Pity the poor family physician. As obesity cases – and the chronic diseases that frequently attend them – continue to rise across all age groups, it’s all a doctor can do to stay on top of the mounting health crisis.
One physician has written about his efforts to help patients manage their health against increasingly difficult odds. Ben Brewer, a family doctor and contributor to The Wall Street Journal, says that the high volume of business required to maintain a successful practice makes it difficult to provide the level of care chronic disease sufferers need to better their condition. In one instance, Dr. Brewer monitored a patient’s blood sugar through regular e-mail updates for two weeks, uncompensated, until levels returned to normal. But even though his office has invested in a medical record tracking system to monitor chronic cases, it has done little to improve the overall situation.
The upshot of Dr. Brewer’s comments: Medical treatment and pharmaceuticals cannot, and should not, be the lone remedies to battling chronic disease. Instead, he advocates exploring “new approaches to wellness” and emphasizes self-management to better control health problems – or to keep them from occurring in the first place.
You can read Dr. Brewer’s article here.
MedBen is among an elite group of organizations that have been awarded Gold Fit-Friendly Company status by the American Heart Association (AHA). This honor recognizes ongoing companywide efforts to promote physical, nutritional and cultural wellness initiatives.
MedBen has taken numerous measures to improve its fitness during the past year that were critical factors in reaching Gold status, like offering employee health club discounts, participating in charity walks and adding heart-healthy options to our vending machines. Our BeneFitness program, introduced in 2005, brings a variety of individual and team wellness challenges to employees.
MedBen President & CEO Doug Freeman believes that encouraging healthier employee lifestyles is just one part of its responsibility as a health benefits administrator. “I think that wellness is the next frontier of health care cost control, and if we’re going to promote that as a company to our clients, we’d better be walking the walk,” Freeman said.
MedBen was one of just four Central Ohio companies publicly recognized at the 2008 AHA Start! Heart Walk on August 23, sharing the stage with fellow Fit-Friendly companies OhioHealth, AEP and Nationwide. A MedBen team also participated in the 3-mile charity walk, which raises money to fund heart disease and stroke research and education.
Consumer-driven health plans (CDHPs) now account for nearly 13 percent of all plans offered by employers, according to a survey conducted by United Benefits Advisors. From 2007 to 2008, the number of health plans offering a CDHP increased by 43 percent, and plan participation nearly doubled in the same period.
The survey of 12,860 U.S. employers also found that 10 percent of respondents have implemented a wellness program as an additional measure to reduce cost increases.
MedBen has been on the cutting edge of the CDHP movement for nearly a decade, and was among the fist to administer health reimbursment arrangements (HRAs). 1 out of every 2 MedBen TPA clients currently offer at least one CDHP.
You can read more about the CDHP survey, as reported in the Houston Business Journal, here.
It’s turning out to be a less-than-sunny summer for members of the pharmaceutical industry. On the heels of their voluntary ban on promotional items for doctors, prescription drug companies are dealing with extra-strength headaches both external and internal, according to two recent reports in The Wall Street Journal Health Blog.
In something of an equal time initiative to presentations given by pharmacy reps, bills have been introduced in both houses of Congress proposing an “academic detailing” program. Under the plan, government-funded experts would speak to doctors about the “safety, effectiveness and cost of prescription drugs,” serving as a counterbalance to drug company messages. Selected healthcare professionals would be trained to present to physicians and pharmacists, and educational materials would be developed by nonprofit medical societies and schools. There’s no mention in the bills of how much such a program would cost.
Of course, such government oversight is necessary only when there is a steady supply of drugs on which to opine. But new medications are being introduced at a relatively slow rate nowadays, particularly when one takes into consideration the mounting costs of research and development. The problem, it would appear, is that while technology and design have made the process more efficient, drug companies are still limited by our collective understanding of what causes disease and the best ways to combat it. Simply put, there is still a high degree of luck when it comes to creating a useful (and profitable) drug – a reality that even the pharmaceutical giants (or government intervention) cannot easily overcome.
The Wall Street Journal Health Blog reports on the practice of pharmacy benefit managers (PBMs) marking up the prices of generic drugs. The PBMs negotiate discounts with pharmacies, but rather than passing the full value of the discounts onto clients, they charge an inflated price to health insurance companies. The insurers, in turn, make up the difference in higher premiums to the patients.
