Employers can help employees catch some Z's with new wellness benefit

According to a study in the Journal of Sleep Research, about 45 percent of the world's population has chronic sleep issues. Employers are starting to offer employee benefits that are focused on a long-ignored but crucial aspect of employee health - sleep. Read this blog post to learn more about this new wellness benefit.


Employers are taking a greater interest in employees’ emotional and physical well-being by offering specialized programs focused on mental health, weight loss, financial health, and now one long-ignored yet crucial aspect of health — sleep.

Beddr, a sleep health technology company, has launched a comprehensive, personalized solution to identify and treat the root causes of chronic sleep issues, though a voluntary benefits platform. The program leverages clinical data captured from Beddr’s app that uses an optical sensor and accelerometer to measure blood oxygen levels, stopped breathing events, heart rate, sleep position and time in bed.

About 45% of the world’s population has chronic sleep issues, according to a study in the Journal of Sleep Research. Poor sleep costs U.S. employers an estimated $411 billion each year, according to a report from Rand.

Employees using the Beddr benefit will have access to an expert-led sleep coaching program and a nationwide network of sleep physicians to provide targeted treatment options to help employees improve their sleep health. The program has the potential to save an employer up to $5,700 per employee, per year in productivity improvements, lower healthcare costs and decrease accident rates, Beddr says.

“Sleep is the foundation to every employee’s mental and physical health. High quality sleep has been shown to both reduce healthcare costs as well as improve productivity, but most employers haven’t found a comprehensive program that addresses the primary root causes of sleep issues and that benefits their entire workforce,” says Michael Kisch, CEO of Beddr. “We have seen a dramatic increase among our users relative to the overall population in their understanding of their sleep health and how their choices impact their overall sleep quality.”

Beddr partners with benefits teams to design a customized program specific to each employer and their employees. The company developed a screening process that makes it easy for an employer to engage their employee base, while providing Beddr the ability to identify employees who are a good match for the program.

In some cases, the company heavily subsidizes the cost of the benefit to employees, while in others it is the full responsibility of the employee. In the latter instance, the company negotiates a discount that is passed on to all participating employees. That discounted price is less than what an employee would pay to purchase the program directly from Beddr.

“Beddr was founded on the belief that the most important thing a person can do to improve their physical and mental health is to get consistent, high-quality sleep,” Kisch says. “We see employers as natural partners in fulfilling this mission because the goals of a company and its management are highly aligned with the goals of our program — to improve the health and productivity of employees. ”

SOURCE: Shiavo, A. (23 October 2019) "Employers can help employees catch some Z's with new wellness benefit" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/beddr-app-helps-employees-get-more-sleep


Move over mainstream: Alternative health options a road to better value

Employers are seeking alternative ways to get a better value when it comes to their healthcare spending. Read this blog post to learn more about alternative health options.


While employers may be the largest purchasers of healthcare outside of the federal government, rarely does one organization have enough influence when negotiating with the powerful health plans and provider systems. As a result, employers — and ultimately the consumers for whom they purchase healthcare services — pay the price.

Instead of taking these lumps of coal sitting down, there are a growing number of employers on the cutting edge of healthcare purchasing seeking alternative ways in 2019 to get better value for their healthcare spending. They are looking for the diamonds in the rough.

In more than half of the healthcare markets in the U.S., providers have merged reducing competition and leaving employers and consumers with little choice for their care. Employers must stop insisting that health insurance products provide access to the broadest network of healthcare providers — if providers know they’ll be kept “in network” no matter how they behave, employers and payers further reduce their negotiating position. Employers also should band together to be sizable enough to call the shots, but this rarely happens.

While this lack of market power and influence is a major frustration for employers, it’s far from the only one. Educated employers also know that the healthcare system produces uneven quality and high prices have nothing to do with excellent care. The amount an employer pays for a service merely represents the relative negotiating strength of the health insurance carriers and providers.

As prices continue to drive healthcare cost growth, Americans are finding their healthcare unaffordable and are willing to trade choice for affordability. Many Americans no longer view having the ability to pick any doctor they choose as essential if it means increased premiums and cost-sharing that comes at the expense of other basic needs. These shifting attitudes represent an opportunity for employers seeking diamonds to pursue the following new healthcare benefits options. Here are some.

Narrow networks: Health insurance plans built around a narrower network that cuts out care providers who are outlandishly expensive or have a particularly poor record on quality. Alternatively, center a smaller network around a direct contract with an accountable care organization selected for its potential to deliver higher quality and value. More commercial health insurance carriers and lesser known third-party administrators are offering and supporting these options. Premiums and cost-sharing are typically lower for the consumer than with broader network plans.

