Member Education: A Year-Round Job

member-educationAs a health plan sponsor or HR professional, you’ve no doubt witnessed the introduction of new tools or applications intended to help plan members become better healthcare consumers. Unfortunately, these efforts often fall a little short of expectations. After decades in self-funded health plan administration, we can say that while these programs were well designed, the education associated with them was not.

Today, a health plan cannot achieve company objectives unless members buy into the utilization strategies. What can a plan do to engage members in ways that will make a difference? Education and incentives can be a winning formula – here are a few ideas.

    • From coping with Covid-19 to open enrollment, employers were forced to communicate differently in 2020. Company-wide gatherings and annual health fairs were replaced by more frequent zoom conferences and digital events. As a result, employers trimmed content and focused on critical topics. While personal meetings will likely return as the fear of gathering subsides, the lessons learned in the past 10 months will improve employee education in the future.
    • Regardless of how your plan chooses to incentivize members, rewards must be tied to member engagement. One option is to share plan savings with members who lower claim costs by choosing high quality, low-cost providers. This often requires that the plan negotiate in advance with hospitals or centers of excellence that are efficient for certain procedures. Giving a member a percentage of the savings realized by the plan can go a long way to boost overall engagement.
    • Some plans reward members who consult with HR before selecting a healthcare provider for an elective procedure. This helps members use their benefits to their best advantage and controls overall plan costs.

Regardless of how you proceed, it’s important to realize that education requires time to plan and resources to execute. Whether you choose virtual lunch and learns, monthly podcasts by HR or something different altogether, it takes repetition to make a positive difference.

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Rules for Pooled Plans

healthcareAs a way to give small businesses the opportunity to offer their employees a workplace-based retirement savings option that is easy and inexpensive to maintain, the Department of Labor moved to establish rules for Pooled Employer Plans or PEP. According to the law, pooled plan providers will need to register with the Labor and Treasury secretaries in advance and once registered, can begin operating PEPs as early as January 1, 2021. The goal for the option, which was made possible by the Secure Act of 2019, is to make saving for retirement cost-effective for more employees throughout the U.S.

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PBMs for Better or Worse

variouspillsWith enrollment in Medicare Part D and specialty drug costs exploding, it’s no surprise that forecasts predict 7 percent annual growth for PBMs over the next several years. Two trends noted in the report were the continued acquisition or startup of PBMs by insurance carriers and the need for employers to better understand their options when comparing proposals.

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What to Expect from Virtual Health

sip-telehealthResearchers define virtual health as continuous, connected care delivered using digital and telecommunication technologies. Healthcare consumers can think of virtual health as telemedicine and video doctor visits, remote patient monitoring, asynchronous communication, medication adherence and provider-facing solutions such as virtual consults and second opinions.

To consider the future impact of virtual health, the Deloitte Center for Health Solutions surveyed clinicians and healthcare executives, with most agreeing that a fourth or more of all outpatient, preventive and long-term care will move to virtual delivery over the next 20 years. Physicians expect to be spending more time in face-to-face interactions with their patients as virtual assistants handle appointment scheduling, prescription orders and transfer of clinician notes into electronic medical records. Nearly 75 percent of respondents see improved clinical outcomes resulting from home-based monitoring and faster, easier access to health plan information helping members and providers alike. Finally, patients can expect virtual physician visits to save them valuable time compared to physical office visits.

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Anyone Can Lower Stress

woman at deskIf 2020 wasn’t everyone’s most stressful year, it has to rank among the top for sure. From hardship created by the Coronavirus to unrest in our biggest cities, virtually everyone’s routines have been disrupted. Whether you’re working from home or transitioning back to the office, here are some steps you can take to improve your mental health.

Mini-Meditation: Even 5 minutes of meditation can help erase negative thoughts and improve your attitude. The people around you will benefit from your improved mood too. If you want something to clear the mind, there are plenty of apps you can access with your mobile device.

Try Tangibles: Meetings and projects will always be there, so why not designate one 10 to 15 minute time slot to turn off your digital devices and do something different. Write a note or journal entry, make notes on a new project or pick up the phone and call a friend or family member just to say hello.

Celebrate Success: Whether you take a few minutes to recognize an accomplishment of your own or congratulate a co-worker on a recent achievement, make “bravos” a small part of your week. Celebrating or sharing our accomplishments can go a long way, especially in challenging times.

