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02/23/18

  06:01:00 pm, by MedBen5   , 257 words,  
Categories: Announcements, News, Prescription, Health Plan Management, Claims management

MedBen Leads Columbus Business First Survey

A new Columbus Business First survey (in the February 16 issue) ranks MedBen as Central Ohio's top employee benefits company, based on the number of Central Ohio benefits workers we employ.

With 143 TPA employees residing in Licking, Franklin and surrounding counties, MedBen employs nearly 100 more local workers than its closest competition.

"MedBen's success is based on the simple fact that we have a great group of professionals working here and they are always focused on helping our clients." said Kurt Harden, MedBen President & COO. "We think long term. Many of our employees have been with us for decades, which I think says something about the quality of people we hire and the culture we promote. Similarly, many of our clients have been long term clients. In a short-term world, we think it helps to think long term."

As benefits management has gotten more diverse with the rise of self-funding and worksite wellness, MedBen has met the call with a variety of flexible service offerings, including a new “Cost Plus” pharmacy program that we're currently rolling out. At the same time, we've built up our team to ensure that clients have the resources they need to design and maintain their health care program.

"Not only are our employees dedicated to our clients' success, they're some of the most innovative people you'd want to meet," Harden added.

One more thing: MedBen is also among the oldest companies on the list, as we were founded in 1938... and we're proud to have called Central Ohio our home for our entire 80 years!

02/22/18

  07:31:00 pm, by MedBen5   , 259 words,  
Categories: News, Health Plan Management, Reporting, Third party administration, MedBen University, Self-funding

In Health Care Planning, One Size Does Not Fit All

businesspeople

A new Network for Regional Healthcare Improvement (NRHI) report highlights the wide disparity of health care costs in U.S. states, with average costs ranging from 17% above comparable populations in Colorado to 16% below in Maryland. The report notes that "there is no one-size-fits-all solution" for health care affordability... and at MedBen, it's a truism that extends well beyond geography.

Nearly 80 years of experience in benefits management has taught MedBen the importance of customizing a health plan to meet the needs of the client. Proper health plan design considers such factors as the particular industry, employee demographics and health care utilization. By treating a business as the unique enterprise that it is, we can create a health plan that addresses specific population health concerns while ensuring that the employer's financial investment is well-managed.

At our upcoming MedBen University roundtables, we'll explore how employer health plans address potential challenges inherent in their industry as well as capitalize on their possible advantages. In addition to industry-specific roundtables for hospitals and municipalities, we're offering a session for private sector employers that breaks down various plan cost factors and offers proven strategies to improve plan effectiveness. Invitations to these events are in the mail (or soon will be), so be sure to look for yours!

Finally, while every business is indeed different, for MedBen one thing always stays consistent -- the level of attention and respect we give to each one of our clients. Learn more about how we can serve your unique needs by contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

02/21/18

  06:41:00 pm, by MedBen5   , 334 words,  
Categories: Wellness, Preventive care, Cholesterol

The Good and Bad of Cholesterol

heart hands

Cholesterol itself isn’t bad. Actually, cholesterol plays an important role in building cells, digestion, and hormone manufacturing. However, since cholesterol is a waxy substance much like a can of Crisco you purchase at the grocery store, the problem occurs when there is excess cholesterol in the body and thus, it begins to build up in the arteries, straining the heart.

Cholesterol comes from two places: your liver and the foods you eat. Interestingly enough, cholesterol is only made by animals, so you only get cholesterol from eating meats and not plant-based foods.

There are two types of cholesterol: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). American Heart Association explained their roles best: LDL cholesterol is like someone who carries stuff all through the house and drops it along the way while HDL cholesterol is like someone who picks up the dropped stuff and puts it away to keep the house from becoming impassable. Without HDL cholesterol, LDL would eventually lead to completely blocked arteries.

Since high cholesterol levels usually show no symptoms, it’s important to have your levels checked by your family physician. MedBen WellLiving recommends a screening every five years (unless your physician recommends otherwise) based on risk factors such as age, sex, family history, smoking history, diabetes and blood pressure. Screenings are simple and require just a small sample of blood.

Full story »

02/11/18

For MedBen, Beating Trend Is All in the Details

MedBen building

In recent years, U.S. health care spending has slowed significantly compared to the double-digit cost spikes we saw a decade ago. But there’s still room for improvement, so MedBen uses containment strategies to keep client claim costs under national trends.

Recently released numbers from the Centers for Medicare and Medicaid Services (CMS) indicate that from the years 2014-2016, U.S. health care spending trend averaged 5.07% annually. MedBen's overall client block for the same period came in at 4.03% trend.

Moreover, as more of our clients have integrated the MedBen WellLiving program into their health plan, their costs have reflected the emphasis on preventive care and early detection of chronic conditions. From the years 2015-2016, our WellLiving block has realized a 1.60% trend compared to 5.05% nationally.