Centers of excellence (CoE): Steer patients to designated high-quality providers with expertise in a given medical area who are willing to enter into an alternative payment arrangement or offer a more reasonable price in return for more patients. Make CoEs attractive through more generous coverage or make them mandatory if employees want an elective or non-emergent procedure (e.g., bariatric or spine surgery). Either way, employers reduce the risk that employees will receive subpar or low value care.

Alternative sites of care: Increase access to and use of alternative sites of care including onsite or near-site clinics and telehealth services. These enhance the convenience of primary or behavioral healthcare for employees and can help the employer better control referrals to overpriced hospitals or specialists.

So, move over mainstream. When it comes to the tactics employers use to purchase healthcare, alternative is likely to become less fringe. Narrow networks, CoEs or alternative sites of care may not solve all of the frustrations. But employers’ pursuit of these new models sends a strong signal that lumps of coal aren’t going to cut it. Employers are on the hunt for a shinier, more attractive set of solutions.

SOURCE: "Move over mainstream: Alternative health options a road to better value" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/move-over-mainstream-alternative-health-options-a-road-to-better-value?brief=00000152-1443-d1cc-a5fa-7cfba3c60000


The ACA Remains In Place After Being Struck Down By Federal Court

Overview

On Dec. 14, 2018, a federal judge ruled in Texas v. United States that the entire Affordable Care Act (ACA) is invalid due to the elimination of the individual mandate penalty in 2019. The decision was not stayed, but the White House announced that the ACA will remain in place pending appeal.

This lawsuit was filed by 20 states as a result of the 2017 tax reform law that eliminates the individual mandate penalty. In 2012, the U.S. Supreme Court upheld the ACA on the basis that the individual mandate is a valid tax. With the penalty’s elimination, the court, in this case, ruled that the ACA is no longer valid under the U.S. Constitution.

Action Steps

This ruling is expected to be appealed and will likely be taken up by the Supreme Court. As a result, a final decision is not expected to be made until that time. The federal judge’s ruling left many questions as to the current state of the ACA; however, the White House announced that the ACA will remain in place pending appeal.

Background

The ACA imposes an “individual mandate” beginning in 2014, which requires most individuals to obtain acceptable health insurance coverage for themselves and their family members or pay a penalty. In 2011, a number of lawsuits were filed challenging the constitutionality of this individual mandate provision.

In 2012, the U.S. Supreme Court upheld the constitutionality of the ACA in its entirety, ruling that Congress acted within its constitutional authority when enacting the individual mandate. The Court agreed that, while Congress could not use its power to regulate commerce between states to require individuals to buy health insurance, it could impose a tax penalty using its tax power for individuals who refuse to buy health insurance.

Highlights

  • A federal judge ruled that the entire ACA is invalid due to the elimination of the individual mandate penalty.
  • This ruling is expected to be appealed and will likely be taken up by the Supreme Court.
  • The ACA will remain in place pending appeal.

Important Dates

December 14, 2018

A federal judge ruled that the entire ACA is invalid due to the elimination of the individual mandate penalty

January 1, 2019

Individuals will no longer be penalized under the ACA for failing to obtain acceptable health insurance coverage

However, a 2017 tax reform bill, called the Tax Cuts and Jobs Act, reduced the ACA’s individual mandate penalty to zero, effective beginning in 2019. As a result, beginning in 2019, individuals will no longer be penalized for failing to obtain acceptable health insurance coverage.

Texas v. United States

Following the tax reform law’s enactment, 20 Republican-controlled states filed a lawsuit again challenging the ACA’s constitutionality. The plaintiffs, first, argued that the individual mandate can no longer be considered a valid tax, since there will no longer be any revenue generated by the provision.

In addition, in its 2012 ruling, the Supreme Court indicated (and both parties agreed) that the individual mandate is an essential element of the ACA, and that the remainder of the law could not stand without it. As a result, the plaintiffs argued that the elimination of the individual mandate penalty rendered the remainder of the ACA unconstitutional.

The U.S. Justice Department chose not to fully defend the ACA in court and, instead, 16 Democratic-controlled states intervened to defend the law.

Because the court determined that the individual mandate is no longer a valid tax, but is an essential element of the ACA, it ultimately ruled that the ACA is invalid in its entirety.

Federal Court Ruling

In his ruling, Judge Reed O’Connor ultimately agreed with the plaintiffs, determining that the individual mandate can no longer be considered a valid exercise of Congressional tax power. According to the court, “[u]nder the law as it now stands, the individual mandate no longer ‘triggers a tax’ beginning in 2019.” As a result, the court ruled that “the individual mandate, unmoored from a tax, is unconstitutional.”

