After several years of notably slow growth, U.S. health care spending took a bigger bump upward in 2013. Many MedBen clients, on the other hand, saw their costs going down last year.
According to Reuters, a new report by IMS Health Holdings found that nationwide health care spending went up 3.2%, to $329.2 billion – the first significant increase in three years. The health care information company attributes the growth to greater consumer use of health services, including doctor office visits and hospitalizations.
Health care spending at MedBen didn’t follow national trends, however. Through a combination of innovative cost controls, actionable reporting tools and worksite wellness incentives, in 2013 our self-funded clients saw a 5% average decrease in medical and pharmacy claims costs PEPM compared to 2012*.
The IMS report notes that while overall use of prescription drugs increased in 2013, a greater use of generic alternatives helped keep cost increases in check. MedBen also emphasizes the use of generics… but to provide even greater savings, we deliver 100% of paid pharmacy rebates back to the client. Additionally, we offer superior Rx discount rates on generics that further encourage their use over costlier brand-name drugs.
At MedBen, staying in step with national trends isn’t good enough. We prefer to navigate our own path… one that ensures that clients get the most value for their money. To learn more about our many savings solutions, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
* Based on a comparison of Jan-Sept 2012 MedBen claims data with Jan-Sept 2013.
In order to help its self-funded clients properly calculate and file their 2014 Transitional Reinsurance (TR) and PCORI Fees as required under the Affordable Care Act, MedBen offers a variety of services at multiple price points. Our services range from providing general covered lives data to full service TR reporting, and include the following:
Basic TR & PCORI Eligibility Report. MedBen will provide general covered lives data at no cost.
PCORI Full Service Report (for employers with one health plan or multiple health plans). If you prefer that MedBen run a detailed report and calculate the specific amount owed, we will provide you with the report and the final amount owed for the year in question which can be entered directly on that year’s IRS Form 720.
TR Full Service Report (for employers with one health plan or multiple health plans). If you prefer that MedBen run a detailed report and calculate the specific amount owed, we will provide you the report and the final amount owed for the year in question which can be used for required reporting to the IRS.
TR Report Filing and Payment Remittance. Separate from the detailed reports service described above, MedBen will file the required reports with the IRS and remit the fee (paid by the plan sponsor) on behalf of the plan sponsor.
MedBen clients that would like to receive more detailed information about these services (including costs) may contact their Group Service Representative. Clients with questions about these services or any other ACA compliance assistance MedBen offers may also contact Vice President of Compliance Caroline Fraker at email@example.com.
Now that the weather outdoors is (finally!) warming up a bit, you’re probably anxious to take advantage of the longer days and more pleasant temperatures. But before you “spring” into action, make sure that your internal machine is running at peak performance by scheduling your annual wellness exam.
Yearly checkups are a key to maintaining good health and improving your odds for a long life. During the exam, your family doctor will run a variety of tests, such as listening to your heart and lungs and measuring your blood pressure rate. Using this information, the doctor can monitor health patterns and detect areas and conditions that warrant further attention.
Annual exams can also help to promote a positive mental attitude and encourage a proactive approach toward personal wellness. Should you have specific concerns about your health or are looking to lose weight or quit smoking, a checkup is an opportune time to discuss such matters.
If you’re a MedBen Worksite Wellness member and aren’t sure about the last time you’ve had an exam, visit MedBen.com and click on “MedBen Access”. Once you’re logged in, select “iHealth Information” to view the dates of your most recent visit and next recommended checkup. And if you’re worried about the cost, don’t be – your employer will “spring” for it!
A review of prescription claims data from early enrollees to the health insurance exchanges suggest that healthier uninsureds didn’t race to sign up. According to Kaiser Health News, individuals who got coverage from federal and state marketplaces in the first two months have pricier care needs than the general population.
The analysis by pharmacy benefit manager Express Scripts revealed that new enrollees are more likely to use expensive specialty drugs to treat conditions like HIV/AIDS and hepatitis C than those with job-based insurance. Prescriptions for treating pain, seizures and depression are also proportionally higher in exchange plans.
