15 states where $1M in retirement savings lasts the longest

According to GOBankingRates data, employees with $1 million in retirement savings can make it last for more than 20 years in Mississippi, Arkansas, Oklahoma and Missouri. Read below to understand what better retirement choices can do for your future.


Employees with $1 million in retirement savings can make it stretch for more than 20 years in Mississippi, Arkansas, Oklahoma and Missouri, according to GOBankingRates data in an article from Business Insider. Retirees in New Mexico, Tennessee, Michigan and Kansas can also live on a similar amount of savings, data shows. Retirees with $1 million can expect their savings to last in average span of 19 years, GOBankingRates estimates.

Less choice could mean better retirement outcomes
The amount of income that seniors can replace in retirement is a good measure to determine whether there is a looming retirement crisis in the U.S., according to retirement expert Mark Miller in this article from Morningstar. However, it is hard to make generalizations, he explains. “I think it varies tremendously, depending which demographic group you’re looking at, you can do it generationally or otherwise,” Miller says.

Retirement requires a shift in thinking
As retirees needs change, they should be ready to adjust their mindset and modify their investment strategies, an expert in Kiplinger writes. Retirees should focus more on preservation and distribution after the accumulation phase, the expert writes. “In retirement, it’s important to think of your savings as income rather than a lump sum. It’s not all about achieving maximum return on investment anymore," the expert says. "It’s about how you can get the maximum return from your portfolio and into your pocket."

Employees nearing retirement? 12 features to look for in their next home
Seniors who intend to move to a new home in retirement should consider a property that offers low yard maintenance, a single-story open floor plan and easy access to loved ones and essential amenities, according to a Forbes article. They should ensure that the new house is cheap to maintain and won’t trigger a hefty tax bill, says one expert. “If those costs are low, it can be a great investment.”

SOURCE: Peralta, P. (15 August, 2019) "15 states where $1M in retirement savings lasts the longest"(Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/states-where-retirement-savings-will-last-the-longest


Employers shouldn’t fear expansion of Medicare

A new survey from the National Business Group on Health found that 55 percent of large employers support a Medicare expansion that's limited to older Americans. In this article from Employee Benefit Advisor, Nison discusses the potential benefits and downfalls of an expansion to Medicare.


Like a significant chunk of American voters, a majority of large employers want to expand Medicare. Just not too much.

A new survey of 147 large employers from the National Business Group on Health found that 55% of them support a Medicare expansion that’s limited to older Americans. Only 23% think eligibility should drop to age 50, however, and 45% don’t think it should expand at all. A majority believe that a broader “Medicare for All” plan would increase health costs.

The same survey also highlights why employers should consider coming around on health reform that reduces their role in the system. The growth in health costs has outpaced inflation and wage growth for years, and the surveyed businesses expect it to rise 5% to $15,375 for each employee next year.

About 70% of those costs will fall on the companies, which plan to try everything from boosting virtual health services to investing in health concierges to rein them in, according to the survey.

History suggests that their best efforts might not amount to much.

Employer-sponsored insurance is America’s single largest source of health coverage. That’s mostly true because the IRS exempted employer health benefits from taxes in 1943, a move that created the federal government’s single biggest tax expenditure. Large companies derive some benefit from the current system because they can provide a significant tax-free benefit that helps them compete for talent and pay people less. But it comes with significant drawbacks. Employers have to devote substantial resources to providing healthcare and controlling costs. Many of them have no particular expertise or advantage in doing so.

The results are mixed. Yes, individuals with private insurance are generally satisfied with the quality of their coverage. They’re not nearly as happy about the cost as deductibles rise. The U.S. pays more than any other developed country for healthcare and medicines and receives worse results on a variety of metrics.

Employers pay particularly high prices and spend heavily on plans that have higher overhead than public alternatives. A recent RAND study found that employer-sponsored plans paid hospitals at 241% of Medicare rates in 2017. Employers are already effectively subsidizing public programs, not to mention the profitability of insurers, health care providers and drugmakers.

It’s not entirely their fault. The American system inherently fragments negotiating power, which gives providers a significant advantage and makes it difficult for even the largest employers to get a good deal. Turning a larger piece of healthcare over to the government would free companies to focus more time and resources on their actual business instead of on navigating the world’s most expensive and convoluted healthcare market.