Because the court determined that the individual mandate is no longer valid, it now had to determine whether the provision is “severable” from the remainder of the law (meaning whether other portions of the ACA can remain in place or whether the entire law is invalid without the individual mandate).

In determining whether the remainder of the law could stand without the individual mandate, the court pointed out that “Congress stated three separate times that the individual mandate is essential to the ACA … [and that] the absence of the individual mandate would ‘undercut’ its ‘regulation of the health insurance market.’ Thirteen different times, Congress explained how the individual mandate stood as the keystone of the ACA … [and,] ‘together with the other provisions’ [the individual mandate] allowed the ACA to function as Congress intended.” As a result, the court determined that the individual mandate could not be severed, making the ACA invalid in its entirety.

Impact of the Federal Court Ruling

Judge O’Conner’s ruling left many questions as to the current state of the ACA, because it did not order for anything to be done or stay the ruling pending appeal. However, this ruling is expected to be appealed, and the White House announced that the ACA will remain in place until a final decision is made. Many industry experts anticipate that the Supreme Court will likely take up the case, which means that a final decision will not be made until that time.

While these appeals are pending, all existing ACA provisions will continue to be applicable and enforced. Although the individual mandate penalty will be reduced to zero beginning in 2019, employers and individuals must continue to comply with all other applicable ACA requirements. This ruling does not impact the 2019 Exchange enrollment, the ACA’s employer shared responsibility (pay or play) penalties and related reporting requirements, or any other applicable ACA requirement.

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4 FAQs about 2019 Medicare rates

Medicare Part B premiums are expected to be held to roughly a 1.1 percent increase for most enrollees in 2019, according to Medicare managers. Continue reading for answers to the four most frequently asked questions about the 2019 Medicare rates.


Medicare managers announced last week that they will hold increases in Medicare Part B premiums to about 1.1 percent for most enrollees in 2019. For some high-income enrollees, however, premiums will rise 7.4 percent.

Medicare Part B is the component of the traditional Medicare program that covers physician services and hospital outpatient care.

Here’s a look at how the monthly Part B premiums will change, by annual income level:

  • Individuals earning less than $85,000, and couples earning less than $170,000:$135.50 in 2019, from $134 this year.
  • Individuals earnings $160,000 to $500,000, and couples earning $320,000 to $750,000: $433.40 in 2019, from $428.60 this year.
  • Individuals earning $500,000 or more, and couples earning $750,000 or more: $460.50 in 2019, from $428.60 this year.

The annual Medicare Part B deductible will increase by 1.1 percent, to $185.

Another component of the traditional Medicare program, Medicare Part A, covers inpatient hospital bills.

Medicare managers use payroll taxes to cover most of the cost of running the Medicare Part A program. Few Medicare Part A enrollees pay premiums for that coverage. But, for the enrollees who do have to pay premiums for Medicare Part A coverage, the full premium will increase 3.6 percent, to $437 per month.

The Medicare Part A deductible for inpatient hospital care will increase 1.8 percent, to $1,340.

Why are high earners paying so much more for Medicare Part B?

Congress has been increasing the share of Medicare costs that high earners pay in recent years.

For 2018, the top annual income category for Medicare Part B rate-setting purposes was for $160,000 and over for individuals, and for $320,000 and over for couples. Premiums from those Medicare Part B enrollees are supposed to cover 80 percent of their Part B claims.

In the Balanced Budget Act of 2018, Congress added a new annual income category: for individuals earning $500,000 or more and couples earning $750,000 or more. Premiums from Part B enrollees in that income category are supposed to cover 85 percent of those enrollees’ Part B claims.

Who do these rate increases actually affect?

Medicare now has about 60 million enrollees of all kinds, according to the CMS Medicare Enrollment Dashboard.

About 21 million are in Medicare Advantage plans and other plans with separate premium-setting processes.

About 38 million are in the traditional Medicare Part A, the Medicare Part B program, or both the Medicare Part A and the Medicare Part B programs. CMS refers to the traditional Medicare Part A-Medicare Part B program as Original Medicare. The rate increases have a direct effect on the Original Medicare enrollees’ costs.

How do the Medicare increases compare with the Social Security cost-of-living adjustment (COLA)?

The Social Security Administration recently announced that the 2019 Social Security COLA will be 2.8 percent.

That means the size of the COLA will be greater than the increase in Medicare premiums for all Medicare enrollees other than the highest-income Medicare Part B enrollees and the enrollees who pay the full cost of the Medicare Part A premiums.