Experts cautioned that the initial data should be kept in perspective.
“This is a snapshot of the population early on,” said Julie Huppert, Express Scripts’ vice president of health care reform. “The hope is the young and healthy come into the system in the later weeks of the enrollment period.”
Robert Lazsewski, a consultant to the insurance industry, concurred: “We all expected that the people who signed up by January and February would be a lot sicker than anyone else.” The consensus among insurers, he added, is that “it will be a year before we know what we’ve got.”
As more health care reform rules have taken effect, MedBen has seen a spike in the number of fully-insured employer groups that want to know if self-funding would work for them. More often than not, the answer is “yes", even for midsize and smaller groups. And MedBen has self-funding solutions that help employers make a smooth transition from traditional coverage.
For over two decades, MedBen has offered Split Solution, a partially self-funded product available to groups with as few as 20 employees. Employers can share in the savings that come from reduced employee claims but still maintain plan design flexibility.
The Split works much like a regular health plan, with one notable difference: Once the employee deductible is reached, the employer funds eligible claim costs up to a preset employer retention (deductible) limit. By retaining some of the claim cost, you can lower premium cost while protecting your business from large claims.
Earlier this year, MedBen also introduced its first reinsurance captive program, which offers employers self-funding advantages plus the opportunity to get part their reinsurance premium back. A second captive is currently being developed for July 1 groups.
In a captive, risk is spread among multiple groups. A portion of the captive’s collective stop-loss premium is held in a separate “captive layer” from which claims above the specific deductible are paid. Any funds remaining in the captive layer go back to the groups – which in a good claims year can represent a considerable return.
Employers interested in learning more about any of MedBen’s self-funded services are welcome to contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Now that the enrollment period is over for the health insurance exchanges, The Wall Street Journal ponders five questions that, when (if?) answered, should give a better idea of just how well government-directed health care is working:
1. How many of the seven million exchange enrollees were previously uninsured? “The marketplaces, an expansion of Medicaid and other policy prescriptions under the law were expected to help cover 13 million uninsured people in 2014, the Congressional Budget Office projected. We won’t know if subsidies for private plans actually led to many people gaining coverage for a while.”
2. How many people will trickle in after Monday’s deadline? “The Department of Health and Human Services granted an extension for would-be enrollees who started signing up before March 31 but never finished. Health insurers say they believe most of those people will have to pick plans by mid-April. But it’s unclear how many of them are there, and how many will show up.”
3. Will all of the new enrollees pay their premiums? “To finalize an enrollment, people need to pay their first month’s premium to their insurer. Those who signed up in the final two weeks of the enrollment period — well over 1 million consumers — won’t have to pay until the end of April. And, even after the first month, some people will simply stop paying and lose their plans.”
4. How sick or healthy are the people who signed up? “Under the law, insurers can’t deny coverage to sick consumers or ask about health status. They need healthy people to offset their costs, and younger consumers may be more likely to be healthy. But it might take weeks for insurers to have a good grasp of the health statuses of people who signed up in the final days of enrollment.”
5. What about people who signed up outside of the marketplaces? “Consumers buying plans directly can’t get federal subsidies, and the government doesn’t necessarily keep track of them. [T]hose unseen enrollees are a key ingredient for the law’s success. If they’re healthy, their premiums will help offset potentially less healthy subsidized enrollees.”
Yet another example of how an emphasis on wellness can lead to long-term benefits: According to a new study, controlling blood pressure after suffering a stroke can reduce the odds of having another stroke by more than half.
MedicineNet reports that the two-year analysis of stroke patient data found that patients who were able to maintain a consistent low blood pressure more than 75% of the time reduced their chance of another stroke by 54%, compared with those who achieved this goal less than one-quarter of the time. Unfortunately, less than 30% of patients maintained consistent blood pressure… but timely aid can help to improve that ratio.