Big businesses most likely fear big Medicare expansion in large part because it would lead to a significant tax increase. But looking at any tax increase as an enemy is a mistake. Those taxes represent a trade-off; they would replace some or all of the billions of dollars that employers are currently spending on care. Depending on what taxes are imposed and whether the public plan is able to control costs better than the current system — and it could hardly do worse — many employers could come out ahead.

There are a lot of unknowns when it comes to Medicare for All and plans that move the country in that direction. Employers are right to be skeptical until they know more, but the results could well shake out in their favor, and they shouldn’t be so quick to discount the approach.

SOURCE: Nisen, M. (15 August 2019)"Employers shouldn’t fear expansion of Medicare" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/articles/employers-shouldnt-fear-expansion-of-medicare

 


Employer-sponsored savings programs could be the future of financial wellness

Do you have money set aside for emergencies or unexpected expenses? Forty-three percent of hourly workers report having less than $400 in savings set aside for emergencies. For these workers, an accident or unexpected expense can be financially devastating. Read this blog post to learn more.


For 43% of hourly workers who report having less than $400 in savings set aside for emergencies, an accident or unexpected expense can be financially devastating.

But employer-sponsored savings programs could be a viable solution. Low- and middle-income employees who are more financially secure have been shown to be less stressed and more productive when they have an employer-sponsored savings program, which may lead to lower healthcare costs, better customer service and stronger attendance, a new survey from nonprofit organization Commonwealth finds.

The national survey of 1,309 employees earning less than $60,000 a year found that employers offering workers savings interventions at the time of raise, can positively impact their employees’ personal finances. Three-quarters of hourly employees surveyed believe that if their employer offered savings options at the time of a raise, they would be less stressed and more confident about their finances.

“There's a lot of talk about financial stress, but when you're really living paycheck-to-paycheck, that stress is about being able to pay your bills on time,” says Commonwealth’s executive director Timothy Flacke. “It's about cash flow, and that's a particularly acute form of anxiety.”

The report analyzes the potential effects of savings programs including split direct-deposit paychecks, low-interest loans and savings accounts — and compares how those programs alleviate employees’ financial stress. Workers surveyed believe if their employer-provided savings tools they would be happier and more productive. Moreover, the survey found individuals with more in savings were less likely to have financial worries than those with little savings.

One of the companies partnered with Commonwealth to link raises with savings is Minnesota-based education company New Horizon Academy. In the beginning of the year, the company piloted a new savings program that gives its employees the option to have the raise diverted through the payroll system to a savings account each pay period, instead of having it go into their normal checking account.

“Through this, our employees are beginning to build up some financial reserves in case of an emergency, or life circumstances that requires them to dip into a savings account,” says Chad Dunkley, CEO of New Horizon Academy. Although it’s too early to state results from the pilot program, the company hopes it will have a positive long-term impact on the financial health of its employees, Dunkley says.

“This is just one of those additional ways [to] stabilize our employees, so they can come into the classroom without the financial stress that certain situations cause when you're not prepared for an emergency, whether it's new tires on your car or health issues,” he says.

SOURCE: Nedlund, E. (19 August 2019) "Employer-sponsored savings programs could be the future of financial wellness" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/news/reduce-stress-increase-productivity-with-financial-wellness


IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met

Recently, the Internal Revenue Service (IRS) released a notice that expanded the list of preventative care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum. Read this post from UBA to learn more.


The Internal Revenue Service (IRS) released a notice, effective on July 17, 2019, that expanded the list of preventive care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum deductible.

UBA-1000-HDHP_Chart2

The services and items listed above are treated as preventive care:

  • only when prescribed to treat a person diagnosed with the associated chronic condition listed in the table’s second column, and
  • only when prescribed for the purpose of preventing the chronic condition’s exacerbation or a secondary condition’s development.

SOURCE: Hsu, K. (20 August 2019) "IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/irs-expands-benefits-that-can-be-provided-before-hdhp-annual-minimum-deductible-is-met


Compliance Recap - July 2019

July was a busy month in the employee benefits world.

The Internal Revenue Service (IRS) released a notice that expands the list of preventive care benefits a high deductible health plan can provide without a deductible or with a deductible below the annual minimum deductible. The IRS also released the indexed affordability percentage for plan years beginning in 2020.