Keeping client health care costs as low as possible starts with focusing on the primary cause of higher spending – claims. MedBen eschews the "claim is a claim" mindset, instead processing every claim with an eye on accuracy and medical necessity. Should our surveillance system detect a claim that merits additional scrutiny, medical specialists review it to ensure the most favorable outcome.

MedBen is committed to finding ways to save your health plan money by beating the trend. See up close how we do it by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

  09:36:00 pm, by MedBen5   , 271 words,  
Categories: Wellness

Giving Up Sleep May Come at a Risky Price

yawning

In today’s busy culture, sleep can sometimes be low on our priority lists. After all, if we sleep for a full eight hours, that only leaves us 16 hours (at least half of which are spent working), to exercise, cook and eat dinner, do housework, socialize, etc. The daily “to-do” list can sometimes be overwhelming, and research shows that more and more often, people are getting less sleep to do more. According to Eve Van Cauter, Ph. D., Director of Sleep, Metabolism and Health Center at the University of Chicago, over the last four decades, sleep has decreased 1.5-2 hours per night.

But at what cost are you willing to give up sleep? Dr. Van Cauter states that research increasingly points to links between insufficient sleep and diseases such as obesity and diabetes, as those who are sleep deprived tend to eat more foods that they would generally avoid. Additionally, lack of sleep can cause a decrease in insulin sensitivity, which increases the risk of type II diabetes.

Van Cauter also notes that sleep deprivation has been connected to cancer and Alzheimer’s disease. Plus, individuals who get less than six hours of sleep are at an increased risk of hypertension – and those who get less than five hours double their risk.

Some suggestions that Van Cauter makes to get more sleep include avoiding mid-day naps, keeping the bedroom dark, cool, and quiet, and establishing a regular and relaxing bedtime routine. Talking to your family physician may be necessary as well. MedBen WellLiving has written a WellCare article about the importance of sleep, which contains additional tips to get your senses ready for bed.

  09:27:00 pm, by MedBen5   , 214 words,  
Categories: Reporting, Cost savings, Third party administration

MedBen Reporting Highlights “Care Gap” Connection

GSRs reviewing report

Among the distinctive features of the MedBen reporting package is a series of reports that examine a group's "care gap."

The simple idea behind a care gap measurement: Individuals who follow wellness recommendations (such as annual exams and cancer screenings) and condition management (i.e., diabetics taking prescribed insulin) have lower care gaps than those who do not. Every MedBen Client Review compares yearly claim costs between plan members with higher and lower care gaps. Typically, we find that plan members with higher care gaps cost the group, on average, three to four times as much as those with lower care gaps.

MedBen reporting also places the care gap in the larger context of care received (or not received) and how it affects your current and future health plan costs. Depending on the report, you can compare care gaps against such factors as disease burdens and specific chronic conditions – and more often than not, these comparisons demonstrate how care gaps are good indicators of the health, and the financial risk, of your employee population.

The care gap is closely linked to current costs and future risk, and MedBen reporting reflects this fact. To see how our reporting approach can reduce your health care spending, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

01/31/18

  02:24:00 pm, by MedBen5   , 214 words,  
Categories: Announcements, MedBen Employees, Social media

MedBen Gets “Social”… on Twitter, Facebook, and LinkedIn

social media

For years, MedBen has posted regularly on Twitter, providing updates and information about our services, as well as links to articles of interest to our clients and self-funded employers in general. And now, we are expanding our social media presence with new pages on Facebook and LinkedIn.

All three sites will share the latest MedBen news, as well as two new weekly features: Motivational Mondays, featuring inspiration thoughts to get your work week off on the right note, and Health Tip Tuesdays – bite-size nuggets of wellness advice that serve as an extra bit of encouragement to live a healthy life!

as MedBen celebrates its 80th anniversary this year, we’ll be periodically spotlighting the people so integral to our growth and success… our employees. We’ll focus on activities around the office as well as the many charitable endeavors in which our team members participate.

Of course, MedBen continues to add new content to the MedBen Blog every week. Or if you prefer to have us deliver updates direct to your mailbox, MedBen e-briefs rounds up the latest happenings in a convenient bi-weekly newsletter. If you’re not currently on our mailing list, we invite you to sign up today… and while you’re at it, connect to any or all of MedBen’s social media platforms!

01/28/18

  11:21:00 pm, by MedBen5   , 341 words,  
Categories: American Health Care Act

MedBen University Season Rolls out with Roundtables

MedBen University

MedBen University (MBU) will soon be in session! Our educational seminar series will offer attendees actionable information on a range of health benefits management topics, from utilization trends to new cost-reducing benefit solutions.

MBU will kick off its 17th season with a series of benefits management roundtables. These special sessions use data from MedBen's business blocks as a starting point for a discussion of medical and pharmacy claim trends, showing where your health care dollars are going and helping you spot opportunities to lower costs. We'll also look at new and emerging coverage strategies, including a unique cost-reducing prescription benefits solution.

All three events will be held at the C. Arthur Morrow Conference Center, 1821 W. Main Street, Newark, Ohio (located next to the MedBen home office). Invitations will be mailed soon, so keep an eye out for yours!

