortly after Conway announced he was leaving CMS to become CEO of Blue Cross and Blue Shield of North Carolina, leaving many to question what the move means for the future of value-based payments. Still others believe that the value-based models were beginning to drive better outcomes and that more and more patients will be attracted to hospitals offering the highest quality of care. With the Medicare Trust Fund projected to run out of money in 2029, something needs to be done to repair or replace traditional fee-for-service reimbursement.
According to the American Time Use Survey released recently by the Department of Labor, Americans spent more time working and less time sleeping in 2016 than in 2015. On average, men and women 15 years of age and older worked about 8 more minutes each weekday and slept for about 5 minutes less than they did in the previous year. Labor officials view this as an indication of a healthier job market. Millennials worked an average of nearly 5 hours per weekday in 2016, their highest level since 2011.
The gradual transition to high deductible health plans is having a significant impact on out-of-pocket costs, according to a study released by the Kaiser Family Foundation/Health Research & Educational Trust. In 2016, for the first time, just over half of all workers (51%) with single coverage faced a deductible of at least $1,000. The study also showed that 29% of workers were in high-deductible plans compared to just 20% two years earlier.
With time running out on an opportunity for Congress to repeal and replace the Affordable Care Act and open enrollment season approaching, thousands of small and mid-sized businesses are likely bracing for another round of premium increases. A growing number of employers, however, will choose to avoid the uncertainty plaguing traditional group insurance markets by moving to a self-funded health plan – an option that provides an opportunity for savings and far more plan design flexibility.
Healthcare benefits continue to be perhaps the biggest obstacle facing small and mid-sized businesses. The Self Insurance Institute of America reports that between 2011 and 2016, the average annual deductible for employer-sponsored plans increased by 49% and the percentage of firms with fewer than 200 employees still providing health benefits fell from 68% in 2010 to 55% in 2016.
Self-funding on the other hand, has proven to be a far more responsible alternative for employers, enabling thousands to not only use their health benefit plan to attract and retain high quality employees, but to do so at an affordable cost. While self-funding has long been a staple for the nation’s largest employers, nearly a third of companies with 200 or more employees now offer at least one self-funded option.
Everyone Benefits from Flexibility
There are many reasons for the growth of self-funding, with flexibility and access to valuable claims data high on the list. Since self-funded plans are governed by ERISA, they avoid many of the costly mandates governing fully insured plans. To manage risk, stop loss coverage is obtained to cover claims that exceed anticipated levels. If claims are below anticipated levels, the plan retains the savings that would have been paid to an insurance carrier in the form of non-refundable premiums. Benefits can be customized to meet the unique needs of the group. When an independent TPA is engaged to administer the plan, claims data can be analyzed to identify chronic conditions and other key cost drivers. Services such as telemedicine and mobile transparency tools can be added to make physician access more convenient and more affordable. From plan design to data analysis, everyone benefits from the flexibility that a self-funded plan can provide. It’s the biggest reason why more small and mid-sized companies continue to move to self-funding with help from an independent TPA.
In a recent legislative update from SIIA, it was noted that the New Jersey Department of Banking and Insurance (DOBI) approved regulations lowering minimum stop-loss attachment points for large groups of 51 lives and above, effective in late August.
This move allows the large group individual attachment points to be $20,000 per individual, reduced from $25,000 and sets the minimum aggregate attachment point at 110% of expected claims, down from 125%. These changes broaden the levels of stop-loss or excess risk coverage available to self-funded health plans and brings New Jersey’s definition in line with the NAIC Stop Loss Insurance Model Act.
An analysis by FAIR Health, an independent nonprofit that reviews health and dental claims led by individuals, shows that severe allergic reactions to foods like peanuts have increased five-fold in the past 10 years. Studies now show that as many as 8% of children have a food allergy, with nearly 40% reflecting a history of severe reactions. More than a fourth of all claims were linked to peanuts, while tree nuts such as walnuts, pistachios and seeds accounted for 18%. One interesting fact is that a third of all claims were in people over the age of 18.