The U.S. Preventive Services Task Force (USPSTF) published an “A” rating final recommendation. The Department of Health and Human Services (HHS) released an update to the notice requirements for plans using the HHS-administered federal external review process.

A U.S. District Court upheld the 2018 short-term, limited-duration insurance final rule. The Third Circuit Court of Appeals affirmed a federal district court’s preliminary injunction regarding contraceptive coverage exemptions.

The Department of Labor (DOL) released an advisory opinion regarding association health plans (AHPs) and multiple employer welfare arrangements (MEWAs). The Fifth Circuit Court of Appeals held oral arguments for the case challenging the ACA’s constitutionality.

HHS and the Food and Drug Administration (FDA) published a Safe Importation Action Plan regarding potential drug importation from other countries.

UBA Updates

UBA released one new advisor: New HDHP Preventive Care Benefits

UBA updated or revised existing guidance:

IRS Expands Benefits That Can Be Provided Before HDHP Annual Minimum Deductible Is Met

The Internal Revenue Service (IRS) released a notice, effective on July 17, 2019, that expanded the list of preventive care benefits that a high deductible health plan (HDHP) can provide without a deductible or with a deductible below the annual minimum deductible.

Preventive Care for Specified Conditions For Individuals Diagnosed with
Angiotensin Converting Enzyme (ACE) inhibitors Congestive heart failure, diabetes, and/or coronary artery disease
Anti-resorptive therapy Osteoporosis and/or osteopenia
Beta-blockers Congestive heart failure and/or coronary artery disease
Blood pressure monitor Hypertension
Inhaled corticosteroids Asthma
Insulin and other glucose lowering agents Diabetes
Retinopathy screening Diabetes
Peak flow meter Asthma
Glucometer Diabetes
Hemoglobin A1c testing Diabetes
International Normalized Ratio (INR) testing Liver disease and/or bleeding disorders
Low-density Lipoprotein (LDL) testing Heart disease
Selective Serotonin Reuptake Inhibitors (SSRIs) Depression
Statins Heart disease and/or diabetes

The services and items listed above are treated as preventive care:

  • only when prescribed to treat a person diagnosed with the associated chronic condition listed in the table’s second column, and
  • only when prescribed for the purpose of preventing the chronic condition’s exacerbation or a secondary condition’s development.

Read more about the expanded list of preventive care benefits.

IRS Releases the Indexed 2020 Affordability Percentage

The Internal Revenue Service (IRS) released the indexed affordability percentage of 9.78% for plan years beginning in 2020. An employer uses the affordability percentage to determine whether it has offered affordable coverage under the Patient Protection and Affordable Care Act’s employer shared responsibility provisions to avoid Penalty B.

Read more about the affordability percentage.

USPSTF Issues a Final Recommendation Giving PrEP an “A” Rating

The U.S. Preventive Services Task Force (USPSTF) published a final recommendation that gives an “A” rating to preexposure prophylaxis (PrEP) treatment. This means that the USPSTF recommends offering PrEP with effective antiretroviral therapy to people at high risk of HIV acquisition.

Group health plans and insurers subject to the preventive services coverage mandate must provide coverage for evidence-based items or services with an A or B rating recommended by the USPSTF without imposing copayments, coinsurance, deductibles, or other cost-sharing requirements when delivered by in-network providers. Group health plans and insurers subject to the preventive services coverage mandate generally must cover preventive services that are recommended by the USPSTF one year after the recommendation is issued.

HHS Releases Updated Notice Requirements for the HHS Federal External Review Process

On July 12, 2019, the Department of Health and Human Services (HHS) released updated requirements for notices that self-insured non-federal governmental health plans and health insurance issuers – using the HHS-administered federal external review process – must provide to their plan participants and beneficiaries.

District Court Upholds Short-Term Limited Duration Insurance Final Rule

As background, on August 1, 2018, the Internal Revenue Service (IRS), the Department of Health and Human Services (HHS), and the Department of Labor (DOL) (collectively, the Departments) released a final rule that amended the definition of short-term, limited-duration insurance (STLDI). HHS also released a fact sheet on the final rule. The final rule allows consumers to purchase STLDI policies that are less than 12 months in length and may be renewed for up to 36 months.