Why should financial professionals care about Original Medicare premiums?

For consumers who already have traditional Medicare coverage, the Part A and Part B premiums may affect how much they have to spend on other insurance products and related products, such as Medicare supplement insurance coverage.

For retirement income planning clients, Medicare costs are something to factor into income needs calculations.

Because access to Medicare coverage is critical to all but the very wealthiest retirees, knowledge about how to get and keep eligibility for Medicare coverage on the most favorable possible terms is of keen interest to many consumers ages 50 and older. Some consumers may like to get information about that topic from their insurance agents, financial planners and other advisors.

Resources

Officials at the Centers for Medicare and Medicaid Services, the agency that runs Medicare, are preparing to publish the official 2019 Medicare rate notices in the Federal Register on Wednesday. A preview copy of the Part A notice is available here, and a preview copy of the Part B notice is available here.

SOURCE: Bell, A. (16 October 2018) "4 FAQs about 2019 Medicare rates" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/16/medicare-posts-2019-rates-pinches-high-earners-412/


COBRA liability in mergers and acquisitions

COBRA requires certain group plans to make health plan coverage available to certain individuals after a business reorganization. Continue reading to learn more.


The Consolidated Omnibus Budget Reconciliation Act (COBRA) requires certain group health plans to make continuation coverage available to certain individuals who would otherwise lose group health plan coverage due to a qualifying event. Employers who go through business reorganizations, such as mergers and acquisitions (M&A), will need to know whether COBRA continuation coverage must be offered and whether the group health plan of the seller or buyer must provide COBRA continuation coverage.

General Rules

Under IRS regulations, if the seller and buyer negotiated their COBRA liability by contract as part of the sale, then the contract will determine who has an obligation to offer COBRA coverage.

See also: Get the Facts on COBRA Coverage – Who, When and How Long?

If the employer who is contractually responsible for providing COBRA coverage fails to perform or if the contract is silent on COBRA coverage obligations, then the seller's group health plan has the duty to offer COBRA coverage as long as the seller maintains a group health plan post-sale.

If the seller doesn't maintain a group health plan post-sale, then the answer depends on whether it's a stock sale or an asset sale.

In a stock sale, if the seller doesn't maintain a group health plan post-sale, then the buyer is responsible for offering COBRA coverage.

See also: What Is COBRA, and Does It Apply to My Business?

In an asset sale, if the seller doesn't maintain a group health plan post-sale and the group health plan's termination is connected with the asset sale, then the buyer is responsible for offering COBRA coverage if the buyer continues business operations associated with the assets purchased without interruption or substantial change.

For more information request our Compliance Advisor “COBRA Liability in Mergers and Acquisitions.”

SOURCE: Hsu, K (9 August 2018) "Cobra liability in mergers and acquisitions" (Web Blog Post). Retrieved from http://blog.ubabenefits.com/cobra-liability-in-mergers-and-acquisitions


How employers can manage the skyrocketing cost of specialty drugs

Since the 90's, the number of specialty medications, not to mention their costs, has grown exponentially. Continue reading to learn what employers can do to manage these costs.


In the past two decades, the number of specialty medications — which treat rare and complex diseases such as multiple sclerosis, pulmonary arterial hypertension, hepatitis C, HIV, cystic fibrosis, some types of cancer and hemophilia — has grown exponentially. In 1990, there were only 10 specialty drugs on the market. By 2015, that number had increased to 300 medications, and by the end of 2016 there were approximately 700 more specialty drugs in development.

These medications are usually very high cost, with some new biologic medications costing more than $750,000 a year. Why are the costs so high? There are a number of factors, including the facts that distribution networks are limited, these medications are complicated to develop and distribute, and there are few, if any, generic alternatives for these drugs.

See also: A Look at Drug Spending in the U.S.

The Pew Charitable Trusts found that although only 1% to 2% of Americans use specialty medications, they account for approximately 38% of total drug spending in the U.S.

So, how can employers better gain control over the cost of specialty medications? Because there are hundreds of specialty medications, there’s no single strategy for cost management that can be applied universally. To build an effective cost management strategy, employers need to first analyze employee use of specialty medications. The best strategy will approach specialty medication management by disease class and drug by drug.

However, there are key building blocks of a strategy that will both manage costs and ensure that employees have access to the medications they need. Here are six things employers can do.

Assess benefit plan design structure. Employers should consider how they are incenting employees to spend their benefit dollars appropriately and wisely. A multi-tiered medication formulary where employees pay less out of pocket for generic drugs and lower cost medications and more for costly medications is one approach that’s proven effective. To help employees afford these higher out-of-pocket costs, employers can promote manufacturer copay savings programs, which many drug makers offer.

