Are Costs Really Beyond Anyone’s Control?

In at least one big city, a major carrier is providing 100% coverage to public employees for MRIs, CT Scans and other imaging services only when free-standing, non-hospital based facilities are used. What do you know? Independent TPAs have been helping self-funded health plans do things like this for years.

Too many people have long considered rising health care costs to be a condition we simply must live with. Fact is there are alternatives, most of which can only be implemented when the plan’s best interests are first and foremost.

Detailed Reporting Needed

In contrast to a fully-insured plan or self-funding with a carrier-owned ASO, using an independent TPA enables the plan to make informed decisions based on detailed reporting – reporting that the plan owns.

There is no secret to controlling plan costs. It requires discipline and the tools to monitor individual parts of the plan, such as prescription drugs, imaging, chronic disease management and more. Analyzing expenditures such as these can yield huge savings over the course of a year, but only when your administrator is free of carrier or provider affiliations. Having checks and balances in place can make all the difference.


CMS Modifies Bundled Pay Requirements

hospital workersWhile hospitals in 34 geographic areas will still be required to participate in the Comprehensive Care for Joint Replacement Model, hundreds of acute care hospitals in other areas have received a reprieve. In addition to modifying CJR model compliance, CMS recently finalized plans to cancel the Episode Payment and Cardiac Rehabilitation Incentive Payment Models, both of which were scheduled to become effective on January 1, 2018.

While a number of hospitals will voluntarily participate in the CJR model and others have expressed interest to participate in the two cancelled models, the agency said there would not be enough time to restructure the models prior to the planned 2018 start date. Even though some have criticized the Trump administration for a lack of interest in value-based care, the administration has expressed a strong commitment to value-based payment, but says it prefers voluntary models.


Latest Happenings in Today’s World

Benefits Linked to Loyalty

A 2012 report by Aflac WorkForces shows undeniable evidence linking benefits offerings and employee loyalty. When asked what their current employer could do to keep them in their jobs, 49% answered, “improve my benefits package.” Employees who are extremely or very satisfied with their benefits program are 9 times more likely to stay with their current employer than those who are dissatisfied with their benefits program. Continue reading

How To Save On Prescription Drug Costs

Health care costs, which include everything from hospital and doctor bills to the cost of pharmaceuticals, home health services, etc., consume more than 16% of the nations economic output. At the current growth rate of over 7% per year, costs can be expected to consume almost 20% in the near future. Prescription drugs represent the most rapidly expanding component of health care expenses, with a double digit rate of inflation approaching 11%.   Continue reading