Encouraging members and their dependents to take their prescriptions as directed by their doctor or pharmacist has long been a concern for health plans. As the Covid-19 pandemic continues to spike in most parts of the country, the problem has intensified, with experts estimating that the increased cost to our healthcare system may be nearly $300 billion annually.
Traditional challenges of rising costs and a failure to read and understand health information have been exacerbated by the fear of in-person doctor visits. Overcoming these issues requires increased communication and support because there is no doubt that when people fail to take their medications as prescribed, health plans often end up dealing with higher claim costs down the road.
A Higher Level of Support
Providing a high level of support can help many members avoid serious medical complications in the future. Collaborating with a PBM or member advocate to send a text message when a refill is due can be a big help. Some plans offer a lower copay as an incentive to fill prescriptions on time.
Taking the time to understand a member’s needs and concerns can go a long way in increasing medication adherence. While concerns about using generic alternatives, copay assistance programs and transportation are common, addressing language barriers, disabilities and other social factors are measures that can make a big difference. Providing a higher level of support will not only produce higher quality outcomes, but lower pharmacy benefit costs as well.
With behavioral health conditions impacting one in five Americans, it’s no wonder we’re seeing more employers search for ways to provide members with better access to behavioral healthcare benefits.
Statistics show that many employees, including some that are insured, fail to get the mental healthcare they need. Because self-funded health plans provide plan design flexibility, some plans are taking bold steps to address this growing need. While many are using telemedicine to improve access and lower costs, some employers are treating out-of-network behavioral health treatment as in-network, enabling employees to pay the same amount for treatment regardless of which provider they use. Others are covering out-of-network behavioral healthcare services even when their plan doesn’t cover out-of-network services for other types of care.
When you consider that mental illness has become the greatest cause of disability claims in the U.S., it is not surprising that employers are looking for ways to help employees obtain the care they need.
Significant Action is Warranted
There is plenty of research to show that Americans are not getting the mental healthcare they need. According to Mental Health America, despite having health insurance, 56.5% of adults with mental illness received no treatment in the past year.
Another problem is that behavioral health treatments are rarely classified as primary care, and are regarded instead as specialty treatment. This makes people find an in-network provider, go out-of-network, pay higher out-of-pocket costs or avoid treatment altogether. Claims data from Collective Health shows that more than 40% of the 2017 behavioral health spend was out-of-network, which is many times the amount spent on primary or preventative care.
With the Supreme Court decisions and regulatory challenges of 2015 behind us, it’s time to catch your breath and resolve to take better control of your health care benefit plan. Here are a few things to think about as you contemplate the New Year.
Look at TeleHealth – Many companies, large and small, have added telehealth to their healthcare plans in order to provide plan members with easier access to care. Email, smart phones and video physician consults are being used with increasing frequency to bring patients and physicians together in more cost efficient settings.
Employee Well Being – Concerns about the impact of chronic disease on plan costs and employee well being have encouraged more and more employers to introduce worksite wellness. From various forms of health promotion to disease management, these programs can foster better health, help prevent chronic disease and ensure appropriate medical treatment for those with chronic conditions. To learn more or to determine what type of wellness program can impact your cost drivers, talk to us today.
Network or Not – If providers in your area are comfortable with pricing tied to an index, such as Medicare, reference based or “cost plus” pricing is an alternative that can deliver significant savings and true cost transparency. Depending on the makeup of your group and your community, direct contracting with a hospital or provider group could be another win-win. In certain areas, options such as these are proving more effective at containing costs than traditional PPO networks.
Transparency Tools – Speaking of cost transparency, we’d be happy to speak with you about “Real Time Choices”, a new mobile app from AHDI that we are helping employer groups implement. With a website and mobile app displaying easy to follow “traffic light” graphics, Real Time Choices enables members to compare prices for more than 200 common health procedures. It’s a system that gives members data to make informed decisions – convenient access to data members have always lacked.
Still looking for that one good idea? How about managing diabetes better? “Real Time Health,” another AHDI product, includes a cellular based glucometer and a 24/7 care support system designed to encourage and motivate members to do what’s needed to control their condition. Managing at-risk groups, such as diabetics, is one way you can improve lifestyles and control costs in the New Year.
The Social Security Administration has announced that monthly Social Security and Supplemental Security Income (SSI) benefits will remain the same in 2016.
The Social Security Act provides for an automatic increase in Social Security and SSI benefits if there is an increase in inflation as measured by the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W). As determined by the Bureau of Labor Statistics, there was no increase in the CPI-W from the third quarter of 2014 to the third quarter of 2015. Therefore, under existing law, there can be no cost-of-living adjustment (COLA) in 2016.
Other adjustments that would normally take effect based on changes in the national average wage index also will not take effect in January 2016. Since there is no COLA, the maximum amount of earnings subject to the Social Security tax remains at $118,500 for 2016.