On July 18, 2019 the U.S. District Court for the District of Columbia (court) upheld the STLDI final rule. The court found that the final rule did not exceed the regulatory authority that Congress delegated to the Departments to define STDLI as a category of insurance that is exempt from individual insurance regulations. Employers should keep apprised of potential future developments as the case may be appealed.

Read more about the STDLI final rule.

Recent Litigation on the Contraceptive Coverage Exemption Rules

As background, the Department of the Treasury (Treasury), Department of Labor (DOL), and Department of Health and Human Services (HHS) (collectively, the Departments) published two final rules on November 15, 2018, regarding contraceptive coverage exemptions, to be effective on January 14, 2019. On January 14, 2019, the U.S. District Court for the Eastern District of Pennsylvania (Pennsylvania Court) granted a nationwide preliminary injunction that prohibits the implementation of the two final rules.

On July 12, 2019, the Third Circuit Court of Appeals (appeals court) affirmed the Pennsylvania Court’s preliminary injunction that prohibits the two final rules’ enforcement nationwide. The appeals court found that, until the final rules’ legality is decided, the injunction will allow states to avoid the imminent financial burden of subsidizing contraceptive services, providing funds for medical care associated with unintended pregnancies, and absorbing medical expenses that arise from decreased use of contraceptive medications for other health conditions.

The appeals court decision means that the Departments are prohibited from implementing and enforcing both final rules nationwide.

Read more about the status of the ACA contraceptive coverage mandate and exemption.

DOL Releases Advisory Opinion on AHPs and MEWAs

The Department of Labor (DOL) released an advisory opinion that analyzed a large retailer’s proposed group health plan to determine that the plan would be an association health plan (AHP) and a multiple employer welfare arrangement (MEWA) under ERISA. Although the advisory opinion can only be relied on by the retailer who requested it, the opinion gives employers an overview of the criteria that the DOL reviews when determining whether a plan fits the AHP definition that existed before the DOL’s 2018 AHP final rule. The opinion also provides a summary of the criteria that the DOL reviews when determining whether an arrangement is a MEWA.

Read more about AHPs.

Status of Court Case Challenging ACA Constitutionality

As background, in February 2018, twenty states filed a lawsuit asking the U.S. District Court for the Northern District of Texas (Court) to strike down the Patient Protection and Affordable Care Act (ACA) entirely. The lawsuit came after the U.S. Congress passed the Tax Cuts and Jobs Act in December 2017 that reduced the individual mandate penalty to $0, starting in 2019.

On December 14, 2018, the Court issued a declaratory order that the individual mandate is unconstitutional and that the rest of the ACA is unconstitutional. The Court granted a stay of its December 2018 order, which prohibits the order from taking effect while it is being appealed in the Fifth Circuit Court of Appeals (appeals court).

On July 3, 2019, the Department of Justice filed its supplemental brief to assert that the court decision striking down the ACA should not apply beyond the 18 plaintiff states. On July 9, 2019, the appeals court held oral arguments.

HHS and FDA Release Safe Importation Action Plan

The Department of Health and Human Services (HHS) and the Food and Drug Administration (FDA) issued a Safe Importation Action Plan that overviews two pathways that could permit drug importation from foreign countries. HHS also issued a press release.

Under the first pathway, HHS would propose rules to allow states, wholesalers, and pharmacists to submit demonstration project plans designed to: import Canadian-approved drugs that are versions of FDA-approved drugs; meet certain conditions such as drug quality, record keeping, testing, and protections against counterfeiting; and significantly reduce consumer drug cost.

Under the second pathway, manufacturers of FDA-approved drugs could import versions of FDA-approved drugs that they sell in foreign countries, if they establish with the FDA that the foreign version is the same as the U.S. version.

Question of the Month

Q: What if a plan sponsor fails to file or pay the PCORI fee?

A: Although the PCORI statute and its regulations do not include a specific penalty for failure to report or pay the PCORI fee, the plan sponsor may be subject to penalties for failure to file a tax return because the PCORI fee is an excise tax.

A plan sponsor should consult with its attorney on how to proceed with a late filing or late payment of the PCORI fee. The PCORI regulations note that the penalties related to late filing of Form 720 or late payment of the fee may be waived or abated if the plan sponsor had reasonable cause and the failure was not due to willful neglect.

If a plan sponsor already filed Form 720 (for example, for a different excise tax), then the plan sponsor can make a correction to a previously filed Form 720 by using Form 720X.

