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10/23/09

  04:46:14 pm, by MedBen5   , 130 words,  
Categories: News, Health Plan Management

Friday Legislative Update: Public Option Rising from the Ashes?

Is the public option, once thought to be on life support, poised for a comeback? ABC News reports that the final Senate reform bill will feature a government-run insurance program provision, if Majority Leader Harry Reid has his way. This is in spite of the fact that some moderate Senate Democrats continue to oppose the measure, and Reid needs their support to get the 60 votes required to pass the bill.

Earlier this week, Democrates in the Senate suffered a setback on another piece of health care legislation, according to The New York Times. A bill to increase Medicare payments to doctors was blocked by a vote of 53-47. A dozen Democrats and one independent sided with the Republicans in rejecting the unfunded bill, which would have cost $247 billion over 10 years.

10/20/09

  03:54:38 pm, by MedBen5   , 109 words,  
Categories: Health Plan Management

Planning Your 2010 Health Coverage

As 2009 is winding down – only ten weeks till Christmas, can you believe it? – it’s time to consider your health plan options for next year, particularly if have a flexible spending account (FSA) or health savings account (HSA). The Los Angeles Times offers several thoughtful strategies for maximizing coverage and reducing costs for your health insurance, FSAs and HSAs.

(By the way, the FSA/HSA article provides a link to a website with an FSA calculator to estimate your medical expenses and federal tax savings, but we’ll save you the trouble of searching for it. Just go straight to The MedBen website and feel free to use ours!)

10/16/09

  04:57:42 pm, by MedBen5   , 123 words,  
Categories: News, Health Plan Management

Friday Legislative Update: Senate Bill Friends and Foes

The Wall Street Journal Health Blog breaks down how certain groups feel about the Senate Finance Bill:

  • The pharmaceutical industry: Supports it.
  • The American Hospital Association: Supports it, but with reservations.
  • The American Medical Association: No official position indicated.
  • Insurers and the Chamber of Commerce: Oppose it.
  • Major unions: Depends on which one you ask, but several unions, including the AFL-CIO, oppose the lack of a public option and the tax on more expensive health plans.

If you’re looking for a useful synopsis of recent reform happenings in the House and Senate, take a look at this New York Times page. And The Washington Post has a neat interactive graphic to help you track the contents of the major bills currently under consideration.

10/13/09

  03:34:18 pm, by MedBen5   , 64 words,  
Categories: News, Health Plan Management

Health Reform Update: Senate Finance Committee Approves Bill

The Washington Post reports that the Senate Finance Committee has approved its health reform bill by a vote of 14 to 9. Senator Olympia J. Snowe of Maine was the sole Republican to vote in favor of the legislation, saying that the consequences of inaction outweighed any concerns she had regarding the measure. A vote in the full Senate may happen as early as next week.

  02:00:26 pm, by MedBen5   , 105 words,  
Categories: News

Study Ranks State Levels of Health Care Quality

Interested in knowing how your state ranks in the quality of health care it provides? A study by The Commonwealth Fund assessed states’ performance based on various benchmarks, including quality, costs and health outcomes. Vermont residents have the best care in the country, followed by Hawaii and Iowa, according to Commonwealth’s State Scorecard; Mississippi, Oklahoma and Louisiana rank the lowest. Better access to medical treatment and an emphasis on preventive care were among the factors common to the states that placed highest in the study.

You can access The Commonwealth Fund report here, or just use this interactive map to see each state’s 2009 and 2007 rankings.

10/11/09

  01:19:06 pm, by MedBen5   , 138 words,  
Categories: News, Health Plan Management

Legislative Update: CBO Delivers Good News to Senate

The Senate Finance Committee’s health reform proposal got a major boost this week from the Congressional Budget Office, The Washington Post reports. The cost of the measure is projected to be $829 billion over the next decade, but would produce over $100 billion in savings and revenue. The Wall Street Journal Blog highlights five key numbers from the CBO assessment – such as 94%, the percentage of legal U.S. residents under 65 who will have insurance in 2019, assuming the Senate bill is passed in its present form. The committee is expected to vote on the amended bill on October 13.

Meanwhile at the House of Representatives, Speaker Nancy Pelosi is preparing three bills to send to the CBO for analysis, according to the Los Angeles Times. All three versions will include a public option, which was voted down in the Senate bill.

10/09/09

  02:00:37 pm, by MedBen5   , 101 words,  
Categories: Prescription, Health Plan Management

Debit Cards Give A Boost to CDHPs

Debit cards have gradually overtaken checks as the payment method of choice, so it should come as no surprise that their acceptance is spurring the popularity of consumer-driven health plans. This article on the Employee Benefits News website sites an Evolution Benefits survey in which two-thirds of respondents indicated that the availability of a debit card influenced their decision to enroll in a CDHP, and three-quarters said that debit cards make account management easier

MedBen offers debit card technology for flexible spending account (FSA) participants with 100% auto substantiation of prescription claims. For more information, contact MedBen Sales and Marketing at (888) 627-8683.

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.

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