MedBen Worksite Wellness offers one-on-one professional intervention for plan members with high blood pressure and other chronic conditions. High-risk individuals are identified and automatically enrolled into the Specialty Care program for personalized disease monitoring and nurse coaching.
The wellness coaches serve as a complement to the family doctor, providing information, counseling and ongoing support. Having an additional avenue of guidance helps the patient to further reduce the risk of a stroke reoccurrence – or preferably, to avoid one altogether.
To learn more about Specialty Care and other components of the MedBen Worksite Wellness program, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
Last year’s announcement that health flexible spending account owners could carry over a portion of their funds came as welcome news for most. But to individuals who also contributed to a health saving account, it created something of a dilemma.
As Business Insurance notes, IRS rules don’t permit employees enrolled in health FSAs to also contribute to HSAs. However, employees enrolled in limited-purpose FSAs – those designated solely to pay for dental, vision and preventive care services – may also make HSA contributions if they so choose.
On March 28, the IRS provided clarification on how employee could roll over up to $500 in FSA funds without affecting HSA contributions:
“Under the first way, an employee participating in a [health] FSA can elect to have unused balances carried over the next year to a limited-purpose FSA.
“Under the second way, employers can design their [health] FSAs so that unused amounts are automatically carried over the following year into limited-purpose FSAs for those employees enrolled in health plans linked to HSAs.”
Employers may also offer employees the option to decline or waive any carryover of remaining funds, thus allowing them to contribute to an HSA the following year.
MedBen clients who have questions regarding the FSA rollover rules are welcome to contact Director of Administrative Services Sharon A. Mills at firstname.lastname@example.org.
The passage of a Medicare “doc fix” bill could delay the implementation of ICD-10 codes by a least a year, Modern Healthcare reports.
The nationwide conversion to the ICD-10 family of diagnostic and procedural codes is scheduled to occur October 1, 2014. But the proposed legislation, which would “patch” the Medicare fee system for 12 months, contains a single sentence that would change the timeline: “The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets.” The bill also cites the Social Security Act and the Code of Federal Regulations where the secretary’s authority to mandate ICD-10 are located.
The bill passed the House on a surprise voice vote earlier today and is expected to also get Senate approval before a Monday deadline, according to The Washington Post. If passed, it would mark the 17th time Congress has made a temporary fix to a much-maligned 1997 budget law.
ICD codes are used by the health care industry to describe diagnoses and treatments. When the new system is implemented, it will expand the number of codes from 14,000 to 68,000.
A postponement would mark the third such delay since ICD-10 was proposed in 2005. Last month, Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner promised the codes “will go live on October 1.”
MedBen remains on track to meet the current ICD-10 conversion deadline should the language be removed from the final legislation.
UPDATE (4/1/14): POLTICO reports that on March 31, the Senate also passed the “doc fix” bill, including the ICD-10 postponement. Assuming the legislation is signed by President Obama, the new coding system rollout will be delayed until at least October 1, 2015.
A review of the coverage numbers under four years of the Affordable Care Act yield some rather underwhelming results. From Wynton Hall of the Breitbart News Network:
“According to CNBC, of the 5 million people the Obama administration claims have enrolled in Obamacare, just 715,000 are previously uninsured Americans who have chosen and paid for new insurance. As the Washington Post notes, there are 48.6 million uninsured Americans. That means that after four years of being the law of the land, Obamacare – whose purported purpose was to cover the uninsured – has provided coverage for just 1.4% of uninsured Americans.
“Indeed, the vast majority of those who have signed up for Obamacare are merely Americans who already had health insurance but whose plans were canceled by Obamacare.“Moreover, a year ago the non-partisan Congressional Budget Office (CBO) reported that between 26 million and 27 million uninsured Americans will never receive health care coverage under Obamacare.”