8/1/2019


Mastering Healthcare Cost Transparency Within Your Self-Funded Benefits Plan

Finding high-value healthcare providers for your employees is a constant struggle. After interviewing our Executive Vice President, Scott Smeaton, he gave us insight on a strategy for conquering cost transparency while maintaining quality care.

Working with Hierl Insurance for over 24 years, Scott shared how his endeavors working with selffunded plans has led him to believe the best strategy is one that starts at the employee-level.

Filling the Transparency Gap

First, let’s define what a high-value healthcare provider is: A high-value provider is a physician and / or facility that consistently demonstrates better patient outcomes at a lower than average cost. This is accomplished by meeting the highest quality standards i.e. low infection and readmission rates, quicker recovery rates, and high patient satisfaction scores, among others, at a lower than average cost.

These high value providers perform more procedures (volume) in facilities where they have greater control of the outcome (low overhead, low infection rates), and often provide “bundled” pricing where the patient knows how much the procedure will cost before the work is ever done.

Have you, in the last year, bought a big-ticket item without knowing the cost? This is the question Scott starts with when speaking to a company’s employees. Often, no one can raise their hand. Why? Historically, the information hasn’t been available. As an industry, we still have a ways to go. We’re moving in the right direction, working with innovative partners focusing on what patients need to make better healthcare decisions.

As a society, it’s common sense – whether you’re buying a car, a TV, or a house – to do some research as to the quality and cost of a product or service. “That ability to access those numbers and identify cost and quality measures has not been available in healthcare,” Scott explained. This gap is beginning to be filled, though primarily in direct-to-provider contracting exclusive to certain specialties.

Because healthcare information can be overwhelming, businesses struggle to find the most appropriate venue for sourcing the lowest costs without relinquishing the highest quality of care.

“We’ve found that the lower cost providers actually have higher quality of care due to the volume of services they offer,” Scott explained. Hierl partners with third parties to identify these providers. “A great example is an orthopedic specialist we work with. They have finetuned their procedures and their processes so much that they receive the highest quality ratings, yet they are the lowest cost providers, in their area. They tell you what it’s going to cost with a bundled price, before the procedure is performed,” Scott mentioned.

Hierl partners directly with high value providers, designing employee benefits programs that offer incentives to employees who use those providers. When buying big-ticket items like a car, it’s often reasonable to assume the more the car costs, the higher quality and value you are going to get from it. In healthcare, it’s essentially the opposite. Take Lasik Surgery, for example. Fifteen years ago, Radial Keratotomy (RK), which was a precursor to LASIK, was performed with a scalpel by a surgeon and cost roughly $8,000. In 2017, the average cost of LASIK was $2,088. Now, the procedure is much more effective due to improved technology.

With high value providers, such as the orthopedic specialist mentioned previously, that “high value” comes from the fact they are typically operating in freestanding clinics and surgery centers. This means there is lower overhead compared to being in a hospital setting, and they are run by specialized teams that can give their patients more attention. “High volume of services, low overhead costs, and high-quality care – those are the key ingredients we look for in the providers we recommend to our clients,” explained Scott.

Flexibility in Cost Transparency Begins with Self-Funding

Perks such as gym memberships and free lunches have become common practice for companies looking to brand themselves as a great employer. However, it is important to understand these tactics aren’t the answer when it comes to employee experience but rather an engagement strategy. Modern employees want to work in a great environment and want to know their contributions are valued through benefit offerings like discounted healthcare.

For anyone looking to unlock the power of employee engagement through benefits, the time to act is now. With the number of companies catching on to the importance of customer experience, it will not only help you gain an edge on your competition but make your company a favorable place to work – the definition of a ‘win-win’ .

The plans that get the most value from this third-party vendor initiative are self-funded plans, due to their flexibility. “That’s not to say we can’t work with fully insured companies,” Scott insisted. “We have found being self-funded really allows the employer to access the ‘cream of the crop’ or the third-tier beyond typical in-network and out-network providers and facilities, which are those high value specialists.” Aiding employer and employee education through third-party care coordinators and plan incentives, Hierl’s benefits plans are next-level.

We give businesses focus and control over their healthcare expenditures. When it comes to shop-able services, or nonemergency services needed, our care coordinators will ensure you partner with the best high value, low cost provider possible. Scott emphasized, “We are a pilot of health plan partners – a conductor of sorts, pulling all the moving pieces and parts together for our clients to guarantee a more focused, transparent result of their healthcare spending.”