Think about utilization management. This can include requiring prior authorization for high-cost specialty medications and step therapies (employees must start with lower cost therapies and can move up to more costly ones if those are not effective).

Consider a custom pharmacy network design. By narrowing the network of pharmacies that fill specialty medication prescriptions, employers can negotiate a better unit price. A freestanding specialty pharmacy or a pharmacy benefits manager can provide savings by optimizing discounts for both employers and employees.

Offer second opinion and other support services for rare and complex diseases. A newly diagnosed rare or complex disease patient will see, on average, seven different specialists over the course of eight years before getting a true diagnosis and appropriate treatment path. These programs aim to reduce that burden and ensure success with that treatment once it’s identified. A second opinion from a top specialist in the field provides an expert assessment of the diagnosis and recommendations on the most effective treatment protocol. This not only helps manage costs, it lowers the risk of misdiagnosis and inappropriate treatment. Additional case management services can include one-to-one counseling and, when the drug regimen requires, in-home nursing services to help patients better manage their disease and improve outcomes.

See also: Specialty Drugs and Health Care Costs

Offer site of care choices. Where specialty drugs are administered can have a significant impact on what they cost. Medications administered in an outpatient clinic at a hospital can cost five times as much as those that are injected or infused in a physician’s office or at the patient’s home. Offering services such as home infusion or injection delivered by nurses or incenting patients with lower copays when they receive their medications at their physician’s office can lower overall specialty drug costs.

Educate employees. When an employee or covered family member is diagnosed with a rare or complex condition that will require a higher level of care and the use of specialty medications, employers can connect employees with case managers or similar services that provide education about the condition and the medication, such as how to manage side effects or what alternative medications are available, which can increase employee adherence with the medication regimen.

SOURCE: Varn, M (8 August 2018) "How employers can manage the skyrocketing cost of specialty drugs" (Web Blog Post). Retrieved from https://www.benefitnews.com/opinion/specialty-pharmaceuticals-and-how-employers-can-manage-cost


7 wellness program ideas you may want to steal

Need more energy and excitement in your office? Keep your employees healthy and motivated with these fun wellness program ideas.


Building your own workplace wellness program takes work–and time–but it’s worth it.

“It’s an investment we need to make,” Jennifer Bartlett, HR director at Griffin Communication, told a group of benefits managers during a session at the Human Resource Executive Health and Benefits Leadership Conference. “We want [employees] to be healthy and happy, and if they’re healthy and happy they’ll be more productive.”

Bartlett shared her experiences building, and (continually) tweaking, a wellness program at her company–a multimedia company running TV outlets across Oklahoma –over the last seven years. “If there was a contest or challenge we’ve done it,” she said, noting there have been some failed ventures.

“We got into wellness because we wanted to reduce health costs, but that’s not why we do it today,” she said. “We do it today because employees like it and it increases morale and engagement.”

Though Griffin Communication's wellness program is extensive and covers more than this list, here are some components of it that's working out well that your company might want to steal:

  1. Fitbit challenge. Yes, fit bits can make a difference, Bartlett said. The way she implemented a program was to have a handful of goals and different levels as not everyone is at the same pace-some might walk 20,000 steps in a day, while someone else might strive for 5,000. There are also competition and rewards attached. At Griffin Communications, the company purchased a number of Fitbits, then sold them to its employees for half the cost.
  2. Race entry. Griffin tries to get its employees moving by being supportive of their fitness goals. If an employee wants to participate in a race-whether walking or running a 5k or even a marathon, it will reimburse them up to $50 one time.
  3. Wellness pantry. This idea, Bartlett said, was "more popular than I ever could have imagined." Bartlett stocks up the fridge and pantry in the company's kitchen with healthy food options. Employees then pay whole sale the price of the food, so it's a cheap option for them to instead of hitting the vending machine. "Employees can pay 25 cents for a bottled water or $1.50 for a soda from the machine."
  4. Gym membership. "We don't have an onsite workout facility, but we offer 50 percent reimbursement of (employees') gym membership cost up to a max of 200 per year," she said. The company also reimburses employees for fitness classes, such as yoga.
  5. Biggest Loser contest. Though this contest isn't always popular among companies, a Biggest Loser-type competition- in which employees compete to lose the most weight-worked out well at Griffin. Plus, Bartlett said, "this doesn't cost us anything because the employee buys in $10 to do it." She also insisted the company is sensitive to employees. For example, they only share percentages of weight loss instead of sharing how much each worker weights.
  6. "Project Zero" contest. This is a program pretty much everyone can use: Its aim is to avoid gaining the dreaded holiday wights. The contest runs from early to mid- November through the first of the year. "Participants will weigh in the first and last day of the contest," Bartlett said. "The goal is to not gain weight during the holidays-we're not trying to get people to lose weight but we're just to not get them to not eat that third piece of pie."
  7. Corporate challenges. Nothing both builds camaraderie and encourages fitness like a team sports or company field day. Bartlett said that employees have basically taken this idea and run with it themselves- coming up with fun ideas throughout the year.

