As more hospitals gravitate away from traditional fee-for-service to alternative payments methods, self-funded groups are making changes to their health care plans to capitalize on the potential savings. According to an analysis by the National Business Group on Health (NBGH), nearly half of employers have incorporated some type of value-based design in their plan.
In a recent article about alternative payment methods, MedBen Vice President of Compliance Caroline Fraker observed that "large employers in your communities are already experimenting with some form of bundled payment models." Likewise, employers have introduced various wellness-based measures that allow them to benefit from the lower costs these payment structures offer — among them, participation in a disease management program and adherence to chronic medications and screenings for chronic conditions.
The NBGH analysis found that, while the transition from fee-for-service medicine has been slow, many employers already have put in place a foundation for the future. Current value-based designs include offers to lower worker premiums and reduce out-of-pocket costs if they “take steps to manage chronic conditions, obtain higher quality care or more efficient care,” the analysis says.
Worksite wellness and disease management programs like MedBen WellLiving are a way to promote better health. But the cost savings from these programs matter, too... and as payment models change, the potential exists for even greater savings. As we continue to roll out our commercial bundled payment services, we'll help to instruct clients on plan design changes that will benefit employer and employee alike.
There's been a lot of hype lately about how private health insurance exchanges — a system in which employees receive a set allowance to select an insurance plan from multiple vendors — are the next big thing in group coverage. But as is often the case, "hype" doesn't always translate to "interest."
A recent Mercer survey found that only 6% of large employers have a private exchange in place or say they will implement one this year. Additionally, 71% of employers surveyed said they had either no plans to consider adopting an exchange platform or had already looked into exchange options and decided not to pursue them.
As to why employers haven't made the switch to private exchanges, 65% said they had seen no evidence that such a system will save them any money. Even a cursory glance at how an exchange works bears this out: They offer no real means for the employer to control costs, instead depending solely on the insurer to handle plan benefits. The only real savings comes from shifting costs to employees through defined contributions.
Self-funding has succeeded largely because employers have the final say about the specific aspects of their health care plan. Working with an experienced benefits manager like MedBen, they can minimize rising health care costs through a variety of money-saving tools, and design a plan that directly addresses employee needs. Any money that doesn't go toward paying claims stays with the employer.
Moreover, because they are not as heavily regulated as traditional insurance coverage, self-funded plans offer a higher degree of legislative freedom, in addition to greater plan design flexibility.
To learn more about self-funded saving solutions available through MedBen, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Let’s do some math. Subtract your age from the number 220 (the answer is your maximum heart rate). Now multiply that number by 0.6. Got it? Repeat the steps, only this time, multiply by 0.8. You now know your targeted pulse range when performing cardiovascular fitness activities. (By the way, a healthy resting heart rage is between 60 and 100 BPM).
Cardio is any activity that makes the heart beat faster and harder for a period of time. This causes the blood flow to your muscles and your lungs to increase. You’ll begin to breathe faster and deeper, maximizing the amount of oxygen in your blood. Your small blood vessels will then widen to deliver the oxygen to your muscles and carry away waste, such as carbon dioxide and lactic acid. Your body even releases endorphins that increase your sense of well-being.
The Centers for Disease Control and Prevention recommends 150 minutes a week of moderate-intensity aerobic activity, but not everyone has that kind of time to burn. Recent studies show that HIIT (High Intensity Interval Training) makes it possible to reap all the benefits of cardio simply by doing short bursts of intense exercise, from 30 seconds to 3 minutes, with short recovery breaks in between (and yes, chasing Pokémon on the new app counts – just stay safe!).
Getting or staying fit in the world of cardiovascular is extremely important. We know too, that staying fit helps to ward off a list of other conditions. However, certain activities are not meant for everyone. Always seek guidance from your family doctor before performing high intensity workouts.