The current state of health care reform has created no small measure of uncertainty among self-funded employer groups… and an unprecedented need to understand how benefit and population changes will affect their bottom line. To meet this need, MedBen provides clients with intelligent reporting tools to make medically sound, financially effective decisions.
Since 2010, MedBen has partnered with Verisk Health to provide Sightlines™ Medical Intelligence. By using this advanced data analytics and reporting platform, our clients receive unique insight into the financial and clinical risks they face, allowing them to chart an effective course of action.
With Sightlines™, MedBen helps employers analyze existing claims data, and identify quality and cost metrics. The reporting information doesn’t simply show what has happened but what will happen, and what clients can do to control costs now and in the long term.
Sightlines™ features leading edge processes to ensure accuracy of client information:
MedBen can help your business take proactive action to manage health risk and implement money-saving wellness strategies, regardless of the prevailing health care climate. To learn more about our innovative reporting solutions, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
On March 25, the Supreme Court is scheduled to hear oral arguments regarding the question of whether or not employers should be required to cover contraceptives even if it conflicts with their religious beliefs. The hearing marks the latest (and final?) chapter in a conflict that has waged on since 2012.
The Affordable Care Act mandated that employers provide no-charge birth control for female members, although it exempted churches from the rule. But when faith-based organizations protested, the Obama administration last year revised the provision, now requiring that insurance companies which cover religious-affiliated groups must provide free contraceptive benefits on their behalf, if so notified by a group of its objection. In turn, the insurer would get a reduced fee to participate in health insurance exchanges.
There remained the question of how to address self-funded religious groups. In such cases, the administration said, the group needed to make arrangements to provide coverage through a separate health plan, and its third-party administrator would notify enrollees of coverage availability.
The changes did not placate religious groups, which proceeded to file over 90 lawsuits across the country. The justices will hear oral arguments from lawyers representing two of the highest-profile cases, Sebelius v. Hobby Lobby Stores and Conestoga Wood Specialties v. Sebelius.
Public sentiment currently favors the administration. A recent NBC News/Wall Street Journal poll revealed that 53% of Americans say employers should not be exempt from the requirement, while 41% say they should be exempt.
MedBen clients who have questions about contraceptive coverage rules may contact Director of Compliance Annette McNair at firstname.lastname@example.org.
Finally, if you’re interested in reading more about the religious and political ramifications of the upcoming hearing, an article in today’s USA Today explores the various legal questions posed by the opposing parties in the case.
Promoting preventive care continues to pay off in a big way. The latest evidence: Colon cancer cases among Americans 50 and older fell 30% in the last decade, according to a new study.
The Wall Street Journal reports that the study of government data by the American Cancer Society also found that colon cancer death rates dropped about 3% a year between 2001 and 2010, compared with 2% a year in the previous decade.
“We’ve almost halved the mortality rate from colon cancer in the last 35 years,” said ACS Chief Medical Officer Otis Brawley in comments about the study.
MedBen Worksite Wellness believes that cancer screenings and regular wellness exams are critical to employee health and productivity – and in turn, employer costs. That’s why our Primary Prevention Program promotes plan member awareness of personal health through individualized wellness screening recommendations, customized for age and gender and based on the individual’s medical claims history. To learn more, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
MedBen follows ACS recommendations that people with an average risk of developing colon cancer get screened starting at age 50. MedBen Worksite Wellness members can check their compliance with colonoscopies and other critical wellness examinations by visiting the MedBen Access website and clicking on the iHealth Information link under “My Plan”.
Money-saving strategies took center stage at MedBen’s 8th Annual Government Employer Roundtable held on March 18. Municipalities whose benefits are administered by MedBen got to see how their plan performed in comparison to other municipal employers, and learned about performance indicators they can use in order to best manage costs.
Vice President of Sales & Marketing Brian Fargus led off his review of 2013 client benchmarks with the observation that PEPY costs of MedBen’s government block had decreased 2% since 2010. While municipality costs still tended to be higher than those of other types of businesses, much of that could be attributed to factors common to public employers, such as an older workforce and richer benefits, he said.
