Will New Healthcare Laws Help?

healthcareWhile price transparency rules have taken effect, the provision intended to make hospitals and health plans display healthcare costs in an easy-to-compare web based format has been delayed in order to allow hospitals to focus on the demands of the pandemic. Nonetheless, experts see some benefits in the ongoing quest to identify the cost of patient care.

The No Surprises Act, also in effect this month, continues to be challenged as several provider-based associations have filed lawsuits to change the way arbitrators will decide how much insurers will pay toward out-of-network bills. Regardless of how these suits play out, health plans and consumers are expected to benefit.


Why Are HSAs So Under Utilized?

hsaThe trade association, America’s Health Insurance Plans, reports that of the 22 million Americans who own Health Savings Accounts, more than half have not contributed in over a year. More discouraging is that while about a third say they can’t afford to contribute, even more say they haven’t even considered it. This would cause one to believe that the majority of people who have this tool at their disposal simply do not understand its many benefits.

Unlike Section 125 accounts, unspent HSA balances carry over from year to year. Offering a triple tax advantage, qualifying contributions are made pre-tax, earnings accumulate tax-free and withdrawals are made tax-free as long as funds are used to cover qualified medical expenses. The ability to carry unspent balances forward makes an HSA a great retirement planning tool since funds can be used to pay for more than healthcare once the member reaches retirement age.

At a time when financial wellness offerings are in demand, it would seem that Health Savings Accounts are a gift that keeps on giving. Rather than positioning your HDHP/HSA option in the back of your enrollment kit, promote it as a valuable benefit that can help cover healthcare costs to and through retirement.


High Praise for Telemedicine

telemedicineAccording to the Employee Benefits Research Institute and Greenwald Research, the percentage of adults saying that telemedicine has become extremely important to them increased from 7 to 17% in the last four years. Even more impressive, nearly 75% who used telemedicine said they were satisfied or very satisfied. One caveat – 62% of respondents reported that their telemedicine visit was with a provider they knew from an existing relationship or a prior visit.

Throughout the pandemic, telehealth has offered a safe, effective way to deliver highly personalized, quality medical care. With a lower cost than in-person visits and the potential to satisfy the public’s need for speed and convenience, there is little doubt that employer sponsored health plans will continue to embrace telehealth beyond the pandemic.


High Quality Health Plans Solve Problems

high-quality-health-plansAt a time when so many businesses are struggling to find and retain workers, it’s important to remind ourselves that health benefits are far more than a line item on your profit and loss statement. Recruiters consistently point out that most job seekers will accept a lower salary if a company offers a great benefits package. When it comes to engagement, few things drive loyalty and performance like a company culture based on caring for employees. Higher productivity and lower absenteeism typically follow.

When stress levels are elevated as they have been for quite some time, your health plan can be both a motivator and a cost saver – especially when your plan is self-funded. Strategies such as reference based pricing and direct contracting provide opportunities for significant cost savings while plan designs can be adjusted to address the needs of your employee population. This is especially important coming out of a period when many people have delayed or skipped care due to Covid-19 lockdowns or out of pocket costs they simply couldn’t afford.

Information and Communication are Key

By consistently analyzing claims data, we keep clients informed not only on large claims and challenges like specialty drugs but on steps they can take to control the costs associated with chronic conditions such as hypertension and diabetes.

Accenture’s Healthcare System Literacy index shows that the number of employees unable to make informed choices about their care continues to rise. When people don’t understand their benefits, they lack the confidence needed to navigate a complex healthcare system and inappropriate treatment and higher costs often result. Even though tools to monitor certain health conditions and compare providers based on cost and quality keep coming, not everyone has the tech savvy needed to benefit from them.

As a result of the pandemic, much has been done to help employees through the enrollment process, however the plan they select needs to help them all year long. Whether ongoing support is provided by a nurse navigator program or an expert customer support team, there must be a greater emphasis on customer service and communication. When designed and administered with your business objectives and employees in mind, a high quality self-funded plan will contribute as much to the health of your business as it does the wellbeing of your employees.


Is Your Health Plan Delivering Value?


