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10/06/09

  12:55:53 pm, by MedBen5   , 82 words,  
Categories: Announcements, News, Health Plan Management

MedBen Achieves $11 Million in Survelliance System Savings

Just one month after reaching the $10 million threshold in cumulative client savings from its claims survelliance system, MedBen has posted an additional $1 million in savings. Introduced in September 2007, our survelliance system performs a comprehensive review of customer claims, looking for potential saving opportunies. The $11 million clients have saved so far is in addition to provider discounts and other MedBen cost containment methods.

For more information about MedBen’s claims survelliance system, please contact the MedBen Sales and Marketing Department at marketing@medben.com.

10/02/09

  04:59:05 pm, by MedBen5   , 102 words,  
Categories: News, Health Plan Management

Friday Legislative Update: Amendments Added to Senate Reform Bill

The Senate Finance Committee adopted several key amendments to its health reform legislation this week. Perhaps the most noteworthy addition is an amendment that reduces tax deductions for insurance executive salaries from $1 million to $500,000, according to The Wall Street Journal. Other amendments would create health insurance exchanges for individuals and small-business employees and offer tax credits or Medicaid benefits to people at or near the poverty level. The Hill reports. The Committee is expected to vote on the bill next week.

The Wall Street Journal also has provided a comparison of the various health care proposals currently under consideration, including President Obama’s.

09/30/09

  12:11:26 pm, by MedBen5   , 69 words,  
Categories: News, Health Plan Management

Health Reform Update: Senate Committee Rejects Public Option

The Washington Post reports that the Senate Finance Committee twice rejected amendments that would introduce a government-run public plan to compete with private health insurers. While this does not completely rule out the possibility that a public option will make it into the final bill, it does severely hinder efforts by Senate Democrats to (quoting the article) “expand the federal role in health coverage as a cornerstone of reform.”

09/28/09

  03:19:24 pm, by MedBen5   , 235 words,  
Categories: News, Health Plan Management

Pain Management Procedures Proving Costly

Dr. Ed Mendoza

The use of pain management procedures has increased 235% in just 10 years, according to a 2009 study by the American Society of Interventional Pain Physicians (ASIPP). At MedBen’s recent Hospital Roundtable, AWAC Consulting Physician Dr. Ed Mendoza addressed the growing use of pain management in the medical profession, and the spiraling costs associated with its application.

Dr. Mendoza noted that while many anesthesiologists, neurologists and other professionals are board certified in pain management, over 1/3 of such procedures are performed by practitioners with little or no formal training in the area, who see pain management as an easy way to make money.

Contributing greatly to pain management costs is the increased use of injections to reduce inflammation in facet joints. Dr. Mendoza observed that such injections can be administered as often as the physician deems necessary. Consequently, a 2008 study by the Department of Health and Human Services found that 63% of facet joint injections did not meet Medicare requirements in 2006, resulting in $96 million in improper payments.

MedBen is working with AWAC to reduce abuses in pain management procedures. Dr. Mendoza estimates that MedBen clients will realize nearly $480,000 in pain management savings in 2009.

MedBen has composed a white paper regarding pain management and the plan options we have come up with to address the issue. This document is available for download in the Plan Design area of this blog, which is password-protected and accessible only to MedBen clients and consultants.

09/24/09

  01:15:29 pm, by MedBen5   , 229 words,  
Categories: News, Health Plan Management

