Health care spending rose 5.5% in 2014, according to a new report published on in the journal Health Affairs -- the first comparatively large increase following multiple years of more modest growth.
Economists from the Centers for Medicare and Medicaid Services also predict that health care spending increases will average 5.8% between 2014 and 2024, spurred in part by the influx of new insureds under health care reform, faster economic growth, and the aging Baby Boomer population.
Also playing a large part in last year's increase and the projected growth is prescription drug spending. In 2014 alone, drug spending leapt 12.6% compared to just 2.5% the previous year. The debut of expensive hepatitis C drugs over the last two years is the primary reason for the increase, and last week's introduction of the cholesterol medicine Praluent will likely factor into future growth.
While these increases hardly rival the double-digit spending jumps we experienced last decade, they nevertheless demonstrate the usefulness of a benefits management partner who can help your health care costs stay below current and future trends. At MedBen, we offer a variety of savings solutions for self-funded groups.
MedBen provides an interactive data analytics platform that enables clients to see where their health care spending is going, and why. Our innovative claims surveillance system uses sophisticated software to find savings opportunities. These and other MedBen cost containment services work together, allowing self-funded employers to make informed plan decisions and keep their health care costs as low as possible.
Let MedBen help your business beat the current national spending trends. Learn more by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
The introduction of a blockbuster cholesterol drug has the health care community abuzz -- but its potential to help millions of Americans comes at a steep price.
Last week, the Food and Drug Administration approved Praluent, an injectable medicine designed to lower cholesterol in people who are at high risk for heart attack or stroke, but can't adequately control their condition with existing drugs called statins. Praluent is expected to be available to patients this week.
In tests, Praluent reduced low-density lipoprotein (LDL), or “bad" cholesterol, by as much as 60%. In its initial offering, the drug will be available in both 75 milligram or 150 mg doses, so doctors have the option of starting a patient at the lower dose.
Such benefits don't come cheap, however. The initial cost for Praluent is expected to run $1,144 for a 28-day supply, or about $14,851 per year.
Based on FDA approval criteria, MedBen recommends coverage of Praluent to patients 18 and over who have a diagnosis of one of the following:
Additionally, the patient in question has been taking a high dose statin for at least 4 weeks or has an intolerance to high dose statin therapy, and has an LDL level greater than 70mg/dL.
MedBen will be providing its clients with specific information about how to best incorporate Parluent into their pharmacy plan design. In the meantime, clients with questions are welcome to contact President & COO Kurt Harden at firstname.lastname@example.org.
A recent survey aptly demonstrates the effectiveness of employer-sponsored wellness programs... and likewise, MedBen WellLiving is showing businesses the health and financial benefits of promoting primary prevention.
According to the survey by Healthmine, 46% of the people who discovered they had a previously undiagnosed chronic condition (i.e., diabetes or hypertension) received the diagnosis through their employer wellness program. Nearly one third of the 750 survey respondents were diagnosed with a chronic condition, MedCity News reports.
Numbers like these reinforce how annual wellness exams and recommended screenings can improve the overall health of an employee population while realizing long-term financial savings for the employer. MedBen WellLiving believes that exams performed through the plan member's family doctor increases the probability of spotting a chronic condition in its earliest stages, and improves the likelihood of successful treatment. And we back up our primary prevention approach with actionable reporting that not only demonstrates the overall progress of their program, but shows in pure dollars-and-cents whether or not the plan is benefiting the business financially as well.
Learn more about how MedBen WellLiving can improve employee health and productivity while helping your bottom line by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com
"Two dozen business groups are urging federal lawmakers to work together to pass legislation to ease the cost and compliance burdens of the health care reform law.
“'There are numerous bipartisan bills that could bring real relief to the employers we represent and their employees. We encourage you to work together to help advance these bipartisan changes' to the Affordable Care Act, the business groups wrote in their letter to members of the House and Senate.
"Those groups include the National Association of Wholesaler-Distributors, the National Federation of Independent Business, the National Retail Federation and the Retail Industry Leaders Association.
"While the letter did not mention any specific bills, an NRF spokesman said bipartisan bills the group backs include those that would repeal the Patient Protection and Affordable Care Act provision that would, starting in 2018, impose a 40% excise tax on health insurance premiums that exceed $10,200 for single coverage and $27,500 for family coverage; and another measure that would bump up the health reform law's definition of full-time employees to those working an average of 40 hours per week from the law's 30-hours-per-week definition."