From BenefitsPRO: "[Health reimbursement arrangements (HRAs)] are making a comeback, most notably among smaller employers (2 to 100), large employers (5,000+), and any size groups with historically low utilization. Their appeal may also increase as they as they appear to have the least impact on the Cadillac Tax thresholds since actual claims versus potential claims paid from the HRA are expected to be used in the calculations, assuming the Cadillac Tax survives."
In spite of an ever-changing health care landscape ‒ or, as BenefitsPRO notes above, sometimes because of it ‒ HRAs and other types of consumer-driven health plans (CDHPs) continue to thrive and save employers money. MedBen Specialty Services has the experience to match the right CHDP with the needs of the employer.
Going back to the earliest days of HRAs as well as flexible spending accounts (FSAs) and health savings accounts (HSAs), MedBen has provided expert support to employers and plan members. We review your group’s goals to help ensure that you achieve the savings you desire, and set the proper course for your health plan.
Once your CDHP is in place, our service team will give you the tools you need to promote it. Plus, we complement our services with online account management tools and debit cards that give plan members an easy way to pay for qualified expenses.
Regardless of how the landscape shifts, MedBen Specialty Services has the CDHP expertise to keep your plan on a firm foundation. Contact your MedBen broker Vice President of Sales & Marketing Brian Fargus at email@example.com to learn more.
While average costs for employer-based health plans nationwide have risen at a fairly moderate pace this decade (though, it should be noted, not as low as MedBen's 5-year trend), specialty drug price spikes continue to concern employers. To reduce the financial impact of these expensive medications, MedBen works with clients to find group-specific solutions.
A new report from the National Business Group on Health estimates that the average cost of an employer-based health plan will increase about 6% in 2017. But specialty drug costs are expected to jump 17% next year, following a similarly high increase in 2016.
MedBen offers a variety of ways to keep specialty drug costs manageable, and offers the services of an experienced pharmaceutical consultant to provide clients with timely advice. Particular strategies can vary from group to group, but they all have a common aim: Giving plan members access to appropriate medications while remaining mindful of bottom line considerations.
Key to saving money on high-end medications is having an awareness of generic equivalents and alternative therapies. In certain cases, so-called "specialty" drugs are nothing more than two or more existing products combined into a single medication that may be more user-friendly, but come at a greatly inflated price tag. MedBen ensures that employers don't get stuck paying for these high-cost medications when far less expensive options are available.
Keeping specialty drug spending in check is critical to controlling costs, and MedBen is dedicated to helping you achieve that goal. Find out more by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Sitting on the sofa all day may be relaxing, but it's costing our country a lot of money. According to Benefits Pro, a new study finds that physical inactivity costs the U.S. $27.8 billion annually, an amount researchers label a conservative estimate. But promoting wellness in the workplace can go a long way toward lowering the bill.
The researchers estimated the costs by looking at expenses, productivity losses, and disability-adjusted life-years for five major diseases related to inactivity — coronary heart disease, stroke, breast cancer, colon cancer, and type 2 diabetes (which alone accounts for 70% of all direct health costs).
MedBen WellLiving focuses on all five of the diseases examined in the study, as well as other chronic conditions like asthma and bad cholesterol. By promoting preventive care and identifying high risks at earlier disease stages, we can greatly reduce potential health care costs as well as improve overall health, on both an individual basis and on a larger scale.
Closely tied to preventive medical care is fostering a workplace philosophy of healthier lifestyles. Simple things, like making fruit available for purchase in the lunchroom or sponsoring a companywide fitness event with appropriate incentives for participants, can make a big difference where costs are concerned.
MedBen WellLiving will work with your group to offer wellness services that encourage healthier lifestyles while improving your bottom line. Contact Vice President of Sales & Marketing Brian Fargus to learn more.
High cost claimants are among the leading contributors to health care spending, topping even medical inflation, pharmaceuticals, and specific diseases. A study from the American Health Policy Institute and Leavitt Partners found that claimants who cost $50,000 or more in a year are the top cost driver for 43% of large employers, and comprise 31% of total spending among employers’ health plans. On average, a high cost claimant costs an employer about $122,000 annually.
