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Is Medicare-for-all Good for Business Owners and Employees?

Jeff Griffin

Today the first official votes will be cast, both in Iowa and California, for the 2020 presidential election. A hot button topic in the discourse leading up to this moment has been whether the country should migrate to a single-payer healthcare system commonly referred to as "Medicare-for-all."

While every Democratic candidate still in the running supports some level of change to the current healthcare system, Medicare-for-all is a solution championed primarily by Vermont Senator Bernie Sanders and Massachusetts Senator Elizabeth Warren.

Both are pushing for a single-payer solution where Americans would be enrolled automatically in a government-run medical insurance plan. Both of their policies call for essentially disbanding private insurance, or relegating it to something only needed to supplement care outside of the provisions provided in their single-payer solutions.

Should Employers Embrace Medicare-for-all?

Would this transition to Medicare-for-all be a good thing for employers, 4.5 million of which are providing employer-sponsored group health insurance to over 160 million Americans representing 49 percent of the country's total population?

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Topics: Cost Containment, Disruption, Legislation

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Skyrocketing Prescription Drug Prices - Finally In Bipartisan Crosshairs

Jeff Griffin

Last week we wrote about a recently issued Executive Order by the White House to hopefully usher in healthcare price transparency from hospitals and insurance carriers, both of whom hold their secret price negotiations close to the vest. We expressed optimism over the order’s ability to tame runaway consumer and employer healthcare costs. Sunlight, after all, is said to be the best disinfectant.

There’s another area of equal concern which has been driving up the cost of employer-sponsored healthcare for quite some time - prescription drug pricing. In a word, it is skyrocketing, with no end in sight.

The price of pharmaceutical drugs is rising 3x faster than wages, and 5x faster than inflation. In fact, more than 3,400 drugs have boosted their prices in the first six months of 2019, an increase of 17 percent in the number of drug hikes from a year earlier. And the average price hike across all prescription drugs stands at 10.5 percent.

A new coalition of health advocate groups was formed in October to make their voices heard on drug price transparency, caps on drug price increases, and other price reducing strategies. The coalition has identified drug manufacturers and pharmacy benefit managers (aka the middlemen) as the culprits, but it’s literally going to take an act of congress to get this under control.

The drug hikes come at a time when (or perhaps because) lawmakers and the Trump administration have vowed to address the problem of rising prescription costs.

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Topics: Cost Containment, Disruption, Legislation, Price Transparency

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Employers Should Welcome Healthcare Price Transparency, Despite Industry Objections

Jeff Griffin

The Trump administration, hungry to notch a win on healthcare prior to the 2020 election, continues to push ahead on initiatives designed to reign in healthcare costs. We applaud these efforts and are disappointed and dismayed by those in the healthcare industry opposed to these undertakings.

Announced November 15, the White House’s price-disclosure initiative would most certainly upend the $3.5 trillion healthcare industry. In fact, the requirements called for, by executive order, are far more extensive than many industry experts predicted. Somewhat expectedly, they have drawn the ire of hospitals and healthcare delivery providers caught in its crosshairs.

The Executive Order On Healthcare Transparency

Issued jointly by the Department of Labor (DOL), Department of Health and Human Services (HHS) and the Treasury Department, the proposal imposes new transparency requirements on group health plans and health insurers in both the individual and group markets.

In the simplest of terms, the proposed rule will force hospitals and insurers to disclose the highly secretive rates they negotiate with each other for an extensive list of services, including doctor and facility fees, supplies, and even drug costs.

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Topics: Cost Containment, Disruption, Legislation, Price Transparency

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Preventive Care Coverage Improves For High Deductible Health Plans

Jeff Griffin

The IRS has added care for a range of chronic conditions to the list of preventive care benefits that can be provided by a High Deductible Health Plan (HDHP) without a deductible.

