What the Pandemic Has Taught Us

pandemicWhether you’re a TPA, broker, employer, plan member or healthcare provider, the past year has been unlike any other. While adapting has often been difficult, some of the lessons learned can have a positive impact on employee healthcare in the future. Here are a few to consider as you begin your planning for the coming year.

Open Enrollment

According to the IFEBP, 1 in 5 companies handled open enrollment differently in 2020, with many using virtual benefit events. Virtual benefits meetings can be viewed by members from any location at any time. In addition, members can easily share their benefits information with a spouse or family member, something that cannot be done with traditional in-person events. Many used short video introductions and important details were typically made available on secure online employee portals following the virtual event. Offering a dedicated email address, phone line or online chat option can make it easy for members to ask questions.

Telemedicine

Think for a moment that Cleveland Clinic delivered 1.2 million virtual physician visits in 2020, compared to just 37,000 in 2019. Even after resuming in-person appointments, 30% to 40% of all visits at Stanford Health Care are virtual and while physicians and patients say there is certainly room for improvement, nearly 3 of 4 patients say they are likely to choose a video consult over in-person in the future. While many physicians say they would prefer to use telehealth visits to manage chronic diseases, many cite low or no reimbursement and technology challenges on the part of their patients as the biggest obstacles to its continued use.

Health Benefit Value

One challenge that remains even as the threat of Covid-19 lessens is the rising costs facing employer-sponsored health plans. Research from the Kaiser Family Foundation and The Hartford show a decline in the perceived value of health benefits by plan sponsors and members. These trends can only change as personal service improves and the barriers standing in the way of healthcare cost transparency are overcome.

As an independent TPA, we place the needs of your health plan and members first by providing personalized service and striving to eliminate costly conflicts of interest that have plagued our healthcare system.

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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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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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Pushing Doctor Visits

on-site-clinicWith many patients still worrying about contracting COVID-19 by visiting a doctor or pharmacy, large healthcare organizations are sponsoring ad campaigns encouraging people to return to their medical providers. Print ads, TV commercials and social media ads tell people that returning to their doctor for regular checkups, emergencies or diagnostic tests is not only important, but safe due to strict cleaning routines and office protocols that eliminate shared waiting areas. Providers and payers fear that leaving conditions untreated will result in more serious and costly medical concerns in the future.

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Calls for Expanded COBRA Coverage

self-fundingWith nearly 40 million workers laid off or furloughed as a result of the Coronavirus, many organizations have urged Congress to expand COBRA coverage. Most of their concerns are focused on encouraging Congress to subsidize COBRA premiums for these workers so that existing health conditions will not get worse because care is delayed.

To date, the Department of Labor and the IRS have extended the time period workers have to decide to enroll in COBRA. With the President’s order setting the end of the national emergency for COVID-19 at June 29th, individuals would have until August 28th to enroll in COBRA. DOL and IRS have also given workers 30 days beyond the end of the national emergency to pay their COBRA premiums for March, April, May and June. Should the Administration decide to extend the national emergency, these timelines would be adjusted accordingly.

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Older Workers and Medicare

It’s doubtful that many technology companies are concerned about employees nearing age 65. Other employers, however, may want to brush up on Medicare eligibility in order to help older workers understand their options and avoid any potential gap in coverage. Here are just a few Medicare-related concerns:

  • For employees who will lose access to employer-sponsored group health coverage at age 65 or who choose to sign up for Medicare upon becoming eligible, the Initial Enrollment Period (IEP) is 3 months before to 3 months after the month they turn 65.
  • Medicare-eligible workers who leave employment with a retiree health plan or COBRA coverage are classified as “former workers” and therefore need to enroll in Medicare during their IEP.
  • Employees who have enrolled in Social Security before their 65th birthday will automatically be enrolled in Medicare Parts A and B. In order to avoid paying for 2 health plans, they may need to inform the Social Security Administration that they do not want Medicare Part B at this time.
  • Finally, for companies with fewer than 20 employees, Medicare becomes primary coverage. Workers and/or their spouses who are 65 or older must enroll in Medicare Parts A & B.

While employees must enroll in Medicare on their own, a little help from HR can go a long way. When questions about Medicare eligibility and enrollment arise, never hesitate to encourage a visit to a local Social Security Administration office or Medicare.gov.

Surprise Bills

A survey of individual healthcare consumers shows that the lack of cost transparency is taking a big toll, with more than half of respondents saying they have passed on doctor visits or prescriptions because of cost. The vast majority of those foregoing treatment cite the cost of higher deductibles and copays as the top concern along with consistently rising prescription drug costs.

Should Employers Care About Student Loans?

A Study by TIAA and the MIT Age Lab shows more than 44 million Americans account for some $1.5 trillion in outstanding student loans. Most borrowers are students, but surveys show that plenty of parents and family members are on the hook as well. While their circumstances vary, all are dealing with some level of financial stress.

Fortunately, an increasing number of employers are taking a more holistic view of wellness. And while most have long recognized the connection between stress and lost productivity, many are waking up to the fact that financial pressures are contributing to the stress.

Financial Education to the Rescue
SHRM says that to deal with the growing problem, more companies are enlisting the services of financial advisors. While counseling won’t directly attack their debt, it often helps families learn to cope with the problem. More large employers are allowing employees to convert a portion of their unused paid time off to debt reduction.

As an employer, anything you do to help will contribute to the overall financial well-being of your people. Just like other components of your wellness strategy, making employees more financially secure will enhance their overall quality of life while improving the culture and productivity of your organization.

Moving Patients Can Be a Win-Win

From hospitals to insurers, you’ve probably heard many say that the goal is to provide the right healthcare, at the right time, in the right place. When it comes to the infusion of high-priced specialty drugs, location can make a huge difference. As an example, the variance in the cost of hospital-administered multiple sclerosis drugs can be staggering. One third party administrator saved a self-funded health plan more than $30,000 by moving a patient from a local hospital to a beautiful treatment facility in the Cayman Islands. The patient not only received their prescription in a beautiful, clean, state-of-the-art facility, but air travel and lodging were included.

Other cases compare the administration of specialty drugs in independent physician offices and patient’s homes rather than hospital outpatient settings. Savings ranged from $16,000 to $37,000 annually and the patient received the same level of personalized care without the hassle of a hospital visit. While the patient’s condition and circumstances always take precedence, finding a more appropriate location for treatment can make a positive difference for the plan and the patient.

Using Social Media More

The Binary Foundation reports that more than half of surveyed adults have used social media networks to search for healthcare providers – a six-fold increase since 2017. More important, 75% of respondents were influenced by online ratings and reviews, with many calling these reviews somewhat or very reliable. Only 9 percent said they do not use online platforms when selecting a provider, compared to 48% in 2017.