Fargus also noted that “for a health plan to succeed, it’s critical that everyone understand its goals.” Only when members are on board with the plan’s objectives – be it taking advantage of free preventive care, using in-network providers or favoring local hospitals over more expensive metro facilities – will costs remain low for employer and employee alike.
In his analysis of pharmacy benchmarks, MedBen President & COO Kurt Harden concurred that employee longevity and more generous benefits contribute to higher prescription plan costs for municipality employees. Many government plans offer set co-pays for all types of prescription drugs, rather than the patient paying a percentage of the costs – which results in greater use of brand name drugs. A better strategy, he suggested, is a fixed generic cost combined with a percentage co-pay on brands.
“A $5 generic, a $10 generic, or a $0 generic beats the uncertainty of a percentage,” Harden said. “The generic dispense rate is driven by the plan design.”
“Now more than ever, it pays to self-fund.” It’s a claim MedBen has made in advertisements and to prospective clients a lot lately. But what does it really mean to an employer that still offers traditional health coverage?
Under the Affordable Care Act, a fully-insured employer pays premiums determined by an insurance company, based on the insurer’s own claims experience. The employer will not receive any refund, even if its own claims experience is good.
Because many ACA rules don’t affect self-funded plans, the employer can set its own premium rates based on its claims history. Additionally, the employer can adjust the plan benefits and use other ways to cut costs. If employee claims are lower than anticipated, the employer keeps any savings.
Self-funded employers assume a limited portion of the liability and risk associated with health care costs in exchange for significant financial benefits, such as:
This all adds up to bigger cost savings, better plan flexibility, and a greater degree of regulatory freedom. And even smaller businesses can benefit from self-funding, because MedBen has coverage options that minimize financial risk while still offering real savings potential.
If you’d like to learn more about MedBen self-funded solutions, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Businesses have gotten a break of sorts from the Affordable Care Act’s Transitional Reinsurance Tax. Business Insurance reports that rather than paying the fee in a lump sum, the Department of Health and Human Services will allow employers to make the payment in two installments if they prefer.
“We recognize that the reinsurance collections provided for in the Affordable Care Act will result in substantial upfront payments from contributing entities for the reinsurance program. Therefore, in consideration of the comments received, we are finalizing our proposal to collect contributions via two payments,” the final rules said.
The per-member tax, which is assessed on group health plans to cover high-cost cases in the individual market, took effect earlier this year. The 2014 fee is $63 per plan participant, and $44 in 2015. HHS has yet to propose the 2016 fee.
The final rules also exempt self-insured plans that also self-administer their benefits from the fees in 2015 and 2016. Only a handful of plans qualify for this exemption, however.
MedBen clients with questions regarding the reinsurance tax are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.
Be it too many tasks, an uncooperative co-worker, or a problem at home that’s affecting your concentration, everyone experiences workplace stress to some degree. The average worker can have as many as 100 projects on the agenda, so it’s understandable to feel your job spinning out of control now and again. The key is to get a handle on things before they overwhelm you.
Workplace stress doesn’t just take an emotional toll – it can do physical damage as well. Mental anxiety can make it harder to control diabetes, increase your risk for coronary heart disease, and even raise your cholesterol level. So don’t take the warning signs for granted.
When you’re feeling the symptoms of stress, such as irritability, headaches, fatigue or stomach problems, be proactive. Meet with your boss about your workload, or speak to your Human Resources representative if a co-worker conflict threatens to boil over.
Even if you’re not overly stressed, studies suggest that removing yourself from the office for just 30 minutes allows you to get away from daily interruptions and helps to clear your mind. And when you can’t take a break, just a series of quick deep breaths for 90 seconds at your desk can help you relax and improve your focus.
“[Pharmacy benefit managers] cut private deals with drugmakers and then set maximum amounts they’ll reimburse drugstores for generic drugs and what they’ll charge companies, insurers or other clients for the drugs. The difference between these two numbers is often called ’spread pricing,’ and remains a murky but highly profitable area.”