This expansion of preventive care services is in response to an executive order signed on June 27 by President Trump. The order, designed to improve price and quality transparency in health care, directed the Treasury Department and IRS to improve the attractability of HSA-compatible HDHPs which cover low-cost preventive care, before the deductible.

The IRS issued Notice 2019-45 in response to this executive order. With this order now in place, it now classifies certain medical care services and items, including prescription drugs for chronic conditions, as preventive care for individuals with certain chronic conditions. 

Employers with HDHPs should review their plan documents and consult with their benefits broker, carriers and benefit administrators to determine how their plans might cover these new preventive care benefits on a go-forward basis. 

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Topics: Cost Containment, Education, HSAs, High Deductible Health Plans

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Common Pitfalls To Avoid With Your High Deductible Health Plan

Jeff Griffin

Employers looking to decrease their healthcare costs often rely on workforce adoption of High Deductible Health Plans (HDHPs), which offer both employers and employees lower premiums. Unfortunately, this strategy doesn’t always work out if enrollment in HDHPs (assuming employees are given a choice) fall short of forecasts.

Rightly or wrongly, HDHPs have been saddled with some baggage. Many people have difficulty making the cognitive leap from traditional healthcare plans to HDHPs for a variety of reasons; in part because change is generally difficult for people, but sometimes, it’s simply a fear of the unknown and a matter of not understanding how they work.

While we certainly aren’t advocating that HDHPs are suitable for everyone, they’re a great fit for some — especially those who are otherwise overpaying for health insurance, meaning that they’re paying high premiums, but rarely using their plans.

Here are some common pitfalls to avoid when designing and marketing a high deductible health plan and suggestions on how to avoid them.

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Topics: Cost Containment, Education, HSAs, High Deductible Health Plans

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Employee Benefits Built With Employee Retention In Mind

Jeff Griffin

Maintaining a competitive edge often comes down to retaining a talented workforce. The growing popularity of so-called “portable” employee benefits, such as Health Savings Accounts (HSAs), certainly hasn't made this any easier. Employers trying to entice workers to remain loyal may want to focus their efforts on providing benefits which are simply too good to surrender. Offering benefits that accrue significant value over time, or improve with tenure, will help keep employees from abandoning that progress for greener pastures, lest they have to start over someplace else.

How the ACA Impacted Employee Retention

Prior to the passage and implementation of the Affordable Care Act (ACA) there was considerably less job mobility for many Americans with pre-existing health conditions. The moment insurance carriers were barred from discriminating based on pre-existing conditions, the need for individuals to stay with a company for insurance reasons essentially vanished. Many employees who were previously stuck in their jobs for fear of losing benefits were now free to explore other opportunities.

Similarly, many budding entrepreneurs set off to start their own businesses while acquiring individual health insurance via the ObamaCare exchange or through other means. One could argue that this new freedom was a benefit to both employers and employees  after all, who really wants an employee who is sticking around just because of benefits? Nevertheless, this new found “employee mobility” has made the search for "sticky" benefits all the more important.

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Topics: Cost Containment, Retention

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Surprise Medical Billing Reaches a Tipping Point

David Rook

All across the country, a sweeping movement to combat surprise medical bills has been slowly percolating and is now finally gaining traction on a national level.

What began as grievances filed by wronged patients has grown into government officials at both the state and federal level championing legislation against this industry practice.

A law that recently went into effect in Arizona and recent remarks from President Trump are merely the latest in an ongoing trend that has the force to reshape how patients are billed for out-of-network expenses.

Unexpected Out-of-Network Charges Result in Surprise Medical Bills

Surprise medical billing isn’t so much an intentional practice of healthcare companies, as much as it’s a byproduct of the fractured healthcare industry. Specifically, it’s a result of multiple institutions and providers treating patients simultaneously while working for different employers.

In its simplest form, a surprise medical bill is an unexpected medical bill that patients receive for out-of-network services that they thought were in-network. The bill is sent after the services are provided, leaving patients with little recourse and high fees since out-of-network charges tend to be much higher than those in-network.