Health Reform Update: Over 500 Amendments Proposed for Senate Bill

Capitol Building
  • Nobody expected the Senate Finance Committee’s health care bill to make it through the legislative process without a few tweaks, and indeed, there have been a number of proposed amendments – 564, at last count. (You can see the official list of modifications here). Notable changes include lowering the penalty for those who don’t purchase coverage and increasing government subsidies to help people buy insurance. The idea of mandatory coverage has drew particularly harsh critism from Republican senators, as The Wall Street Journal reports.
  • Medicare is also being hotly debated in the Senate – specifically, Medicare Advantage, the private health insurance program that currently serves about one-quarter of Medicare beneficiaries. The Senate bill aims to cut $123 billion in payments to private insurers, a proposal opposed by Republican members of the Senate. The New York Times offers an overview of Medicare Advantage and the current battle surrounding it.
  • Flexible spending accounts (FSAs) could be negatively affected by reform efforts, according to USA Today. Under the proposed Senate bill, the maximum FSA contribution, currently set by the employer, would be capped at $2,000 per year beginning in 2013.
  • So what exactly are these “health insurance co-ops” we keep hearing about? Short answer: a nonprofit, consumer-owned, voluntary association formed for the express purpose of providing health insurance coverage. For a more detailed examination, check out this New York Times Q&A and this FAQ.

09/18/09

  12:39:02 pm, by MedBen5   , 61 words,  
Categories: Announcements

MedBen to Perform System Upgrades

MedBen will be performing system upgrades on Saturday, September 19th beginning at 7:30 a.m. We estimate the process will be completed within 12 hours.

During the upgrades, MedBen Access, e-mail and AS/400 will not be available at all times. Any correspondence that is received at MedBen during an outage will be queued up and distributed once the system is brought back up.

09/15/09

  11:47:40 am, by MedBen5   , 232 words,  
Categories: News, Wellness

Swine Flu Recommendations and Links

Caduceus

By now, you’ve undoubtedly heard numerous news reports warning of a second outbreak of the H1N1, or “swine", influenza. While some segments of the population are more susceptible to the swine flu than others, every individual – regardless of age or personal health – should be aware of the potential dangers of the virus and the best preventive measures to take against it.

MedBen’s prescription benefits consultant Pharmaceutical Horizons has produced a memo that offers a swine flu overview, likely vaccination candidates and treatment recommendations. You can download and print the document here.

One portion of the document, which we reproduce below, offers useful links to the Centers for Disease Control (CDC). We encourage you to review the information found on these pages.

“The CDC has posted on its website guidance for the public on how to deal with H1N1 issues including:

  1. What to do if one becomes sick with flu-like symptoms, http://www.cdc.gov/h1n1flu/sick.htm;
  2. Taking care of a sick person at home, http://www.cdc.gov/h1n1flu/guidance_homecare.htm;
  3. The use of face masks and respirators to reduce the H1N1 transmission, http://www.cdc.gov/h1n1flu/masks.htm.”

We’ll add one additional link to the CDC site, this one a Q&A featuring prevention and treament tips: http://www.cdc.gov/h1n1flu/qa.htm.

09/11/09

  01:28:22 pm, by MedBen5   , 255 words,  
Categories: Announcements, Discounts, Health Plan Management

MedBen Claims Surveillance System Savings Exceed $10 Million

Woman Reviewing Folder

MedBen has just achieved an impressive benchmark. In its first two years of operation, its advanced claims surveillance system has saved clients 10.4 million dollars – savings over and above plan provisions, network discounts and medical management.

MedBen introduced the proprietary cost containment system in September of 2007, as a member of the AWAC® Alliance, a select network of third party administrators. The system goes beyond normal claims processing programs, in that it thoroughly analyzes a claim using over 80,000 financial and clinical algorithms to determine the potential for large loss, inappropriate billing or fraud, and cost reduction. This service is performed at no additional cost to the client.

When the surveillance system flags a claim, it is evaluated – with the consent of the client – by a medical panel to determine potential cost savings from both a clinical and cost perspective. On average, this physician-driven process saves clients 43% per selected claim.

MedBen President and CEO Doug Freeman said, “We saw the addition of the claims surveillance system as a real opportunity to provide our customers proven and measureable savings on top of our other cost controls. To reach $10 million in savings so quickly is a true testament to its effectiveness.”