Recognizing that plan members sometimes require high-priced treatment, MedBen has multiple means to keep claim costs in check. Key to our claims management approach is a panel of over 125 board-certified medical specialists. Reviewing claims flagged for potential clinical problems, they work with the provider to reach a proper resolution — all before the plan pays the provider, so you don’t have to recoup expenses later.
Going hand in hand with controlling costs is early detection of chronic conditions through MedBen WellLiving. This program utilizes customized education and nurse coaching to help plan members who are at greater risk of developing conditions that could prove physically and financially costly in the long run.
MedBen offers a variety of ways to keep high claimant costs in check as well as helping employers to promote healthier plan members. To hear more about how we can assist your business, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
When it comes to matters of personal security, sometimes common-sense solutions are the most effective — which is why MedBen performs full backups of electronic client data and stores it offsite at a secure location. Recent ransomware outbreaks have only reinforced the importance of having such a system in place.
According to the CSOonline.com news site, new research has determined that health care organizations' computer networks are 114 times more likely to suffer ransomware attacks than those at financial institutions. This is due to the inherent value of their data as well as the (false) perception that such businesses are often technologically lacking.
Threat intelligence analyst Terrance DeJesus of the security firm Solutionary says that off-site backups are critical for health care data as well as the systems used to access it. Going a step further, MedBen also has a high availability disaster recovery solution in place along with our secure backup solution.
Long before the term "ransomware" entered the vernacular, MedBen has been proactive in taking appropriate steps to minimize threats. Of course, backups and recovery are just starting points... we have in place a wide variety of tools to maximize data security and guarantee client privacy.
The growth of cyberattacks has called for an unprecedented level of vigilance, but MedBen is up to the challenge. Clients who would like to know more about our security measures are welcome to contact Vice President of Information Systems and Chief Security Officer Rose McEntire at firstname.lastname@example.org.
It should come as little surprise that a proven wellness program like MedBen WellLiving can help to reduce the risk of serious health conditions. But a new study shows just how much of an impact regular preventive care can make.
According to HealthDay News, researchers determined that 90% of all strokes worldwide are preventable — and the biggest risk factor is hypertension. Eliminating high blood pressure was estimated to reduce risk by nearly 48%, the findings showed.
Other risk factors include: physical inactivity (36% potential stroke reduction if eliminated): bad cholesterol (27%); poor diet (23%); obesity (19%); smoking (12%); heart causes (9%); and diabetes (4%).
Early detection of hypertension and other chronic conditions can mean the difference between a treatable health issue and a major (and costly) problem. Toward that goal, MedBen WellLiving performs an electronic claims data analysis of the employer's total employee population, using company claims history to identify individual health patterns that would benefit from specialized nurse coaching.
Plan members with better health records benefit from WellLiving, too. Our focus on primary prevention puts the physician first, promoting an ongoing doctor-patient relationship that spots potential conditions before they have a chance to worsen.
Wellness works best by reducing risk that leads to preventable diseases. Learn more about how MedBen WellLiving can work for your group by contacting Vice President of Sales & marketing Brian Fargus at email@example.com.
As in years past, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee no later than July 31, 2016. All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans — including employees, retirees, spouses and dependents. Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other self-funded plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.
All plan sponsors must use the IRS Form 720 dated April, 2016 to record and remit the amount due. This year, the IRS Form 720 has been modified to include the payment amounts due under the schedule shown below. Make sure to complete the correct section of Part II for “Applicable self-insured health plans” and that you select the correct payment amount based on your plan’s year end date. The form is available on the IRS website, or simply perform a search for "IRS Form 720."
This year’s payment schedule is as follows. If your plan year ended on October 31, 2015, November 30, 2015 or December 31, 2015 you will owe $2.17 per covered life. All other plans years owe $2.08 per covered life.