An all too common scenario shows how easy this can happen to patients. A patient goes to a hospital for a covered surgical procedure. They’ve done their research and have made sure that both the hospital and the surgeon’s practice are within their insurer’s network. In completing this due diligence, they then assume that the entire procedure will be covered as an in-network expense. Seems reasonable, right?

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Topics: Cost Containment, Legislation, trends, Arizona, healthcare costs, Arizona Regulations

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Full Replacement High-Deductible Health Plans (HDHPs) Losing Luster with Employers

David Rook

The verdict is in – employer adoption of high-deductible health plans (HDHPs) as the sole medical option for employees is beginning to fade.

Brought on, in part, by the need to offer richer medical benefits in the face of a tightening labor market, a recent survey by the National Business Group on Health (NBGH) indicates that 23% of large employers who currently offer an HDHP as the sole medical option for employees are planning to introduce other medical options this year. 

This represents a drop from 39 percent to 30 percent of large employers who only offer an HDHP to their workforce. Similar surveys by the Kaiser Family Foundation (KFF) and Mercer support these findings. 

The intense competition for talent (who may be seeking richer plans) is only one reason for the decline in popularity of HDHPs as an employer’s sole medical plan option. Also contributing to this waning interest has been the ongoing postponement of the Affordable Care Act’s “Cadillac tax” on higher-value plans, which was initially a driving force for HDHP adoption by employers. 

The threat of the tax has abated to the point where it seems dubious if the tax will ever come to fruition. (The 40 percent tax on high-value health plans was originally set to take effect in 2018 but was then postponed to 2020 and then again to 2022.)

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Topics: Cost Containment, ACA, Plan Design, High Deductible Health Plans

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What Is Value-Based Insurance Design and Does It Lead To More Effective Employee Benefit Programs?

Jeff Griffin

In an effort to mitigate rising health insurance premiums and increase overall efficiency within the healthcare industry, an increasing number of insurers and employers are integrating value-based insurance design into their group health plans. 

For everyone involved -- including insurers, providers, employers and employees -- insurance plans integrating value-based design help to spotlight and migrate healthcare to services that have been proven to yield better results vs. those which are less effective.

Value-Based Insurance Design Recognizes Value

Value-based insurance design recognizes that not all healthcare services provide patients with the same level of value. Simply put, some health services are more effective than others.

These insurance plans seek to encourage employees to use services that have proven to be more effective and beneficial. Decisions on which services to encourage aren’t made on conjecture, but rather are based on research that shows which services have the best positive impact on patient health given the resources invested. In most cases, encouragement is created in the form of financial incentive (e.g. lower copays).

Some of the highest value services are outpatient treatments offered at clinics, and most value-based designs focus on promoting clinical services. There is a particular surgical example, however, that illustrates how these plan designs work.

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Topics: Cost Containment, Education, Plan Design

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Four Ways Employers Can Reduce Smoking Rates Among Their Workforce

David Rook

Smoking has been in steady decline in the United States for decades, with Gallup reporting that smoking rates among adults have dropped from 45 percent in 1953 to 16 percent in 2018.

Nevertheless, according to the CDC,  almost 38 million adults in the country still smoke cigarettes regularly (defined as “every day” or “some days”). This doesn’t even take into account anyone who enjoys pipe tobacco, cigars or other cigarette alternatives.

The malignant effects of these habits are well documented. In addition to the personal health issues individuals suffer, smoking also impacts non-smokers, both in terms of health risks and more expensive healthcare.

The following is an exploration into just how much smoking costs businesses each year and what measures employers can take to reduce smoking rates among their employees.

The Added Cost of Employing Smokers

CDC research places the increased cost of employing a smoking adult at nearly $6,000 per smoking employee, per year. Much of this figure comes from lost productivity and increased healthcare costs, but it also takes into account other less obvious expenses.

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Topics: Cost Containment, wellness, Behavioral Psychology, Smoking

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