Provider choice is significantly more limited for individuals covered through the Affordable Care Act's marketplaces, Modern Healthcare reports:
"A report released Wednesday by consulting research firm Avalere Health found that plans offered through the ACA's exchange offered an average of 34% fewer providers in network compared to the choices provided by the average employer-based or individual non-exchange commercial plan.
"The study found plan networks offered 32% fewer primary-care and behavioral health providers, 42% fewer oncology and cardiology physicians, and nearly a quarter fewer choices of hospitals."
The survey also found that respondents say they prefer lower costs over provider choice. And while that may be true, MedBen sees no reason that plan members can't have both.
Self-funding your group's health care plan offers you the freedom to select a provider network that best serves your employee population while still offering contracted discounts that help to keep costs in check. MedBen maintains relationships with networks throughout the country in order to find the best client fit.
Of course, provider discounts are just one part of the MedBen Advantage. Through a combination of discount, plan design, medical management and leading-edge cost controls, we offer clients quality, low-cost health care backed up with verifiable savings. Learn more about our money-saving solutions by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
While online convenience is certainly critical to doing business in the 21st century, people still like the personal touch... and it's why face-to-face interaction remains a important component of the MedBen business model.
A recent U.S. Worker Survey showed that over half of employees enrolling for group benefits do so online, while another 25% use a paper form to complete their benefit selections. No real surprises there.
What is interesting is the level of satisfaction employees get when the human element is added to the enrollment process. According to the survey, only 74% of employees who completed their enrollments online with no assistance reported they were very or somewhat satisfied with the process, while just 72% responded similar feeling about completing paper forms with no help.
But here's the thing: By involving another person to assist with the enrollment process, the satisfaction level jumps up to 88%. And with MedBen as your health benefits manager, you get that personal assist.
All MedBen self-funded clients are assigned a team of dedicated group service representatives who not only serves as an everyday contact to the employer, but is also available to meet with employees during initial enrollments as well as any time a client wishes to inform or educate plan members. Our reps will work one-on-one with plan members to ensure they understand their plan benefits and are satisfied about the enrollment process.
The year’s already half over... have you gotten your annual wellness exam yet? If not, you should schedule an appointment as soon as possible. Not only could the visit have a positive impact on your health, but skipping the exam could have a negative impact on your wallet.
A wellness exam is free when performed by an in-network physician. However, many health care plans have financial incentives for members to get their exam by the end of the calendar year. If that’s not enough reason, an exam can also help detect any chronic conditions that may be present. Studies have shown the earlier a condition is caught, the better the prognosis and the less money it will cost.
If you’re uncertain as to when you need to have your next wellness exam, just visit MedBen.com and click “MedBen Access.” Once you’re logged in, select “WellLiving Information” to view the next recommended checkup date, in addition to other important screenings your plan may require.
Once you’re aware of the tests you need, don’t schedule an appointment with just anyone! MedBen WellLiving encourages you to establish a professional relationship with a primary care physician. Seeing a doctor who knows your health history makes it easier to discuss concerns and increases the likelihood of detecting a chronic condition early. You save time and money – and potentially avoid health headaches down the road.
Last week, the Obama administration released new rules in hopes of putting to rest a hot-button issue under health care reform -- the requirement that employers must provide free contraceptive coverage to female employees. Under this latest proposal, employers with religious objections can opt out of the requirement, and their insurer or, if the employer self-funds its health plan, their third party administrator must cover birth control at no cost to plan members.
According to the Associated Press, companies with religious objections can opt out if they are not publicly traded on stock markets, and more than half the ownership are in the hands of five or fewer individuals. (In this case, a family counts as a single individual.)
If an employer meets the exemption requirements, it does not have to pay for contraceptive coverage, even though its health plan is still required to offer this benefit at no cost to the plan member. That means that an insurer providing health insurance to that employer must provide the contraceptive coverage without premiums for such coverage.
If an employer is self-funded, the regulations anticipate that the TPA will pay for that benefit without passing the cost of the contraceptive claims on to the employer/plan sponsor.
The proposal also attempts to address the complaints of some religious nonprofits that notifying insurance administrators of their objections to covering birth control would, in essence, be comparable to arranging coverage. To get around this, such organizations can instead notify Health and Human Services.
Despite the nationwide decrease in mortality from colorectal cancer, there are three regional "hot spots" where death rates are rates are still high -- and one of them is in Ohio and adjoining states, a new study finds.
According to The Washington Post, researchers from the American Association for Cancer Research determined that death rates from colon cancer in west central Appalachia, which comprises Southern Ohio, Eastern Kentucky and Western West Virginia (along with several counties in Indiana), ranked 18% higher than the rest of the country during 2009 to 2011.