Of the cumulative two-year total, $6 million was saved in the last 12 months alone. “Thanks to the work of the panel physicians, we’ve seen claims savings range from 20% to upwards of 80% during this past year,” Freeman added.

If you should have any questions regarding the MedBen claims surveillance system, please contact MedBen Marketing Services at (888) 627-8683 or marketing@medben.com.

09/03/09

  03:31:59 pm, by MedBen5   , 213 words,  
Categories: Announcements

McClain Joins MedBen as Regional Sales VP

MedBen is pleased to announce the addition of a new associate to its Sales and Marketing team. Kelly McClain will serve as Regional Sales Vice President in Southern and Central Ohio and West Virginia, assisting his region’s broker network with the sales of all MedBen product lines.

A 13-year veteran of the managed health care industry, Kelly has extensive experience working with TPAs, PPO networks, brokers and consultants – knowledge that will serve him well in his new position. He is a graduate of Ohio University and currently resides in Dublin, Ohio with his wife Katrina and two sons. Please join us in welcoming Kelly to MedBen!

Throughout 2009, MedBen has been revamping the Sales and Marketing Department to ensure that our clients and brokers have the means necessary to help them provide comprehensive group health coverage while keeping costs as low as possible. Part of this overhaul includes our recent reassignment of sales regions. In addition to Kelly, Michael DeBois now oversees sales efforts in Northern Ohio, Northern Indiana and Michigan, while Blair Pickerill manages broker network activity in Southern Indiana, Kentucky and Tennessee.

If you have any questions regarding MedBen sales territories or the current Sales and Marketing team, please contact Brian Fargus, Vice President of Sales and Marketing, at (800) 423-3151, Ext. 388.

08/27/09

  02:20:44 pm, by MedBen5   , 230 words,  
Categories: News, Health Plan Management

Health Reform Update: How Will Kennedy's Passing Impact Reform?

Congress
  • The big question in the media today: What effect will the death of Senator Edward Kennedy have on health care reform? According to The New York Times, Democrats say they are even more determined to pass a bill in Kennedy’s name, while Republicans believe his ability to find common ground will be missed as the legislative debate continues. And this brief piece in The Wall Street Journal blog reviews the influence Senator Kennedy had on health care throughout his long career.
  • As Congress wraps up its summer vacation, the Los Angeles Times offers a refresher of President Obama’s key health reform goals – among them, universality, a public option and a deficit-neutral plan.
  • This CQ Politics website article examines the various claims made by health reform proponents and opponents, and judges whether they’re true, false or misleading.
  • With the dialogue at town hall meetings becoming so heated nowadays, it can be frustrating to those looking for informed conversation on health reform. This Washington Post Q&A offers some intelligent back-and-forth discussion on the subject. While the commentator makes it clear as to her wariness about reform, the generally civil discourse offers interesting arguments regardless of which side of the issue you’re on. And for a pro-reform viewpoint, click here.

Stay informed on the latest news and breaking stories on health care reform and other topics at MedBen’s Twitter page.

08/11/09

  07:04:39 pm, by MedBen5   , 245 words,  
Categories: News, Health Plan Management

New Insurance Mandates in Indiana, West Virginia

Recent legislative sessions in Indiana and West Virginia have yielded new mandates that will be incorporated into MedBen plans for those states.

Indiana:
For policies issued, amended or renewed on or after June 30, 2009, health insurers must cover “routine care costs” in relation to clinical trials, though not the costs of the trials themselves. “Routine care costs” are those incurred in the course of a clinical trial that would have been covered under the plan, were they not incurred in a clinical trial.

A similar mandate, this one regarding cancer clinical trials, is already in effect in Ohio.

West Virginia:
Effective July 1, 2009, health insurers must cover dental anesthesia costs – including its administration, outpatient hospital and ambulatory surgical facility charges – for the following groups:

  • Children seven or younger, if a superior result would be achieved by performing the dental service under anesthesia;
  • Developmentally disabled persons, if a superior result would be achieved by performing the dental service under anesthesia;
  • Children twelve or younger with documented phobias or documented mental illness, for whom a successful result cannot be expected from dental care provided under local anesthesia.