MedBen clients who need more information about how to count covered lives under their plan or how to prepare and remit their payment are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
Over half of all stop-loss reimbursements can be traced to a mere ten ailments, finds a new study that highlights the importance of stop-loss coverage for self-funded employers. MedBen is here to help groups with stop-loss carrier advice and cost control strategies.
Benefits Pro reports that, between 2012 and 2015, self-insured employers covered by Sun Life stop-loss insurance paid out 53% of stop-loss claims reimbursements for just ten catastrophic claim conditions. Of these, various forms of cancer made up 26.6% of reimbursements, due in part to new treatments and high-cost medications.
For self-funded employers, numbers like these serve as a stark reminder to have a stop-loss carrier that not only serves as a safety net for catastrophic claims, but balances quality coverage with cost considerations. Toward this goal, MedBen shops multiple carriers to ensure that clients retain the desired level of specific and aggregate protection, and negotiates the best possible rates.
Moreover, while stop-loss insurance helps to limit potential losses, MedBen reduces client risk even further. Our cost containment solutions range from advanced claims management to plan language expertise for specific catastrophic conditions, including chronic renal disease (ranked #3 in the Top Ten) and transplants (#6).
Learn more about MedBen stop-loss services and savings solutions by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
The complete Top Ten:
Vision care is typically described as an ancillary benefit, but its advantages make it more than just an add-on. MedBen VisionPlus offers a great complement to your group medical and pharmacy coverage.
HealthDay News reports that, according to a new study, after receiving routine eye exams more than half of people with no new symptoms or vision problems receive new prescriptions or treatment changes. Meanwhile, 16% were diagnosed with a new eye condition and 31% had a change in their ongoing care.
Furthermore, regular vision checkups do more than correct eyesight and reduce the risk of eye diseases — they also can potentially detect such chronic conditions as diabetes, hypertension and high cholesterol. Conversely, people with these conditions are more prone to losing their eyesight. So the benefits of vision care extend well beyond simply getting a fashionable pair of eyeglasses.
MedBen VisionPlus puts your employees’ eyes first. By emphasizing regular exams and early detection and treatment of visual impairments, our group vision product enhances your overall health care plan. It's an affordable benefit that pays for itself in multiple ways.
Learn more about the advantages of quality vision care through MedBen VisionPlus by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The Centers for Medicare and Medicaid Services recently projected that U.S. health care spending trend will continue to outpace the economy over the next decade. But MedBen uses its proven saving strategies to keep client cost trend as low as possible.
From 2011-2015, MedBen's five-year average claims cost trend for its overall block of business was only 4.9%. That compares to a 9.5% trend nationally during the same period.
MedBen uses a variety of claims management tools to help clients realize long-term savings — chief among them, a surveillance systems that calls on the expertise of over 125 medical specialists. When the system flags a claim, panel members quickly review it to determine potential clinical problems and work with the provider to reach a proper resolution. All of this is taken care of before the plan pays money out, so clients don’t have to recoup expenses later.
In 2015, MedBen's claim surveillance measures saved an average of $13.61 per employee per month. And the savings hardly stop there — our plan design and plan language solutions, network discounts, medical management and other cost controls all benefit the bottom line.
MedBen is committed to beating national cost trends today and in the future. Learn more about the ways we save our clients money by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
"Pharmacogenetics" — it's a big word that could make a huge difference in how doctors prescribe drugs, while helping self-funded employers see long-term savings on pharmacy costs. And MedBen is rolling out a new service that will allow clients to take advantage of this important new form of personalized medicine.
MedBen now offers an innovative pharmacogenetics test that determines personal compatibility with over 300 commonly prescribed drugs in a variety of therapeutic categories. Plan participants receive reports that provide clear, concise guidance on which medications will work and which ones to avoid, greatly reducing the "trial and error" approach common to prescribing.