The highest colon cancer death rates are in the lower Mississippi Delta, where rates were 40% higher than elsewhere in the country for the same time period. Eastern Virginia/North Carolina, the third hot spot, had a 9% higher rate.
While the researchers didn't offer a specific reason for the higher death rates, they did cite such underlying factors as obesity rates, poor access to health care and lower colon cancer screening rates.
Rebecca Siegel, an epidemiologist with the American Cancer Society and one of the study's authors, noted that increased screenings would be the quickest fix to bringing the numbers down. A greater emphasis on such screenings was the main reason that colon cancer death rates dropped 27% across the U.S. between 2000 and 2010.
MedBen WellLiving also 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.
An increasing number of states are placing ceilings on the amounts that insured patients are required to pay for specialty drugs, Stateline reports:
"At least seven states — Delaware, Louisiana, Maine, Maryland, Montana, New York and Vermont — limit the out-of-pocket payments of patients in private health plans. Montana, for instance, caps the amount that patients pay at $250 per prescription per month. Delaware, Maryland and Louisiana set the monthly limit at $150 and Vermont at $100. Maine sets an annual limit of $3,500 per drug."
Additionally, New York prevents insurers from singling out specialty drugs from higher out-of-pocket costs, while California, Massachusetts and North Carolina legislators, in an effort to hold down prices, have proposed requiring drugmakers to provide broad financial disclosures justifying higher prices.
Critics of mandated out-of-pocket limits argue that such measures do nothing to control the rising costs of specialty drugs and will ultimately result in higher insurance premiums. "They don’t get at the underlying issue of how drug prices are set,” said John Rother, president and CEO of the nonprofit National Coalition on Health Care.
Specialty drugs currently represent nearly one-third of U.S. pharmaceutical spending while making up just 1% of all prescribed medicines, according to prescription benefits manager Express Scripts.
A recent report from stop-loss carrier Sun Life Financial says that, based on an analysis of the firm's data from 2011-2014, various cancers accounted for the two costliest catastrophic conditions at 25.7% of the $2.1 billion paid to claimants. End-stage renal disease followed with 7.8% of total stop-loss claims paid.
Other costly conditions listed in the report included congenital anomalies, or conditions present at birth, premature births, congestive heart failure, cerebrovascular disease, pulmonary collapse or respiratory failure, medical and surgical complications, and septicemia. In total, the top 10 costliest conditions accounted for 52.8% of the total claims paid over the four-year period analyzed.
Just missing the over top 10: Transplants, which represented more than $41 million in stop-loss claims from 2011-2014. However, the number of claims for these procedures -- in particular, bone marrow and stem cell transplants -- has jumped in the past two years, moving them from the 10th-costliest condition in 2013 to the fifth-costliest last year.
Also noteworthy is that the number of individuals with claims of more than $1 million continued to grow. Cancer, conditions present at birth, and premature births accounted for 28% of all claims exceeding $1 million, according to the report.
Read more at Business Insurance (registration may be required).
Happy Independence Day from MedBen! In observance of the holiday, our home office will be closed on Friday, July 3 and reopen at 8:00 a.m. on Monday, July 6.
It's always our hope that during any holiday, health care claim matters are the last thing on your mind. But should a question arise while our office is closed, MedBen Access likely has the answer. Plan administrators and plan members alike can take advantage of this convenient online customer service center any time of the day or night.
To log onto MedBen Access, just go to MedBen.com and click on the "MedBen Access" link. New users will need to click on the “First time?” link in the Login box and follow the registration instructions.
MedBen Access offers a variety of useful administrative services, 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 functions available.
Nor do the features end there. Members with pharmacy plans administered by PDMI will find a "My Rx" link that allows them to review their prescription drug purchases, get medication information and compare brand name drug prices with generic and therapeutic alternatives. If you offer an FSA or HRA, those participants can use MedBen Access to see their balances, claims submissions and payments by selecting the "FSA/HRA Online Inquiry" option. And MedBen WellLiving members can check their compliance with annual exams and cancer screening tests by selecting the Wellness Plan link under “My Plan.”
The entire MedBen team wishes you a safe and relaxing Independence Day!
July 31 is not only the anniversary of the creation of the federal Department of Health, Education and Welfare, it is also the date that the Department’s successor – Health and Human Services – set as the Affordable Care Act's PCORI Fee filing date.
No later than July 31, 2015, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee. 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 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, 2015 to record and remit the amount due. Below is a schedule of the amount due based on your plan’s effective date.