MedBen doesn’t subscribe to the “big discount/bigger premium” pharmacy concept – in fact, we take the exact opposite approach. Our prescription plan is unique in offering “pass-through” benefits – we pass through 100% of any paid formulary rebates directly to our clients. That means no unnecessary mark-ups on generic drugs, resulting in significant savings to employer and employee alike!
This level of transparency also is notable for stemming the tide of rising Rx plan costs. Employers using the MedBen Prescription Plan – offered through our Rx partner, Pharmacy Data Management (PDM) – actually saw a 2.2% decrease in the amount they paid per member in 2007. And, all Rx clients have free access to a pharmacy consultant who will review your current prescription plan design and offer additional cost savings strategies.
Competition and camaraderie are fueling employer efforts to help their employees lose weight, according to an article in The Wall Street Journal. And as workers drop the pounds, employers are enjoying some sizable benefits.
Wesley Willows, an Illinois-based employer spotlighted in the article, responded to an increasingly overweight workforce by implementing a companywide wellness contest. Through competitive challenges and financial incentives – $3 for every 1% of body weight lost – the 290-person staff lost a cumulative 750 pounds in just a little over a year. Equally impressive, the program coincided with a 19% reduction in the company’s health insurance claims from 2006 to 2007.
Participants in the Wesley Willows weight-loss program can choose to be part of a team or participate individually, and can track results through a customized website. One unexpected benefit from the program: Employee turnover dropped 30% from 2007 to 2008, a trend the employer credits to “a more collegial environment.”
You can read more about Wesley Willows and other employer wellness programs here.
MedBen recently came across a “guaranteed discount” from a competitor that so defied belief, we thought we should share some of the details, as a public service.
First, the competitor offered a “targeted” 43% discount guarantee – that is, the averaged in-network discount would meet or exceed 43%. One small catch: There was a “no penalty corridor” between 39% and 43%. So the 43% guarantee target really didn’t exist.
Next, the discount average did not include claims above $100,000 and Children’s Hospitals claims – additions that would drive down the average down significantly. It did, however, treat denied claims as having a discount of 100%!
So what happened if the 39% target was not still met? The competitor guaranteed a payout schedule that maxed out at $15,000. Sounds like a generous sum – except when one observes that the competitor’s fixed costs were $20,000 higher than ours to begin with!
And, one more not-insignificant point: The client was already achieving a discount of 42.7% through MedBen!
Here’s the reality about guaranteed discounts: A penalty paid for lower-than-expected discounts rarely, if ever, comes from the carrier – it comes directly from the employer’s pocket! A carrier will always protect its risk by covering the potential penalty cost with an increase in a client’s service fees – either upfront or after the penalty is paid.
MedBen doesn’t offer so-called “guaranteed discounts”. Rather, we work with high-performance networks that can offer similar average discounts. And we examine every claim, regardless of type or dollar amount, for additional cost savings potential.
MedBen has developed a series of MedBen Solutions to inform clients and partners about a variety of market practices. You can get a copy of our MedBen Solutions for Guaranteed Discounts by e-mailing firstname.lastname@example.org or by contacting your Regional Sales Director.
The Wall Street Journal Health Blog reports that a new code of conduct among drugmakers may bring an end to free pens, pads and coffee mugs.
More employers are using financial incentives as a way to promote wellness in the workplace, according to a survey of 225 major U.S. companies conducted by the ERISA Industry Committee (ERIC), the National Association of Manufacturers (NAM) and IncentOne, Inc.
From 2007 to 2008, the percentage of employers surveyed who offered inducements with their worksite wellness programs rose from 62 to 71%. Such monetary rewards were typically tied to participation in the program, rather than achieving benchmark goals like losing a certain amount weight or quitting smoking.
While financial incentives can range from as little to $5 to upwards of $600, the overall average is $192. Most financial incentives came in the form of gift cards, followed by reduced employee premiums and cash payments.
The survey also examined the return on investment (ROI) compared to employer expectations. Of those employers who have measured ROI, 83% say their wellness program has exceeded the break-even point.
Occupational Health & Safety magazine highlights additional findings from the wellness survey on their website. You can read their article here.
Anytime is the right time for an employer to offer smoking cessation assistance as a wellness initiative, but several existing factors make such a program particularly attractive to employees nowadays – call it tobacco’s “perfect storm”:
Employers have an additional incentive to put a cessation program in place: Since smoking is a primary contributor to heart disease, a successful cessation program will provide benefits in the short term (reducing heart disease risk and its related medical costs) as well as the long term (a healthier and more productive workplace).