So what is pharmacogenetics? Simply put, it concerns how a person responds to a drug based on inherited characteristics. Because every individual is unique, the ways our bodies react to a medication can vary greatly. What works well for one person may be less effective for another, or may not work at all.
Studies show that the average efficacy rate for drugs treating the most prevalent diseases is estimated to be only 50%. But regardless of whether a medication works or not, the pharmacy bill is the same to the health plan. So having a way to know in advance if a drug is right for a patient reduces wasteful spending.
MedBen works with a state-of-the-art laboratory that studies DNA variants to determine if and how well an individual's body will metabolize various medications, and makes its report based on scientific evidence. In this way, the patient gets better quicker, the physician saves time, and the employer saves money.
MedBen is now in the process of contacting clients about the benefits of personalized medicine through drug compatibility testing, but if you'd like to get additional information about the technology today, just contact your Group Service Representative. And if you're not a current client but want to learn more, contact our Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org (888 623-2364).
Chronic health conditions are often closely linked ‒ that is, one existing condition contributes to the development of another. It's a major reason that MedBen WellLiving places such a great emphasis on the ongoing doctor-patient relationship.
According to the Centers for Disease Control and Prevention, about half of all American adults have one or more chronic conditions. One of four adults have two or more conditions.
Conversely, too much bad cholesterol raises your odds of developing diabetes, hypertension, and heart disease, and even asthma may lead to other health problems. Suffice it to say, chronic conditions are seldom isolated occurrences ‒ and as the conditions add up, so does the risk of even more serious, and costly, diseases.
The solution to multiple chronic conditions is to stop them from getting a foothold in the first place... and here, MedBen WellLiving can help. Our program's "physician first" approach encourages members to get wellness exams from the same family doctor every year. These visits also serve as a perfect opportunity to review health history and address the symptoms of a chronic condition before it progresses further ‒ or sows the seeds of additional conditions.
MedBen WellLiving focuses on chronic condition prevention while cultivating a healthier workplace and long-term cost savings. Learn more by contact Vice President of Sales & Marketing at email@example.com.
As bundled payments and other alternative payment methods become more commonplace, hospital readmission rates and costs are dropping. MedBen Analytics has been working to ensure that hospitals realize the benefits of bundled payments ‒ benefits that will ultimately carry over to commercial health plans as well.
From HealthLeaders Media: "From 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries held steady at about 19% to 19.5%, according to the Centers for Medicare & Medicaid Services. But those rates fell to 18.5% in 2012 and 17.5% in 2013, CMS reports."
MedBen Analytics is helping hospitals make the transition to value based payments, through an advanced reporting system that takes raw Medicare claims data and converts it into actionable reports. Using the insights offered, providers can make informed choices necessary to improve services.
When hospitals can see where opportunities for improvement lie, they benefit from higher returns on bundled payments. Patients and health plans benefit, too... from more focused care and lower costs.
Organizations interested in a demonstration of the MedBen Analytics system or additional information are welcome to contact MedBen President and COO at 888-633-2364 or firstname.lastname@example.org.
Recently, we discussed here how MedBen helps to keep self-funded, non-grandfathered plans compliant with new preventive care requirements under the Affordable Care Act (ACA). However, it's not enough to just monitor new recommendations — we also continue to watch for any clarifications on existing recommendations.
As you may know, under the ACA, non-grandfathered health plans are required to cover preventive care recommendations at 100% when services are obtained through an in-network provider. The recommendations come from the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices, and guidelines supported by the Health Resources and Services Administration that are applicable to women and children.
From time to time, the Departments of Labor, Health and Human Services and the Treasury (the “Tri-Agencies”) will release joint FAQs that address commonly asked questions relating to federal acts, including the ACA. It is the goal of the Tri-Agencies to shed light on existing issues and regulations by offering clarifications on recommendations already in effect. Because these are clarifications and not new recommendations, the Tri-Agencies expect these changes to be made to health plans right away, unlike new recommendations which have a future implementation date.