So states a USA Today article regarding PBMs, which also notes that such companies are becoming “more profitable and powerful” in the era of health care reform. And indeed, it is true that some PBMs hold back a portion of those rebates – typically, to offset so-called “lower” administrative fees – and pocket the difference.
At MedBen, however, we partnered with a PBM which shares our belief that such tactics have no place in Rx benefits management. And that’s why 100% of discounts and paid pharmacy rebates go directly into your health plan.
MedBen offers a transparent, full pass-through Rx model that results in better savings for clients. We offer superior discount rates, including generic discounts that are among the best in the industry. And we support our pharmacy program with strong, useful reports and recommendations that drive groups toward good plan design decisions.
MedBen will work closely with your group to design a pharmacy plan that best meets member needs, with no hidden fees – instead, you get the maximum savings possible. To learn more, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Earlier today, MedBen clients and non-clients turned out for the company’s 12th Annual Hospital Employer Roundtable at the Morrow Conference Center in Newark, Ohio. Members of the MedBen team offered their insights on the current state of health care benefits, with an emphasis on showing ways that hospitals are bringing down their group coverage costs.
MedBen Vice President of Sales and Marketing led off the roundtable with a review of hospital benchmarks for 2013. In prefacing his comments, Fargus observed that stop-loss carriers have seen a rise in large claims over the past several years, a trend that invariably affects employer benefit costs. One carrier reported a 79% jump in claims of a million dollars or more from 2011 to 2012 – a period that coincided with the elimination of lifetime maximums under Affordable Care Act rules.
Yet in spite of the uncertainty surrounding health care reform, Fargus noted that MedBen’s block of hospital clients have seen minimal increases of late – in fact, “average costs have gone up an average of only 2.4% since 2010,” he said.
Among the reasons Fargus cited for the slow growth is a greater emphasis on employee wellness. By reducing the “care gap” – a measure of what preventive exams and screenings a group’s plan members should be receiving compared to what they’re actually getting – MedBen’s hospital clients have seen overall improvements in employee health.
Also key to keeping costs low, he stressed, was promoting an advantage distinctive to health care facilities – in-house treatment. Hospitals can realize substantial savings by encouraging plan members to favor their own physicians, as well as buying their prescription drugs from the hospital’s own pharmacy.
As we recently noted on this blog, MedBen introduced its first reinsurance captive in January, and is developing a second to take effect July 1. A captive is an ideal solution for fully-insured employers that would like to make the switch to self-funding but are concerned about taking on the financial risk.
While a reinsurance captive may seem complicated to those unfamiliar with the concept, it’s actually pretty simple. On its face, a captive is similar to standard self-funded coverage. Employers within the captive still choose their own benefits and specific deductibles, and pay premiums as they normally would for their chosen deductible levels. The real difference resides in a separate pooled or “captive” layer.
A portion of the captive’s collective stop-loss premium is held in this layer, from which claims above the specific deductible are paid. Any funds remaining in the captive layer go back to the groups – and in a good claims year, that can represent a considerable return!
In the sample chart above, the employers pay claims up to their respective specific deductibles. Once reached, an employer’s claims are paid from its own captive layer – and if the maximum amount is reached there, the employer’s stop-loss insurance kicks in.
At the end of the plan year, all employers in the captive share remaining funds in their collective captive layers. Funds are distributed in proportion to an employer’s stop-loss premium – the higher the premium, the more money you get back!
At 2014 MedBen University events in Ohio and Indiana, MedBen will provide guests with a more detailed explanation of how the captive concept works. If you’d like to be notified of upcoming MBUs in your area, just email MedBen Sales Analyst Sally Wood at email@example.com. Or if you’d prefer to learn more about MedBen Reinsurance Captives now, contact Vice President of Sales and Marketing Brian Fargus at firstname.lastname@example.org.