MedBen has updated its summary of the PCORI fee filing requirement applicable to self-funded clients; clients can request a copy from their Group Service Representatives. If you have purchased PCORI reporting serivces from us, your GSRs will order reports on your behalf and e-mail them to you.
Clients who need more information about how to count covered lives under your plan or how to prepare and remit your payment, don’t hesitate to contact the MedBen Compliance Department.
The landmark Supreme Court decision to allow same-sex marriage nationwide will have a substantial impact on group health care coverage, says Kaiser Health News:
"The logic is simple. Fewer than half of employers that offer health benefits make the insurance available to same-sex partners who aren’t married. Virtually all of them offer coverage to spouses.
"By marrying partners with employer health plans, people in same-sex relationships are likely to get coverage in states that banned gay marriage until now, as well as in those that welcomed it. Thanks to rapidly shifting legal ground, 37 states recognized gay marriage before last week’s ruling, up from nine in 2012."
The KHN story also notes that while the expectation is that most companies will cover same-sex spouses if they already offer benefits to opposite-sex spouses, the decision doesn't require them to. But refusing to do so could conceivably leave the employer open to a charge of sex discrimination.
And while the ruling has been met with widespread approval, it actually comes as something of a mixed blessing for same-sex couples who currently receive domestic-partner benefits and don't plan to get married:
"Though it is unclear what most employers will decide, some companies are likely to deliver what feels like an ultimatum, at least to some: Marry within a certain time frame, or lose your partner’s health care coverage.
"Some large employers — including Verizon, Delta Air Lines, IBM and Corning — already have. They rescinded domestic partner benefits to employees living in states where same-sex marriage was legalized and replaced it with spousal coverage."
Whenever the Supreme Court rules on a high-profile care, it invariably generates a flood of responses from politicians and pundits alike. And while yesterday's decision to allow health insurance subsidies nationwide essentially maintained the status quo, there's still plenty of opinion on what the ruling means for the future of health care reform... from the top down.
President Barack Obama, in a statement after the ruling: “After multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay. Today is a victory for hardworking Americans all across this country, whose lives will continue to become more secure in a changing economy because of this law.”
Henry J. Aaron, Brookings: "[The Supreme Court decision] returns the debate about health care policy to the political arena where it belongs. In so doing, it brings a bit closer the time when the two parties may find it in their interest to sit down and deal with the twin realities of the Affordable Care Act: it is imperfect legislation that needs fixing, and it is decidedly here to stay."
Sen. Orrin Hatch, R-Utah: “Clever judges can find ambiguities that others aren’t able to find. [...] We’re going to have to repeal Obamacare and replace it with something better.”
Reihan Salam, Slate: "As a political matter [...] King v. Burwell would have left Obamacare’s opponents in an extremely precarious position for the simple reason that conservatives in Congress had failed to coalesce around a coherent post-King strategy in the months preceding the decision."
Stephen Stromberg, The Washington Post: There are many things Republicans could do short of a full repeal that would nevertheless undermine the law. Electing a GOP president and a GOP Congress next year would almost guarantee the death of Obamacare’s medical device tax, a source of revenue for the health-care expansion that Republicans may or may not make up with something else.
Margot Sanger-Katz, The New York Times: "Now, with the Supreme Court ensuring that every state’s consumers will have equal access to federal subsidies, it is becoming clear that more of those states will revert to a federal system for enrolling people in health insurance."
The U.S. Supreme Court today upheld, by a 6-3 vote, the nationwide tax subsidies available under the Affordable Care Act. The decision means that the subsidies to help low- and moderate-income people buy private health insurance will remain available in all 50 states.
In the matter of King v. Burwell, the petitioners' argument that the health care reform law didn't authorize subsidies in the 34 states that offer a federally-run insurance exchange hinged on six words: "An exchange established by the state." While acknowledging that "petitioners' arguments about the plain meaning ... are strong," the court's majority concluded that the subsidies are nonetheless legal.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," the court's majority said in the opinion, which was written by Chief Justice John Roberts. "The context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."
Roberts was joined by fellow conservative Justice Anthony Kennedy and the court’s liberal Justices in the majority.
In his dissent, Justice Antonin Scalia said: "We should start calling this law SCOTUScare," an apparent reference to the fact the Supreme Court has now saved the Affordable Care Act twice. Scalia called the majority's reading of the text "quite absurd, and the court's 21 pages of explanation make it no less so."
And for an interesting bit of "what if," this Forbes article examines Republican proposals to extend the subsidies had the justices struck them down.
Here's a distressing bit of information: Based on the results of a new study, over two-thirds of the U.S. adult population are either overweight or obese.