SOURCE:
Mayer K (14 June 2018) "7 wellness program ideas you may want to steal" [Web Blog Post]. Retrieved from https://www.benefitspro.com/2015/10/10/7-wellness-program-ideas-you-may-want-to-steal/


Bettering Health Plan Management Through Modern Healthcare Technology

Taking advantage of modern technology is part of the reason why Hierl excels in providing the best results for our clients. In this installment of CenterStage, we asked our Executive Vice President, Scott Smeaton, to give an in-depth overview of how we use our technological resources to create customized, high-quality, low-cost health plans for our clients.

Technology and Data

There are three steps to developing plans for our clients, when using technology and data. The first step is to identify the client’s cost drivers within their health program(s). For example, we may look at a client’s claims data and find their highest dollar claims are musculoskeletal – such as hip and knee replacements – identifying whether health plan members are going to the higher cost, lower quality provider. These are becoming much more prevalent and are among most plans top cost drivers. With the technology at Hierl, we can import our client’s data – medical and prescription claims and health screening results from wellness – and aggregate it into one technology platform. Doing so, will help keep our clients’ members updated on physician requests and advice.

Competitive Advantage

The second step beyond identifying our client’s cost drivers is to implement management programs and plan designs to address their health plan issues. This kind of technology is newer to the healthcare industry. It can be a great resource and tool that larger employers can use to their advantage. Think about Netflix. They analyze their viewer’s behaviors and apply predictive modeling in a way that they know what their viewers like to watch and when they want to watch it, incorporating those preferences into the ads their customers see. That kind of technology is coming to healthcare, allowing us to look at all claims and behaviors and predict where the next large claim will come from. This helps plan administrators fully understand what’s driving their health plan costs and do something about it through plan design changes, provider relations and contracting, member incentives, and member education and engagement.

Employee Betterment

After identifying areas that can be improved upon and creating a plan to address these cost drivers as discussed above, our third and final step is to create a communication program that will engage and educate employees. Our goal is to help employees understand that, within a healthcare system, there are some providers who perform better than others and cost less. When we give employees the tools and resources they need to be better healthcare consumers, everyone wins. Employer sponsored health plans have lower overall costs. This means their employees and their families lower their out-of-pocket costs, save healthcare dollars for the future, and have better outcomes. Not to mention that a happier, healthier employee is also a more productive employee at work and in the community. Hierl accomplishes this with our “Why Matters” program, which is a custom designed, year-round member education and communication program using a variety of mediums to reach our clients’ members. Through Why Matters, Hierl builds a custom (intranet) and mobile app for our clients to access basic information about their benefits 24/7. Think of it as a homepage to one of your favorite websites that you bookmark in your browser. This is where your members go to research, make decisions, educate themselves on your benefit offerings and how to be a better healthcare consumer. Based on the cost drivers identified through the process above we build out a 12-month calendar of communication materials specifically addressing the areas we’ve identified as a concern and can be delivered via paper, email, mobile app, etc.

Hierl strives to bring our clients the best possible solutions that result in high-quality, low-cost benefits. If you think your company needs to take this step toward improvement, please contact Scott Smeaton at 920.921.5921 or send him an email at ssmeaton@hierl.com.


Pay-to-shop health care incentives gaining traction

Laurie Cook went shopping recently for a mammogram near her home in New Hampshire. Using an online tool provided through her insurer, she plugged in her ZIP code. Up popped facilities in her network, each with an incentive amount she would be paid if she chose it.

Paid? To get a test? It’s part of a strategy to rein in health care spending by steering patients to the most cost-effective providers for non-emergency care.

State public employee insurance programs were among the early adopters of this approach. It is now finding a foothold among policymakers and in the private sector.

Scrolling through her options, Cook, a school nurse who is covered through New Hampshire’s state employee health plan, found that choosing a certain facility scored her a $50 check in the mail.

She then used the website again to shop for a series of lab tests. “For a while there, I was getting a $25 check every few weeks,” said Cook. The checks represented a share of the cost savings that resulted from her selections.