To speak with Scott, contact him today at (920) 921-5921 or by email at ssmeaton@hierl.com.


Summer Days, Summer Hours

Employee retention is important and so is knowing how to maintain it. A new study provides insight into what type of effect summer hours could have on a company. Keep reading to learn more!Read more


Healthcare Industry with Technology

Technology is a huge part of the world we live in today and the healthcare industry is no exception. For better or worse, technology is transforming just about every industry. The healthcare and employee benefits industries are no different, whether you’re an employer seeking benefits for your workforce or an individual shopping for benefits. Here’s how technology will change the insurance-buying process in the near future:

Apps will push value-based care
This tech shift to shopping for benefits will bring with it the rise of platforms and app-based insurance. The hope is that apps and platforms will make it easier to buy and understand insurance, and easier to get the best healthcare fast. That means high-quality care at a low price at a time that’s convenient for patients.

Emerging tech platforms should provide employees with more options for insurance — and a better understanding of those options — and make it easier to manage wellness, healthcare and insurance coverage. Apps will put more information in front of the average employee, giving them more freedom to make choices about their care.

The idea is these emerging platforms and apps tie together payroll and HRIS with wellness and healthcare navigator apps to help workers live healthier lives.

Here’s how it could work: When an employee isn’t feeling well, the first turn to their telemedicine app instead of picking up the phone to make a doctor’s appointment or visiting urgent care. Telemedicine is more convenient for them and costs less than a traditional doctor’s visit. If the telemedicine provider refers them to a specialist, they can then turn to a health navigator app to find a high-quality specialist at the lowest price for their next appointment.

When they're feeling better, they can use a connected wellness app to record gym visits, meditate, speak to a therapist and earn points for wellness activities like reaching a step-count milestone or getting a preventive checkup. These points can contribute to a real-time insurance premium discount that they can easily view from an app. The app can also present them with the opportunity to add or change voluntary benefits and, during open enrollment, learn about their benefit choices and decide on the best plan.

Apps specific to shopping for benefits will provide more information to healthcare consumers and the necessary tools to make better care decisions. The hope is this technology will help people become healthier, get better care and use insurance more efficiently.

How HR fits in
Though employees will have the ability to make easy changes to benefit plans — especially voluntary benefits — the role of HR may change, depending on the employer’s size.

Large, more than 1,000 life employers will likely partner with a technology company and a benefits consultant who will manage the platform and the insurance-buying process for employees. Representatives from the HR technology platform, the benefits consultant and human resources staff will be responsible for educating employees about their options. Importantly, the employer will continue to sponsor employee benefits. They may present cafeteria-style benefits plans and provide a dollar amount toward the purchase of benefits.

Bigger changes may come for small companies with fewer than 100 employees. Many of these businesses may turn to a professional employer organization or other HR outsourcing arrangements with a built-in technology platform. Though healthcare insurance costs will continue to rise, small employers will continue to contribute to employee benefits premiums to help attract and retain talent.

The imperative for employers: communicate and educate
The only way this shift to platforms, apps, and other technology-based solutions will work is if employers, benefits brokers and platform companies themselves work to educate and communicate with employees about how this all works. Insurance platforms can no longer be staffed with technologists only; they need experts who understand health and welfare benefits in order to onboard employees and teach them how to get the most from their benefits platform.

And while HR’s role may change slightly, those teams are still in charge of helping employees learn about the benefits landscape and plan their healthcare and financial well-being for the next plan year. HR teams need to focus on communicating through any channel necessary, whether it’s email, social media, in-person education meetings or podcasts. It benefits everyone when employees understand how to choose the best plan and make decisions about appropriate care.

Putting more healthcare and insurance information in front of employees when they’re shopping for benefits and seeking services can drive them to make smarter decisions and look for better options when possible, but only if they understand how it all works.

SOURCE- Lisa, Mike. (24 July 2019). “Shopping for benefits: What technology holds for clients” (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/what-technology-holds-for-employee-healthcare-benefits?brief=00000152-1443-d1cc-a5fa-7cfba3c60000 


Creating an ‘urgent care first’ mindset for employee benefits

Urgent cares are popping up everywhere, making getting quick healthcare easier and more convenient for patients. Read this blog post to learn why it's important to guide employees to adopt an "urgent care first" mentality.