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Is Reference Based Pricing Saving Money?

healthcareWhen the independent think tank finds that on average, prices paid to hospitals by younger, healthier policyholders were 100 percent higher than what Medicare would have paid for the same procedures, it’s easy to understand the impact that payment contracts based on what Medicare pays can have on health plan costs.

In contrast to traditional fully insured plans, self-funded health plans with reference based pricing (RBP) enable consumers to learn the cost of treatment before they receive it. This is the advantage of basing provider payments on publicly available cost and quality data rather than arbitrary network discounts. And because Medicare varies its pricing by geographic region, providers are compensated fairly, and medical price inflation can be controlled.

From Big to Small

While very large employers were early adopters, the model is becoming far more commonplace among smaller groups that partially self-fund. TPAs are helping some of these plans realize overall savings in the 20 percent range and for a plan with 300 members, this can mean annual savings of $1 million or more.

In a marketplace that has lacked transparency and accountability for far too long, Medicare reference is proving to be not only a market disruptor, but an approach that can help employer-sponsored health benefits thrive. Contact us if you want to learn more about how a RBP plan could work for you.

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Orders to Cut Drug Costs

In an effort to revive an important promise made to the American people prior to his election in 2016, President Trump recently signed 3 executive orders aimed at bringing the cost of prescription drugs more in line with what consumers in other countries pay. One order, directed at Medicare Part D plans, would require that PBMs pass discounts or manufacturer’s rebates directly to consumers rather than to their health plans.

A second order would permit individuals to import lower cost drugs from other countries, including Canada, and re-import insulin. The third order is intended to provide uninsured or underinsured individuals with life-saving medications such as insulin and epinephrine. It is doubtful that these executive orders will yield any immediate relief to consumers since legislative bodies and federal agencies will need to follow government protocols in order to put the orders into practice.

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How Healthy Are We?

According to the 2019 edition of the Bloomberg Healthiest Country Index, the United States ranks 35th among 169 recognized by the World Health Organization. This was one position lower than the U.S. earned in 2017. Spain surpassed Italy to become the world’s healthiest country and four other European nations ranked in the top 10. While Japan was the healthiest Asian nation, China dropped from 51 in 2017 to 53 in the 2019 rankings. Based on data provided by the World Health Organization and the United Nations Population Division, the index evaluates health factors and risks including behavioral concerns, environmental characteristics and more.

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Regulating Off-Duty Conduct

When you consider that laws governing travel and social distancing vary from state to state, with a couple having no such laws at all, determining how your organization will regulate and discipline off-duty conduct is very challenging. And when an employee travels to another state that has different laws, which take precedence? Some experts have compared this debate to employer’s efforts to regulate employee use of social media, but it seems that how you regulate social media activity is much different than carrying out your responsibility to keep employees and working conditions safe during a public health emergency.

Given the fact that states have established their own guidelines, an example of an employee who traveled out of state to participate in a large public gathering can present a big challenge. While one employer might decide to quarantine the employee upon return because the gathering violates laws where the person lives and works, another might prefer to act in accordance with a less restrictive law that exists in the state where the gathering took place. Given the complexity of the COVID-19 pandemic, many will likely look beyond the laws and act in a manner consistent with their duty to keep their workplace safe for all employees.

One thing most employers and attorneys seem to agree on is that like so many employment issues, determining an appropriate course of action in matters such as these often comes down to whether or not your organization has a policy in place and how that policy has been communicated to employees.

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Approving a Vaccine

vaccineGuidance recently released by the FDA outlining conditions for approving a Covid-19 vaccine includes a 50 percent benchmark, meaning that any vaccine must be at least 50 percent more effective than a placebo in preventing the disease. This is the same benchmark used annually to approve flu vaccines. In the announcement, Commissioner Stephen Hahn told a Senate panel that the FDA would not approve a vaccine for the general public without clinical evidence that it is both safe and effective.

In accordance with established FDA guidelines, an emergency authorization can move much quicker than a typical full approval, but would still require the vaccine maker to show through clinical studies that the vaccine produced lower levels of disease. Several clinical studies are underway, with one manufacturer having just initiated clinical testing by 60,000 adults.

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