The American Benefits Council reports that employer-sponsored healthcare plans deliver a healthy return on investment for U.S. taxpayers. In fact, the Bureau of Economic Analysis and Joint Committee on Taxation say in 2019, every dollar U.S. companies saved due to tax exemptions resulted in $5.34 spent on employee healthcare.

For plan sponsors, there is no question that their plan members receive value. Virtually all health plans provide much stronger benefits than members could afford on their own. What about your plan? Are there steps you can take to achieve greater value for your organization and your people?

Time for Examination

While COVID is still concerning, this is a good time for close examination. One strategy yielding cost savings and quality outcomes for many self-funded plans is the use of Centers of Excellence (COE). These programs, often focused on specialized care such as joint replacement surgeries, cardiovascular procedures and maternity care, may prove very valuable as people pursue screenings and treatments that were delayed during the pandemic. You don’t have to be a Fortune 500 company to pursue a COE program. Knowledge of the local provider land- scape and value-based claims expertise enable your TPA to pursue these and other opportunities on your behalf.


Help for Smaller Groups 

An analysis released by the Urban Institute and the Robert Wood Johnson Foundation shows that even though small businesses were hardest hit by the pandemic, the vast majority of those that survived were able to maintain health benefits. Nonetheless, maintaining health benefit programs has been increasingly difficult for small employers, especially in industries such as travel and hospitality. 

One option that small groups continue to find workable is level funding, which offers self-funded features like lower premium taxes, plan design flexibility and access to valuable claims data. By including stop-loss insurance, level funded plan sponsors can establish a monthly budget for health benefits. Stop loss reimburses the plan when claims exceed employer funding but in contrast to fully insured options, the plan retains the savings when claims are lower than anticipated. If your organization is searching for a way to attract and retain workers in a tough job market, talk to us to learn more about level funding. 


Quality Health Benefits Can Be Affordable

health-benefitsLast Fall, COVID-19 was weighing so heavily on our minds that simply keeping health benefits available during the Pandemic was the top priority. Today, with many people needing medical care they may have postponed and pressure to maintain sufficient staffing, keeping your health plan both effective and affordable is a must.

The fact is that after a year unlike any other, your organization needs to huddle with its broker/advisor and TPA to do all it can to fight back against rising healthcare costs. Remember that your organization transitioned to self-funding to take control of rising costs and gain the flexibility needed to compete successfully in a rapidly changing world. So, with 2022 right around the corner, let’s revisit a few steps that could keep your organization on the path to high quality, affordable healthcare.

Question Everything – For self-funded employer groups, there are no off the shelf plan designs. When a plan year was successful, we want our clients to know what made the difference. If claims were higher than expected, we help you understand where your healthcare dollars went and what your plan can do to bend the curve.

Be a Disruptor – Annual rate increases of 5 to 7 percent should never be accepted as being par for the course. Solutions to rising costs are in your claims data and the right advisors can help you explore new options. Carve-outs for Specialty Pharmacy and Referenced Based Pricing are just two of the ways we’re helping health plans achieve significant savings.

Blocking & Tackling – Monitoring claims and utilization data day in and day out takes industry-leading technology and skilled claims analysts. Digging deeper into claims will help your plan uncover billing errors and find hidden revenue in your health plan.

Communicate, Educate, Advocate – Because managing the cost and quality of employee healthcare is a year-round responsibility, we do our best to keep employers, plan members and broker advisors informed and supported throughout the year. This is especially critical given the costs associated with chronic healthcare conditions and the rising frequency of high-dollar claims.

These measures may not be new, but when implemented consistently, they will produce significant savings, not only for your health plan but also for the members your business depends on.


Goodbye Haven, Hello Morgan

Only a few months after Amazon, JPMorgan Chase and Berkshire Hathaway ended their “Haven” healthcare experiment, JPMorgan Chase introduced a new unit dedicated to collaborating with outside organizations to accomplish its healthcare objectives. Morgan Health is expected to partner with leading health plans and provider groups to improve access, quality and cost for its nearly 300,000 employees and dependents.