Urgent care centers are popping up everywhere, which means getting quick healthcare is easier and more convenient for patients. But these centers could also help employers minimize expensive emergency room claims. That’s why it’s important to guide employees to adopt an “urgent care first” mentality.

The concept of urgent care has been around since the 1970s, but rising healthcare costs, especially for ER care, have spurred an increase in centers across the U.S. over the last decade. In fact, from 2014 through June 2017, the number of urgent care centers rose by nearly 20%.

Urgent care centers provide care for health problems that aren’t life-threatening, but can’t wait for an appointment with a primary care provider. No one wants to suffer with a sore throat all weekend. Many urgent care centers are staffed with doctors and nurses, and provide more advanced capabilities than what’s typically available at a primary care doctor’s office. For example, some urgent care centers give stitches, provide X-rays and even MRIs.

Patients can also get treatment at urgent care for conditions they’d typically see a primary care doctor for, such as the flu or a fever, mild to moderate asthma, skin rashes, sprains and strains, and a severe sore throat or cough — illnesses that produce unnecessary high claims if treated in an ER.

Still, when a severe sore throat and high fever strike on a weekend and the doctor’s office is closed, employees may gravitate to the ER because they’re sick and need help right now. That’s where the urgent care first mindset becomes good medicine. It typically costs the employer (and often the employee) far less if that sore throat is treated in an urgent care facility.

The high cost of ER care is enough to make anyone run a high temp. From 2009 to 2016 (the most recent data available), the average amount that hospitals billed insurance carriers for an emergency room visit more than doubled, from $600 to $1,322. By contrast, urgent care typically costs about $150 per visit. Members often pay a lower copay for urgent care visits, too.

The urgent care first mindset is starting to take hold. New data analysis from Aetna shows that as urgent care centers began to proliferate, ER visits for minor health issues dropped 36%, while the use of urgent care and other non-emergency health settings increased 140%.

However, the same study shows that plans only saw a decrease in ER visits if there were several urgent care centers in the geographic region where their employees lived. Awareness is key.

Fostering an urgent care first mentality

Employers can’t just include urgent care in a benefits plan and expect employees to use it. They need to design the plan to encourage use and follow up with plenty of education.

Education about the benefits of primary care versus urgent care versus the ER should take place during open enrollment and throughout the plan year so members understand the medical necessity and financial implications of each option. Including the closest urgent care centers to employees, as well as a list of services they provide, can help encourage them to adopt an urgent care first mentality.

A word of caution: not every nearby urgent care center is actually in-network. It literally pays for employees to keep a list of nearby in-network centers handy when that inevitable weekend sore throat strikes.

Reminders about urgent care before spring allergies, summer vacations, fall school physicals and flu season can also help encourage their use.

The too-low ER copay

Plan design is another important piece of the puzzle to help steer employees to the right level of care for their needs. It’s not that unusual to see a $100 copay for an emergency department visit. While no one wants to discourage ER visits for true emergencies, it makes sense to adjust the plan design to encourage primary and urgent care visits instead. That may mean a $20 copay for primary care, a $40 copay for urgent care and a $200 to $250 copay for ER visits — which is waived if the plan participant is admitted to the hospital.

For high-deductible health plans paired with a health savings account, the savings can be even more drastic; patients may pay $200 for an urgent care visit versus $1,200 for an ER visit.

The combination of education and plan design can help curb unnecessary ER visits, which could help employers control healthcare increases from plan year to plan year. For health issues that crop up during off hours, the urgent care first mindset is good for both employers and employees, who will ultimately save time and money.

SOURCE: O'Conner, P. (5 July 2019) "Creating an ‘urgent care first’ mindset for employee benefits" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/creating-an-urgent-care-first-mindset-for-employees


It’s time to incorporate cancer screenings into your wellness program

About a third of the eligible population has never been screen or are not up-to-date with the cancer screening guidelines. According to the National Cancer Institute, newer FDA-approved novel immunotherapies have shown to be beneficial responses to colorectal cancer, but at staggering costs that can be upward of $400,000 per year. Read this blog post to learn more about incorporating cancer screenings in corporate wellness programs.