An article in the June issue of Managed Care explores how smoking cessation programs have found greater acceptance with employers. Through telephone coaching, nicotine replacement therapy, and a supportive doctor-patient relationship, tobacco users stand a much better chance of kicking the habit for good.
Smoking cessation is one of many services offered through MedBen’s Worksite Wellness program. Each program participant is assigned a nurse coach who will help to establish realistic goals, and create a practical plan to reach those goals.
The ETHEX Corporation has announced that it is voluntarily recalling several lots of its 30mg and 60mg morphine sulfate extended-release tablets. The recalled lots were distributed to pharmacies between June, 2006 and May, 2008. The recall is due to the possibility that oversized tablets, some with as much as twice the labeled amount of morphine sulfate, were distributed. The extra dosage in the abnormal tablets could lead to overdose, which can have life threatening consequences such as respiratory depression (difficulty or lack of breathing) and low blood pressure.
If MedBen manages your prescription drug benefit, those individuals who are currently taking an ETHEX Corporation morphine sulfate in the doses listed above were notified directly regarding the recall.
If you are using ETHEX Corporation morphine sulfate extended-release 30mg or 60mg tablets, we encourage you to call your doctor, pharmacist or healthcare provider.
Questions regarding the recall can be directed to ETHEX Corporation Customer Service at 800-321-1705 Monday through Friday, 8:00 a.m. to 5:00 p.m. CST. Additional information can be found on the Food & Drug Administration’s MedWatch website: www.fda.gov/medwatch/safety.htm. You can also call the Food & Drug Administration at 888-INFO-FDA (automated) or 301-827-4570.
Processing claims electronically with auto-adjudication software is a common practice in the insurance industry, but without sufficient safeguards in place such systems is vulnerable to fraud – a lesson recently learned the hard way by Medicare, which uses auto-adjudication to pay the vast majority of its claims. As detailed in a Washington Post article, it took one person, armed with just a laptop computer, to bilk $105 million from the government health program over a four-year period.
MedBen’s auto-adjudication system, which contains more than 300 checks to ensure key claims data is properly recorded, is an important tool in turning around claims quickly and accurately. But much more critical to minimizing fraud is the human element that complements the technology. All MedBen claims examiners are required to meet daily performance standards and have current accuracy rates of 99.6% procedural and 99.8% financial accuracy.
MedBen is unique in that it audits 5% of every examiner’s claims daily to verify claims data has been interpreted and coded correctly.
Most recently, MedBen took a significant step to protect against fraud by adding a proactive, physician-to-physician claims cost management system. Every day, proprietary surveillance software scours your claims prior to payment, using over 60,000 physician-produced algorithms. Potentially fraudulent claims are flagged for physician review to confirm or dispute the legitimacy of the claim.
The MedBen Claims Department also works closely with an internal Anti-Fraud Unit. This dedicated team reviews questionable claims, and other related information, to protect client assets. The Anti-Fraud Unit is also a member of multiple associations formed to share information regarding possible deceptive activities.
A survey conducted by the Society for Human Resource Management (SHRM) reveals that current economic conditions have led some employers to take a long-term approach to employee health: scaling back certain health care benefits while encouraging worksite wellness.
Based on the responses of 996 randomly selected employers, businesses are providing a consistent level of employee benefits despite the recent financial downturn. But to accomplish this, they have decreased some costlier health care and financial benefits while increasing the availability of less expensive perks, such as telecommuting and job cross-training.
In response to these benefit changes, the SHRM survey indicates that employers are increasingly taking a proactive approach to employee health and medical cost reduction by offering wellness programs. Among the key study findings:
Other lower-cost worksite wellness benefits, such as health club discounts and on-site vaccinations, also gained in popularity.
Read about the survey here at the Employee Benefit News website.
Yet another reason for employers to promote worksite wellness: The New York Times reports that drugs designed to lower blood pressure are losing their effectiveness, as patients are becoming sicker overall.
An American Heart Association panel of experts found that when high blood pressure is accompanied by other conditions, such as diabetes and obesity, it requires additional medications to keep it in check. 20-30% of the hypertension patients in the panel’s study could not control their blood pressure with three or more drugs, and the panel warns that percentage may continue to increase. High blood pressure is a contributing factor to heart disease, heart attacks and strokes.