Lawmakers in nearby Maine took the idea further, recently enacting legislation that requires some private insurers to offer pay-to-shop incentives, part of a movement backed by a conservative foundation to get similar measures passed nationally.

Similar proposals are pending in a handful of other statehouses, including Virginia, West Virginia and Ohio.

“If insurance plans were serious about saving money, they would have been doing this stuff years ago,” said Josh Archambault, a senior fellow at the Foundation for Government Accountability, a limited-government advocacy group based in Naples, Fla., that promotes such “right-to-shop” laws. “This starts to peel back the black box in health care and make the conversation about value.”

Still, some economists caution that shop-around initiatives alone cannot force the level of market-based change needed. While such shopping may make a difference for individual employers, they note it represents a tiny drop of the $3.3 trillion spent on health care in the U.S. each year.

“These are not crazy ideas,” said David Asch, professor of medicine, medical ethics and health policy at the Penn Medicine Center for Health Care Innovation in Philadelphia. But it’s hard to get consumers to change behavior — and curbing health care spending is an even bigger task. Shopping incentives, he warned, “might be less effective than you think.”

If they achieve nothing else, though, such efforts could help remove barriers to price transparency, said Francois de Brantes, vice president and director of the Center for Value in Health Care at Altarum, a nonprofit that studies the health economy.

“I think this could be quite the breakthrough,” he said.

Yet de Brantes predicts only modest savings if shopping simply results in narrowing the price variation between high- and low-cost providers: “Ideally, transparency is about stopping folks from continuously charging more.”

Among the programs in use, only a few show consumers the price differences among facilities. Many, like the one Cook used, merely display the financial incentives attached to each facility based on the underlying price.

 

Advocates say both approaches can work.

“When your plan members have ‘skin in the game,’ they have an incentive to consider the overall cost to the plan,” said Catherine Keane, deputy commissioner of administrative services in New Hampshire. She credits the incentives with leading to millions of dollars in savings each year.

Several states require insurers or medical providers to provide cost estimates upon patients’ requests, although studies have found that information can still be hard to access.

Now, private firms are marketing ways to make this information more available by incorporating it into incentive programs.

For example, Vitals, the New Hampshire-based company that runs the program Cook uses, and Healthcare Bluebook in Nashville offer employers — for a fee — comparative shopping gizmos that harness medical cost information from claims data. This information becomes the basis by which consumers shop around.

Crossing Network Lines

Maine’s law, adopted last year, requires insurers that sell coverage to small businesses to offer financial incentives — such as gift cards, discounts on deductibles or direct payments — to encourage patients, starting in 2019, to shop around.

A second and possibly more controversial provision also kicks in next year, requiring insurers, except HMOs, to allow patients to go out-of-network for care if they can find comparable services for less than the average price insurers pay in network.

Similar provisions are included in a West Virginia bill now under debate.

Touted by proponents as a way to promote health care choice, it nonetheless raises questions about how the out-of-network price would be calculated, what information would be publicly disclosed about how much insurers actually pay different hospitals, doctors or clinics for care and whether patients can find charges lower than in-network negotiated rates.

“Mathematically, that just doesn’t work” because out-of-network charges are likely to be far higher than negotiated in-network rates, said Joe Letnaunchyn, president and CEO of the West Virginia Hospital Association.

Not necessarily, counters the bill’s sponsor, Del. Eric Householder, who said he introduced the measure after speaking with the Foundation for Government Accountability. The Republican from the Martinsburg area said “the biggest thing lacking right now is health care choice because we’re limited to our in-network providers.”

Shopping for health care faces other challenges. For one thing, much of medical care is not “shoppable,” meaning it falls in the category of emergency services. But things such as blood tests, imaging exams, cancer screening tests and some drugs that are administered in doctor’s offices are fair game.

Less than half of the more than $500 billion spent on health care by people with job-based insurance falls into this category, according to a 2016 study by the Health Care Cost Institute, a nonprofit organization that analyzes payment data from four large national insurers. The report also noted there must be variation in price between providers in a region for these programs to make sense.

Increasingly, though, evidence is mounting that large price differences for medical care exist — even among rates negotiated by the same insurer.

“The price differences are so substantial it’s actually scary,” said Heyward Donigan, CEO of Vitals.

At the request of Kaiser Health News, Healthcare Bluebook ran some sample numbers for a Northern Virginia ZIP code, finding the cost of a colonoscopy ranged from $670 to $6,240, while a knee arthroscopy ranged from $1,959 to $20,241.

Another challenge is the belief by some consumers that higher prices mean higher quality, which studies don’t bear out.

Even with incentives, the programs face what may be their biggest challenge: simply getting people to use a shopping tool.

