While price transparency rules have taken effect, the provision intended to make hospitals and health plans display healthcare costs in an easy-to-compare web based format has been delayed in order to allow hospitals to focus on the demands of the pandemic. Nonetheless, experts see some benefits in the ongoing quest to identify the cost of patient care.
The No Surprises Act, also in effect this month, continues to be challenged as several provider-based associations have filed lawsuits to change the way arbitrators will decide how much insurers will pay toward out-of-network bills. Regardless of how these suits play out, health plans and consumers are expected to benefit.
The 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.
According to a survey of healthcare professionals by Klas Research, telehealth visits have leveled off at about 20% of all healthcare appointments. While telehealth services are still used frequently for primary care and behavioral health, the percentage of telehealth visits is considerably lower than it was during the early phase of Covid-19.
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.
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.
With healthcare costs expected to rise by some 6.5% this year and growing concerns over hospital price transparency, many employers are open to new ideas. Some who have looked at Self-Funding or Reference Based Pricing (RBP) in the past are now revisiting these options in an effort to keep healthcare affordable for their organization and their employees.
Alternative ways of funding employee health benefits have always been a concern for HR directors, charged with helping employees adapt to change. The fact is that these strategies are becoming more and more widespread every year. In most cases, moving away from a fully insured plan with a traditional PPO can often result in a health plan that is not only stronger but more cost-effective as well. If your broker has failed to speak with you about self-funding or reference based pricing, contact us to learn more.
Whether 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.
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.
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.
As 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.
When 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.
With 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.