The complete article is available here.
An Employee Benefit News article states that more employers are learning what MedBen clients have known for some time now: Prepaid benefit cards are a smart accessory to many consumer-driven health products. Plan participants with a flexible spending account (FSA), health reimbursement arrangement (HRA) or health savings account (HSA) can use these special debit cards to make a variety of medical purchases, from paying physician bills to buying a bottle of cough syrup. And, many vendors now offer automatic substantiation, so card users do not need to provide a receipt to their employers afterward.
According to the article, employers that offer a debit card typically see a spike in plan participation, often doubling or tripling the number of employees who use their FSA or HRA. This in turn benefits employers by saving money on FICA taxes. You can read the full article here.
MedBen can provide prepaid benefit cards for FSA, HRA and HSA participants at the request of the employer. We also offer instructional materials for proper and effiective use of the card. Click here to learn more about our debit card services.
Promoting preventive care in the workplace is one of the most important steps an employer can take to maintain good health while helping to keep medical costs in line, says Dr. Luke Burchard, Vice President of Cost Containment and Medical Director for iHealth. “By practicing a focused approach to employee wellness, employers can produce real claims savings for health plans,” he emphasized.
At a recent MedBen wellness conference, Dr. Burchard recommended six annual screenings that benefit both employee and employer:
MedBen offers medical plans that encourage preventive care, such as low patient co-payments for standard screenings. We also can assist self-funded employers in developing a fully-rounded wellness program.
During a recent Wellness Conference held at MedBen, employers learned some tricks of the trade from life-long fitness center manager, Larry Miller. Among the information shared were some important “not-to-dos” when starting up a worksite fitness facility:
MedBen can provide clients with professional consultation on worksite fitness facility start-up, ongoing management and fitness programming through its BeneFitness service, which is short for the Benefit of Fitness.
In an industry where buyouts and mergers are a common occurrence, MedBen is something of an anomaly – growing and thriving as a benefits management company while remaining independent throughout its many years. In fact, MedBen’s 70th Anniversary coincides with its most successful period ever.
The Newark, Ohio-based organization began operations on May 6, 1938. MedBen started as a Hospital Service Association in 1938 by Licking Memorial Hospital, a group of local physicians and some forward-thinking Industry leaders. Today, MedBen serves about 450 employers in Ohio, West Virginia, Kentucky, Michigan and Indiana. Health benefit services are delivered to 200,000 employees spanning all 50 states.
“MedBen has relied on continuous change and innovation in order to remain a leader in such a highly competitive industry,” explains President Doug Freeman, who has led the company for 20 years. In recent years, this has meant developing a wide range of Internet self-serve tools where employers can access reports and other decision-making information and employees can check on a personal medical claim or find out the lowest cost prescription option. “Like most industries today, our clients require around-the-clock access to service,” Freeman pointed out.
Makes sense but National Geographic has laid it out in a neat little chart. Your odds of dying from a variety of causes:
“You know what it is?” she said. “Everybody’s got to die. You always want to write about what’s going to affect somebody, and nobody gets off the hook for that.”
Read the article here at The Wall Street Journal Health Blog.
While MedBen employs a full arsenal of claims savings tools, we believe there is always more that can be done. For this reason, we joined the AWAC® Alliance in September of 2007. This allows MedBen to take advantage of some groundbreaking, forward-thinking cost savings methods, which have saved our clients more than $1 million in five short months. And, we mean savings that are beyond any network discounts.
AWAC® is a physician-powered organization that enhances our claims processing system. MedBen still conducts an initial claims scrub using 300 system autochecks and staff claim reviews to identify potential billing errors and to ensure that network discounts are applied.
Then our clients’ claims are scrubbed a second time – and we mean every single claim regardless of size or type – and analyzed against 60,000 financial and clinical algorithms to determine additional potential for large loss, inappropriate billing or fraud, and cost reduction opportunities. This analysis is conducted within 48 hours by AWAC® PRIOR to the claim being paid – and for NO additional charge. All flagged claims are reviewed by physicians to see where further savings may be possible. With the client’s permission, these physicians will negotiate on the client’s behalf and save on average 43% per selected claim.
While loss control is something we typically associate with property and casualty insurance, it is every bit as important when looking for effective health coverage for your employees.