In addition, effective October 3, 2009, West Virginia’s current mental health parity law has been revised to only apply to groups with an average of 50 or more employees in the prior year. This may be an attempt to bring state law in closer compliance with the new federal mental health law, but it appears that the federal law would pre-empt it anyway.

08/03/09

  04:35:03 pm, by MedBen5   , 256 words,  
Categories: News, Health Plan Management

Health Reform Update: House Committee Passes Reform Bill

Capitol Building
  • While Congress will not meet President Obama’s goal of passing health reform into law before the August recess begins, The House Committee on Energy and Commerce has approved legislation that may provide a glimpse into what a final bill may contain. The Wall Street Journal reports that the committee’s bill calls for a public insurer plan, small businesses (with some exemptions) to provide coverage or contributions to employees, and direct government negotiations with pharmaceutical companies under Medicare. And The New York Times states that common ground is being reached Democrats and Republicans in such areas as the elimination of pre-existing condition restrictions by insurers and requiring most Americans to have coverage.
  • Meanwhile, the Senate is unlikely to make any major reform news until it reconvenes in September. According to The Washington Post, the Senate Finance Committee has pledged to have a bill ready by September 15 – preferably, but not necessarily, one with bipartisan support.
  • On the Sunday talk show circuit, National Economic Council Director Larry Summers suggested that a middle-class tax hike may be necessary to pay for health reform. The Hill website reports that the White House advisor said, “It’s never a good idea to absolutely rule things out no matter what,” but added that the President’s goal is not to place an undue burden on middle class families.
  • The Los Angeles Times offers another Q&A update on the status of reform legislation.

Stay informed on the latest news and breaking stories on health care reform and other topics at MedBen’s Twitter page.

07/31/09

  12:54:09 pm, by MedBen5   , 134 words,  
Categories: Announcements, Discounts, Health Plan Management

Claims Surveillance System Savings Near $10 Million

Dr. Luke Burchard

At a MedBen health plan language seminar on July 29, AWAC Vice President of Cost Containment Dr. Luke Burchard announced that since implementing new claims surveillance software in September 2007, MedBen clients have saved $9.97 million.

“That means clients are saving $100,000 every week through MedBen,” Dr. Burchard said. The savings he referenced are on top of network discounts, plan provisions, medical management and other cost controls

The proprietary surveillance software thoroughly screens claims before they are paid, using 80,000 algorithms to detect occurrences of potentially large employer loss as well as inappropriate billing and possible fraud. This service is provided at no fee to MedBen customers.

When the system flags a claim, the AWAC medical team works physician-to-physician to determine potential savings, from both a clinical and cost perspective. The process saves clients, on average, 43% per selected claim.

07/27/09

  04:53:34 pm, by MedBen5   , 260 words,  
Categories: News, Health Plan Management

Health Reform Update: Senate, House Bills Likely Delayed

Capitol Building
  • President Obama and Senate leaders have all but conceded that no health reform legislation will make it to the Senate floor for a vote until after the August recess. CQ Politics reports that there still exists an outside chance that the House may get a bill through before adjourning for the summer. But Blue Dog Democrats, who have criticized aspects of the House bill, make that increasingly unlikely. Even in the face of mounting resistance, House Speaker Nancy Pelosi insisted on CNN’s “State of the Union” the legislation will ultimately pass: “When I take this bill to the floor, it will win.”
  • Employee Benefit News reports that 56% of Americans approve of health care reform, according to the July Kaiser Health Tracking Poll. However, support dropped by 5% from June. The poll also finds that more respondents would support reform if it allowed them to keep their current doctor and health plan and not increase the budget deficit. Conversely, higher premiums and taces and limited doctor choice would reduce the level of support.
  • The Los Angeles Times has published a Q&A that provides a good encapsulation of the health reform overhaul as it currently stands. Among the noteworthy items: If a government plan is offered, it would initially be available only to individuals whose employers do not offer a plan or can’t afford their employer’s plan, and people who work for small businesses that elect to offer the government option.

