Lower Blood Pressure and Lower Costs

286785548HRThe CDC reports that compared to heart healthy workers, those with heart disease cost health plans a week of absences plus $1,100 in lost productivity per year. Controlling high blood pressure is a huge part of maintaining heart health. It can reduce health risks associated with conditions such as sleep apnea, diabetes, cardiac arrhythmias, elevated blood cholesterol, obesity, heart failure, kidney disease and other related conditions.

Confirming that heart disease is still the number one cause of death in the U.S., the CDC states that nearly half of all adults have high blood pressure. Sadly, less than one in four has their blood pressure under control. With February being American Heart Month, take time to educate employees on the risk of heart disease and the need to get their blood pressure under control. It can make a huge difference in their quality of life and everyone’s cost of healthcare.

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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.

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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.

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Lyft to the Doctor?

In response to a 2019 study showing that millions of patients fail to receive required medical care due to a lack of transportation, ride-sharing company Lyft is partnering with sponsoring

healthcare organizations to let patients request rides for non-emer- gency medical appointments, vaccinations or prescription pickups. While the company tried this previ- ously with employers covering the cost for employees, these “Lyft Passes,” similar to those used to provide rides to and from Covid-19 vaccinations, would be sponsored by health plans including Medicare and Medicaid.

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Price Transparency Rules Issued

90-price-transparencyNew guidelines issued by CMS earlier this Spring state that all files uploaded by health plans and insurance carriers must be in formats the public can use. Before issuing this guidance, some files included coding that kept Google and other search engines from indexing names and prices listed by hospitals on their websites, making it very hard for consumers to access the data.

The American Hospital Association lost a suit to block the rule on the basis that HHS lacks the authority to oversee its regulation and such rates are not useful to consumers. According to CMS, hospitals are expected to comply  with these requirements to provide pricing information that is searchable and accessible without barriers.

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Regs Coming for No Surprise Billing Act

regs-erWhile former President Trump signed the No Surprises Act into law as part of the Consolidated Appropriations Act of 2021, CMS is still working on regulations that will become effective for insured and self-funded health plan years that begin on or after Jan. 1, 2022. Implementing this law will be interesting, experts say. While many of its provisions were designed to protect people from getting unexpected bills for care from out-of-network providers at in-network hospitals and surprise bills from out-of-network emergency care providers including air ambulance services, many types of bills that “surprise” consumers may indeed be outside the scope of the Act.

There are other concerns as well. One of these is a part of the law that requires health plans and out-of-network providers who disagree about charges to seek arbitration. Another is a provision that lets some providers offer care on an out-of-network basis if they advise the patient about potential billing and get a consent form signed. Even though there will be challenges to work through once the law is implemented, policymakers are confident that the No Surprises Act will be a great help to consumers.

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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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HSA Limits Increase for 2021

stethoscope and moneyInflation-adjusted limits for contributions to health savings accounts and high deductible health plans for the coming year were just announced. According to the announcement, eligible individuals with self-only HDHP coverage will be able to contribute $3,600 to their HSA in 2021, an increase of $50 from 2020. Those with family coverage will be able to contribute $7,200 in 2021 and those who are 55 years of age or older will be able to make an additional “catch-up” contribution of $1,000 to their HSA.

While minimum deductibles for HDHPs will remain the same for 2021 plan years at $1,400 for self-only coverage and $2,800 for family coverage, the maximum limits for out-of-pocket expenses will increase to $7,000 for individual coverage and $14,000 for family coverage.

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How a Premium Dollar Is Spent

premium-dollarAmerica’s Health Insurance Plans, a national trade association whose member companies provide insurance coverage and health-related services to consumers and businesses, has released a study revealing the breakdown of today’s healthcare premium dollar, as follows:

  • 23.3 cents of every premium dollar is used for prescription drugs
  • 22.2 cents cover the cost of physician services
  • 20.2 cents are used to pay for office and clinic visits
  • 16.1 cents are used to cover hospital stays
  • 13.5 cents are applied to care management, administrative expenses, business expenses, provider management and other fees
  • 4.7 cents of every dollar go to taxes, and…

AHIP reports that on average, 2.3 cents of every premium dollar make it to the bottom line as net profit.

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Federal Judge Derails New Association Health Plans

judgeAs reported by The Phia Group on March 29, 2019, a federal judge in Washington, D.C. ruled that the new Department of Labor rules expanding the marketing of Association Health Plans (AHPs) violate existing law. TPAs, brokers and employers see this as a significant blow to AHPs, especially new self-funded AHPs that have been preparing to launch on April 1, 2019.

Federal Judge John Bates sided with several states that took issue with the DOL’s final rules several months ago, arguing that a broad availability of AHPs is not within the scope of ERISA, which defines an employer as having at least two or more employees. The final rules were going to allow small employers, including working business owners (employers of one), to join with others based on either common geography or industry affiliation to form an AHP. It appears that the Judge’s ruling means that both criteria, geography and industry affiliation, must be met and that qualifying employers must have a minimum of two employees.

Thus far, we are not aware of any response filed by the DOL. We will continue to monitor reactions to the ruling and other developments regarding Association Health Plans.