Kentucky state spokeswoman Jenny Goins said only 52 percent of eligible employees looked at the shopping site last year — and, of those, slightly more than half chose a less expensive option.

“That’s not as high as we would like,” she said.

Still, state workers in Kentucky have pocketed more than $1.6 million in incentives — and the state said it has saved $11 million — since the program began in mid-2013.

Deductibles, the annual amounts consumers must pay before their insurance kicks in and are usually $1,000 or more, are more effective than smaller shopping incentives, say some policy experts.

In New Hampshire, it took a combination of the two.

The state rolled out the payments for shopping around — and a website to look for best prices — in 2010. But participation didn’t really start to take off until 2014, when state employees began facing an annual deductible, said Deputy Commissioner Keane.

Still, the biggest question is whether these programs ultimately cause providers to lower prices.

Anecdotally, administrators think so.

Kentucky officials report they already are witnessing a market response because providers want patients to have an incentive to choose them.

“We do know providers are calling and asking, ‘How do I get my name on that list’ [of cost-effective providers]?” said Kentucky spokeswoman Goins. “The only way they can do that is to negotiate.”

Read the article.

Source:
Appleby J., Kaiser Health News (5 March 2018). "Pay-to-shop health care incentives gaining traction" [Web blog Post]. Retrieved from address https://www.benefitspro.com/2018/03/05/pay-to-shop-health-care-incentives-gaining-tractio/


Financial shocks could disrupt tomorrow’s retirees

While today’s retirees, dependent as they are on Social Security and traditional pensions rather than 401(k)s, are better able to withstand financial shocks, tomorrow’s retirees won’t have it so easy.

They will be more in danger of being forced to downsize or spend down their assets to meet unexpected expenses such as a spike in medical bills or a loss of income through being widowed.

So says a brief from the Center for Retirement Research at Boston College, which investigated the financial fragility of the elderly to see how well they might be able to deal with financial shocks.

The reason the elderly are seen as financially fragile, the brief says, stems from the fact that, “once retired, they have little ability to increase their income compared to working households.”

And with future retirees becoming ever more dependent on their own retirement savings, and receiving less of their retirement income from Social Security and defined benefit plans, those financial shocks will get harder and harder to deal with.

To see how that will play out, the study looked at the share of expenditures a typical elderly household devotes to basic needs. Next, it looked at how well today’s elderly can absorb those aforementioned major financial shocks. And finally, it examined the increased dependence of tomorrow’s elderly on financial assets, whether those assets are sufficient, and how well those assets do at absorbing shocks.

Nearly 80 percent of the spending of a typical elderly household, the report finds, is used to secure five “basic” needs: housing, health care, food, clothing, and transportation. In lower-income households or the homes of single individuals and in households that rent or have a mortgage, those basic needs make up even more of a household’s spending.

And while there are areas in which a household can cut back—such as entertainment, gifts or perhaps cable TV—as well as potential cutbacks on basic needs, typical retirees can’t cut by more than 20 percent “without experiencing hardship.” And among those lower-income and single households, as well as those with rent or mortgages to pay, the margin is even slimmer.

The need for medical care is so important to those who need it, says the report, that the question becomes whether medical expenditures crowd out spending on other basic items.

And while a widow is estimated by federal poverty thresholds to need 79 percent of the couple’s income to maintain her standard of living, other studies indicate that widows get substantially less than that from Social Security and a pension—estimates, depending on the study, range from 62 percent to 55 percent. And that likely does not leave a widow enough to meet basic expenses.

Among current retirees, only 10 percent report having to cut back on necessary food or medications because of lack of money over the past 2 years.

However, retirees tomorrow, if they have failed to save enough to see them through retirement, are likely to experience income declines of from 6 to 21 percent for GenXers—and that’s assuming that GenXers “annuitize most of their savings at an actuarially fair rate…” despite the fact that very few actually annuitize, and cannot get actuarially fair rates even if they do.

And since the brief also finds that the greater dependency of tomorrow’s retirees on whatever they’ve managed to save in 401(k)s means that they’re exposed to new sources of risk—“that households accumulate too little and draw out too little to cushion shocks and that their finances are increasingly exposed to market downturns”—that means that future retirees will be subjected to a reduced cushion between income and fixed expenses.

To compensate, they will need to downsize and cut their fixed expenses. Neither one bodes well for a comfortable retirement.

Read the article.

Source:
Satter M. (1 March 2018). "Financial shocks could disrupt tomorrow’s retirees" [Web Blog Post]. Retrieved from address https://www.benefitspro.com/2018/03/01/financial-shocks-could-disrupt-tomorrows-retirees/