Stay informed on the latest news and breaking stories on health care reform and other topics at MedBen’s Twitter page.

07/22/09

  10:53:27 am, by MedBen5   , 98 words,  
Categories: Announcements

MedBen is Now on Twitter!

Link: http://twitter.com/MedBenTPA

Twitter

MedBen has joined the Twitter generation! Our new Twitter page will complement this blog by providing you the up-to-the-minute news and commentary on health care reform, regulatory changes, wellness and other vital matters. You can get messages from MedBen on your computer or straight to your cell phone, if you wish. Please take a look at http://twitter.com/MedBenTPA.

If you haven’t signed up for Twitter, we encourage you to do so – it only takes a minute and is a great way to keep up with breaking news and current events. Best of all, it’s free!

07/16/09

  05:33:25 pm, by MedBen5   , 258 words,  
Categories: News, Health Plan Management

Reform Update: Senate Health Committee Approves Reform Bill

Capitol Building at Night
  • The Senate’s health committee – voting along party lines – approved a health reform bill that would require Americans to obtain health insurance and create a government-sponsored plan to compete with private insurers. According to The New York Times, the bill also would forbid insurers from denying coverage for pre-existing conditions or setting a maximum lifetime benefit. To help pay for the bill, members of the Senate Finance Committee have called for instituting new fees on the insurance industry.
  • Meanwhile, The Washington Post reports that three committees in the House are working on reform legislation of their own. While the bill has yet to be voted on as of this writing, it contains several of the same features of the Senate bill, including mandatory universal coverage and a public insurance plan. To offset a portion of the bill’s cost, the House Ways and Means Committee proposes an income tax surchage on individuals making more than $280,000 and families making more than $350,000.

    The Wall Street Journal Health Blog offers a breakdown of the similarities and differences between the two bills.

  • Despite President Obama’s stated desire that a health reform plan pay for itself, the plans thus far proposed by Congress are expected to cost at least $1 trillion over 10 years. But just how will that $1 trillion be spent? USA Today reports that the bulk will go toward helping to pay premiums, followed by Medicaid expansion and incentives for small business to provide employee coverage. The article also notes that despite the high cost, 15-20 million people would remain uninsured after 10 years.

07/10/09

  12:54:40 pm, by MedBen5   , 225 words,  
Categories: News

Reform Update: "Blue Dog" Democrats Not on Board for Health Care Bill

Capitol Building
  • Conservative Democrats in the House aren’t sold on health care reform just yet. USA Today reports that a coalition of so-called “Blue Dog” Democrats have advised House leadership that they will not approve current legislation, saying it “lacks a humber of elements essential to preserving what works and fixing what is broken.” The Representatives feel that the legislation as written does not address growing health care costs or the disparity in Medicare payments to rural providers.
  • It may come as no surprise that the idea of taxing employer-sponsored health benefits has received a lukewarm reception with the American public. According to The Washington Examiner, internal Senate polls have shown a strong opposition to the tax on benefit-rich health plans, making it an unlikely candidate to become law. But that doesn’t necessarily end the idea: Employee Benefit News reports that people with incomes of $100,000 or more ($200,000 for families) could potentially see some kind of income tax surcharge.
  • Senators are looking at non-profit hospitals as a possible source of health plan funding, according to The Wall Street Journal. Members of the Senate Finance Committee have suggested that non-profit hospitals – over half of which pay no federal, state or local taxes – offer a minimum amount of charity care and lower costs to uninsured patients. Those that fail to comply would have to pay an excise tax.