Scott Wilson, an employee at brewing company Molson Coors in Denver, was diagnosed with stage four metastatic colorectal cancer in 2016 — a disease that would cost him upward of $1.3 million to date, with significant dollars paid out for non-covered medical expenses.

As a consequence of a later-stage diagnosis, colon and liver resections were necessary coupled with aggressive treatment using chemotherapy and Vectobix — a newer and costly immunotherapy that is priced at $8,000 per week. On average, more than 40,000 people undergo treatment for metastatic colorectal cancer each year and the cost of treatment varies depending on the stage at diagnosis, treatment response and plan.

The availability of newer FDA-approved novel immunotherapies have shown to be beneficial responses to this deadly cancer, but at staggering costs that can be upward of $400,000 per year at market introduction, according to the National Cancer Institute.

Today, about 60% of diagnosed colorectal cases are discovered in later stage disease due to under-screening — a third of the eligible population have never been screened or are not up-to-date with screening guidelines. As a result, about 140,000 Americans are diagnosed with any stage of colorectal cancer and about 51,000 people die of this cancer annually. A recent study examined 1,750 colorectal cancer deaths from 2006 to 2012 in the Kaiser Permanente Health System — 76% of those deaths occurred in patients who were never screened or were not up-to-date with screening.

Cancer screening in the workplace

Last year, the American Cancer Society lowered the colorectal cancer screening age to 45 based on the rising rates of cancer trending in younger age populations — other cancer organization’s recommendations remain at age 50. Employers are in a unique position to reinforce and support these national recommendations among their employees.

Employees between 50 and 65 years of age have the lowest screening rates for colorectal cancer screening, and are typically covered by employer-sponsored health plans. Employers find offering cancer screening programs that reward participation via health and wellness programs are reducing disease risk and financial burdens for themselves and their employees.

The costs for treatment of cancer are more than double the rate of other healthcare expenses. For an employer, the impact of a late versus an early stage diagnosis is significant. National expenditures for treatment and care of colorectal cancer are second only to breast cancer.

In people age 65 and younger, the U.S spends in excess of $7.4 billion for treatment of colorectal cancer. For those employees diagnosed with any stage of colorectal cancer, a large percentage of costs are paid out by company-sponsored health plans despite the implementation of high-deductible health plans.

It would seem prudent to institute a screening initiative to find cancer early in your employee populations, or prevent it altogether by supporting screening for preventable cancers. Employees who test positive are referred by their physician for diagnostic colonoscopy to determine if colorectal cancer is present or to remove precancerous polyps or lesions. The intangible costs associated with cancer is the time off of work for treatment and lost productivity.

Most companies administer a wellness program for employees and families, like Molson Coors, but only about 20% offer colorectal cancer screening. Incorporating a blood test as a preventive cancer screening strategy alongside workplace wellness programs can get employees up-to-date with screening recommendations. Employers who are interested in instituting a colorectal cancer screening program in the office should consider the following suggestions.

Incorporate CRC screening into wellness programs. Screenings provide the opportunity to identify risks early and can bridge the gap between doctor office visits for employees who do not see their providers on a regular or annual basis.

Partner with third-party administrators. Third party administration services can ensure HIPAA regulations are followed for privacy. TPAs also will arrange for the delivery of results.

Create communications campaigns. Target your messaging to those eligible for colorectal cancer screening and make sure to cite the correct statistics for benefits and risk.

Reward participation. Participation is shown to increase when incentives are provided to reward participation. Decide what incentives work for your employees – PTO, financial rewards, gym memberships, coupons or gift cards.

Follow up. Plan for next steps based on employee screenings. Results should be provided in a timely manner to enable employees.

Wilson, the Molson Coors employee, remains in remission for nearly 20 months. He’s since devoted his time to advocate for access to colorectal cancer screening, especially in the workplace. Wilson recently joined the Colorectal Cancer Alliance organization as a board member, a non-profit dedicated to reducing the incidence of colorectal cancer through their many efforts aimed at prevention and awareness. He also wrote a book, “Through the Window: A Photographic Tale of Cancer Recovery” for the alliance. Wilson has been an advocate for the vital need for employee access and employer support for CRC screening in the workplace.

SOURCE: Childers, P. (27 June 2019) "It’s time to incorporate cancer screenings into your wellness program" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/add-cancer-screenings-to-wellness-programs