HealthDay reports that the study, which used data from the National Health and Nutrition Examination Survey gathered between 2007 and 2012, found that about 35% of men and 37% of women are obese, while another 40% of men and 30% of women are overweight.
"This generation of Americans is the first that will have a shorter life expectancy than the previous generation, and obesity is one of the biggest contributors to this shortened life expectancy because it is driving a lot of chronic health conditions," said Lin Yang, a lead researcher of the study.
Obesity has been linked to a number of chronic health conditions, including type 2 diabetes, heart disease, certain cancers and arthritis, Yang added.
However, the picture isn't totally bleak. The proportion of obesity in kids has leveled off in recent years, suggesting that efforts to promote healthier eating and exercise for younger people is paying off. But a renewed push on better health for adults is crucial, Yang said.
“Overweight and obesity is something one can deal with as an individual, but we also need strategies for prevention at the collective level,” she said.
According to a KHN article on the study, those strategies include enhancing primary care efforts to prevent and treat obesity, changing behavior in schools and the workplace, and changing physical environments to make healthy food and exercise options more accessible.
Midsize and smaller employers are increasingly making the switch to self-funded health care coverage due in part to greater reinsurance availability, says a leading stop-loss carrier... and at MedBen, we're helping these employers benefit from the opportunity.
“Historically, there’s been some reluctance from stop-loss carriers to insure the smaller organizations that are moving to self-insured plans, as they typically don’t have sufficient claims data to use for pricing and evaluating risk,” says Brad Nieland, vice president of stop-loss at Sun Life Financial. “But stop-loss carriers now see the growth potential of the smaller-market segment, and in wanting to capitalize on it, many are finding ways to open their programs and offer competitive coverage.”
One such way that carriers can make stop-loss coverage more accessible to smaller employers is through reinsurance captive programs. MedBen introduced its first captive in January 2014, and participating employers are realizing a level of savings not available through fully-funded insurance.
Self-funding through a MedBen captive reinsurance program affords employers the opportunity to get part of their reinsurance premium back, by spreading risk among multiple groups. A portion of the collective premium is pooled into a “captive” layer owned by all participating groups -- and any funds remaining in this layer at the end of the plan year go back to the participants.
For employers who have considered self-funding but have been reluctant to make the switch from traditional insurance, a captive offers an ideal means of transition. And with MedBen as your health benefits manager, you get access to cost containment tools that can save you even more money!
Learn more about the reinsurance captive advantage by contacting MedBen Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Several weeks back, we posted an article about a new Affordable Care Act regulation that would apply an "embedded" maximum out-of-pocket limit on individuals enrolled in family coverage. The rule, which applied to non-grandfathered fully-insured and self-funded health care plans, says that once the stated 2016 maximum of $6,850 for individual coverage has been reached, the individual will be then covered in full by the health plan, even if the family maximum has not yet been met.
Now, the ERISA Industry Committee, a Washington-based benefits lobbying group, is asking federal regulators to withdraw the embedded maximum requirement, arguing that there is no basis in the ACA for it:
“'Nowhere does the statute suggest that family coverage is subject to two out-of-pocket limits: an umbrella limit for aggregate costs incurred by all family members, and an embedded individual limit, equal to the self-only limit, for costs incurred by any individual member of the family,' according to the letter, signed by ERIC President and CEO Annette Guarisco Fildes and sent Wednesday to top Labor, Treasury and HHS officials.
“'The assertion that these plans are subject to the self-only limit when they provide coverage other than self-only coverage is not supported by the statute. We ask the departments to recognize that the requirement is unenforceable and to announce that it has been withdrawn,' Ms. Guarisco Fildes wrote."
Read more at Business Insurance (registration may be required).
Since the IRS announced in 2013 that flexible spending account participants could carry over up to $500 of their unused funds to the following year, many employers have added the option to their FSA plan. (About half of MedBen clients that offer FSAs currently allow it). And based on the results of a new survey, carryover acceptance will likely go higher.
In March 2015, the Employers Council on Flexible Compensation conducted a member survey regarding the carryover rule and found that:
Since the "use-it-or-lose-it" rule was a major sticking point for employee enrollment in FSAs, it's not surprising that the ability to carry over a portion of their funds would spur participation. And of course, FSAs offer additional advantages, such as enabling employees to pay for medical products and services with pre-tax dollars, and debit card convenience.
MedBen clients who are interested in adding the carryover option to their FSA plan or have questions about are welcome to contact Director of Administrative Services Sharon A. Mills at email@example.com. Or if you'd like to learn more about the ways an FSA can benefit your group benefits package, please contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.