07/07/09

  11:38:37 am, by MedBen5   , 225 words,  
Categories: News, Prescription, Discounts

Health Care Industry Facing Medicare Cuts

White House

While Congress labors to hash out a workable overhaul of the health care system, President Obama is pushing cost savings through Medicare cuts to hospitals, pharmaceutical companies and medical specialists – just part of a proposed $313 billion health care savings during the next decade.

Three associations representing the nation’s hospitals have agreed to $155 billion in Medicare cuts over a 10-year period, according to The Washington Post. Nearly two-thirds of the savings would be realized through reduced Medicare and Medicaid payments to hospitals, while decreased compensation for care to the uninsured would account for another $40 billion. Should the final health care legislation include a government-sponsored health plan, hospitals would be compensated at a higher rate for non-Medicare/Medicaid patients.

The hospital agreement comes on the heels of an offer by pharmaceutical companies to provide discounts to senior citizens over the next decade. As reported in The Wall Street Journal, U.S. drug makers will reduce revenue by $80 billion, mainly by covering a greater share of brand name drug costs to Medicare D users.

The Wall Street Journal also reports that the Obama administration has proposed Medicare payment cuts to specialists while slightly increasing payments to primary care physicians. This represents an ongoing effort by the administration to reduce overall costs while making family care practices more appealing to medical students, as concerns of primary care availability grow.

06/30/09

  03:19:02 pm, by MedBen5   , 216 words,  
Categories: Announcements

Group Billing Statement Change Reduces Paper Use

Recycling Symbol

MedBen continues to do its part to reduce excess paper usage, one bill at a time. Beginning in August (for September group billings), we are decreasing the number of group billing statements sent in our monthly mailings, from two per group to just one.

MedBen originally provided two copies of the monthly group billing statement in case the plan administrator wished to send the extra statement back with any eligibility changes. As most groups now submit such changes either via fax or through our MedBen Access website, we find this redundancy is no longer necessary.

Should additional copies of the billing statement be needed, designated group members can download PDF copies from MedBen Secure. This website provides multiple layers of protection to ensure that all protected health information (PHI) will be available only to those with proper clearance. To learn more about accessing statements through MedBen Secure, read this MedBen Basic.

Decreasing the number of group billing statements is the latest step in MedBen’s ongoing “Go Green” program. In addition to looking for ways to reduce the print volume required for client communication (like this newsletter), we internally promote such environmentally conscious measures as recycling and minimizing paper waste wherever possible.

If you have any questions regarding this change, please contact your MedBen Group Service Representative.

06/22/09

  02:33:06 pm, by MedBen5   , 253 words,  
Categories: News, Health Plan Management

Reform Update: Democrats May Fly Solo

Capitol Building at Night

Health care reform stories in the news this week:

  • Democrats may be preparing to push through a health care package that includes a government-sponsored public plan, even if it lacks Republican backing, according to the Washington Post. The article also cites a New York Times-CBS News poll that most Americans are for a government alternative to private plans, even though they’re uncertain as to its implications.
  • The Senate Finance Committee is debating the pros and cons of adding an employer mandate – also known as “pay or play” – to the health care plan, as reported on the Morningstar website. If a plan is eventually passed with the mandate, businesses with more than 50 employees that do not offer health insurance would be required to pay the government a portion of the cost of employee coverage through a public plan or Medicaid.
  • Sen. Max Baucus (D., Mont.), Chairman of the Senate Finance Committee, has proposed a 1.5% annual reduction for projected Medicare spending – a cost-cutting measure to help pay for the health care overhaul. The Wall Street Journal reports that if the set target were not met for a given year, automatic Medicare cuts would be implemented across the board.
  • Former Senators Tom Daschle, Bob Dole and Howard Baker have offered a report outlining their suggests for achieving a bipartisan bill, according to the Medical News Today website. Such a bill would include employer mandates, an individual requirement to carry insurance, and a tax on benefit-rich ("Cadillac") policies that are paid for by employers.

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