For example, colonoscopies must be covered at 100% in-network under the ACA and have been for some time. A recent FAQ, released in April of 2016, specifies that any medically appropriate bowel preparatory medications that precede the colonoscopy must also be covered at 100%, when prescribed by a health care provider.
MedBen’s Compliance and Group Service Departments work together to make sure your self-funded plan complies with these requirements. Additionally, we will help you to understand the requirements and notify any necessary vendors, such as your pharmacy benefit manager, if applicable.
FAQs can be reviewed on the Department of Labor website.
A complete list of recommendations can be found at the following websites:
MedBen clients who have any questions about the requirements under the ACA are welcome to contact Compliance Supervisor Erin Kelly at email@example.com.
A recent Benefits Pro article explores how the use of predictive analytics can help to reduce wasteful health spending. At MedBen, this statistical approach serves as the foundation of our reporting platform — an approach that helps our clients to know in advance where potential risks are and act accordingly.
As the article notes, the use of data and algorithms by the health care industry to predict particular events benefits plan sponsors in a variety of ways, such as minimizing wrong diagnoses and steering patients toward the most affordable care. For MedBen clients, predictive analytics serves an equally valuable purpose, enabling them to determine and mitigate clinical as well as financial risk.
MedBen reporting offers patient-level drill-down functionality, so clients can identify and target high-risk plan members in need of clinical interventions. When risks are found, we work with the client to chart an effective course of action. This can range from making strategic plan benefit changes to simply encouraging members to get their cholesterol checked.
Moreover, the MedBen reporting platform tracks group medical and pharmacy spending trends using existing claims data, and analyzes them against appropriate benchmarks. If changes are deemed necessary, our tools compare various plan alternatives and visualizes the financial impact of those changes on future costs and coverage.
With predictive analytics, MedBen helps clients identify risks and develop solutions to reduce health risk and spending, while maximizing the overall value of their health plans. Learn more about how our intelligent reporting features can save your health plan money by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Drinking soda has no nutritional benefits for our bodies, but we already knew that. It isn’t the healthiest choice, nor does it provide much hydration. The taste is generally why Americans consume more than 44 gallons per person per year. So what really happens when you drink a 12 oz. can of, let’s say, Coke?
About 20 minutes in, your body receives 100% of its daily intake of sugar (that’s ten teaspoons!). The only reason you don’t instantly vomit from the sugar overload is because the phosphoric acid cuts the flavor. With so much sugar at one time, your blood sugar spikes, creating an insulin burst, and your liver starts turning all sugar into fat. Within 40 minutes, the caffeine absorption is complete. Your pupils dilate, your blood pressure increases, and your liver is now dumping all of the sugar it can grab into your bloodstream.
The final 20 minutes, dopamine is released in the brain, and a compound in your lower intestine is created to further boost metabolism. But before that compound can make its way to your bones (along with the sodium, electrolytes, and the minimal water consumed), it will be excreted via the urinary track. You are now only left with the irritable and drowsy feeling known as a sugar crash.
Not only are the short-term effects of drinking a can of soda less than appealing, so are the long-term effects. Some studies have shown there is a connection between drinking soda and conditions such as stroke, weight gain (linked to type II diabetes), kidney stones, liver damage, and much more.
Is that taste still worth it?
Happy Independence Day from MedBen!
In observance of the holiday, our home office will be closed on Monday, July 4 and reopen at 8:00 a.m. on Tuesday, July 5. Hopefully your day off is all about cookouts with friends & family and community fireworks... but should you need claims or benefits information, our online customer service center, MedBen Access, is open for business!
MedBen Access offers a number of useful management functions, such as ordering ID cards, monitoring claims activity and reviewing change of information requests. Plan members can check a claim's status, review Plan Document coverage and download forms, to name just a few of the 24/7 services available.
The entire MedBen team wishes you a safe and relaxing 4th!