16th Annual Hospital Roundtable
Because of a hospital's position as a care provider, benefit planning poses particular challenges and opportunities for plan administrators. Attendees will learn ways to use this industry advantage to their best benefit, and what performance indicators to watch in order to best manage costs.

12th Annual Municipality Roundtable
City and county governments, school systems and other public sector employers also face unique health care cost control issues. Attendees will learn cost reduction strategies that municipalities can apply to their coverage, and ways that they can make more informed planning decisions.

2nd Annual Employer Roundtable
While no two businesses are alike, there are actions that every employer can take to maximize the effectiveness of their self-funded plan. This session will highlight strategies that have proven successful to MedBen clients as well as new approaches to benefits management that promise to reduce plan costs even further.

Even if you've attended previous MBUs, you'll still get plenty of useful and timely information about health care planning. Our team of benefit management professionals will be happy to answer your questions... and yes, a continental breakfast and lunch will be provided at every session.

We hope to see you at an MBU event in 2018!

  11:14:00 pm, by MedBen5   , 238 words,  
Categories: American Health Care Act

Treatment Advances, Regular Screenings Reduce Breast Cancer Mortality

pink ribbon

A focus on preventive care and breakthroughs in screening and treatment reduced breast cancer deaths by 49% in 2012, compared with a 37% reduction in 2000, a new study finds.

"Advances in screening and treatment are saving lives," said lead researcher Sylvia Plevritis, a professor of radiology and biomedical data science at the Stanford University School of Medicine. "Here's an example that all this investment in research and discovery has had a real benefit. This has translated into making a difference."

The reduction in breast cancer deaths has also coincided with the rise in employer wellness programs like MedBen WellLiving. From its inception, WellLiving has emphasized the importance of regular cancer screenings based on age and gender... and we're pleased to assist employers in their efforts to help employees achieve better health and realize a higher quality of life. WellLiving recommends that women start getting mammograms at age 40 every two years until their physician decides not to order the screening.

Encouraging preventive care in the workplace offers physical and financial benefits alike. Not only do non-invasive (stage 0) and early stage (I and II) breast cancers have a better prognosis than cancer in its later stages (III and IV), which could possibly even save a life, early stage detection can save a health plan hundreds of thousands of dollars in treatment costs.

Learn how you can make a real difference by contacting MedBen Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

01/25/18

  06:45:00 pm, by MedBen5   , 255 words,  
Categories: News, Health Care Reform, Taxes, IRS

Delayed Again . . . Cadillac Tax Postponed Until 2022

IRS Building

While things have been relatively quiet on the Affordable Care Act front, in recent weeks employers were starting to wonder if they needed to implement strategies to manage costs under the controversial Cadillac Tax which was set to become effective in 2020.

This week’s short-term budget bill put those concerns to rest for a couple more years. The bill that passed out of Congress and was signed by President Trump on January 22 included another delay of the Cadillac Tax – now postponed until 2022.

The biggest problem with planning for the Cadillac Tax is that there are still no implementing regulations. That means that there is no definitive guidance for plan sponsors who want to determine how this tax might affect them. In its current form, the Cadillac tax would assess a 40% penalty on health plans in excess of certain thresholds. Those thresholds, set in 2014 at $10,200 for single coverage or $27,500 for family coverage, increase each year thereafter by statute.

One important fact to remember is that, for Cadillac Tax purposes, the value of a health care plan is determined not just by what the plan offers, but by the overall costs of the plan, which is calculated using the same methodology as used in determining a plan’s annual COBRA rates. So simply removing a benefit here and there will not significantly affect the coverage cost in relation to the threshold amount if the overall plan costs are not affected.

For more information about the Cadillac Tax, contact Vice President of Compliance Caroline Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

01/14/18

  05:12:00 pm, by MedBen5   , 187 words,  
Categories: Announcements, Cost savings, Third party administration, Claims management

MedBen Claims Surveillance Continues to Save Clients Money

magnified dollar

MedBen's claims surveillance system, which screens and selects claims for specialist review, saved clients, on average, an additional 38% per selected claim in 2017... savings produced after network discounts are applied, but before claims are paid.

Our advanced surveillance technique takes claims processing to another level. This system works in tandem with our in-house processing, using physician-managed algorithms to find claims that may not meet medical necessity or appropriateness standards. If a claim is flagged, board-certified medical specialists further review the claim (with the client's approval) to find possible resolutions.

In dollars and cents, this added layer of claims analysis saved clients an average of $7.57 per employee per month (PEPM) in 2017. Furthermore, looking at the PEPM amounts from 2013 to 2016 reveals a five-year average client savings of $10.09 PEPM.

It should be noted that these savings come on top of savings derived from plan provisions, network discounts, and medical management. Taken together, these cost controls and other claim management strategies help MedBen clients remain under national plan spending trends.

Learn more about claims surveillance and other MedBen saving solutions by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

  05:09:00 pm, by MedBen5   , 345 words,  
Categories: News, Wellness, Compliance

Judge Vacates EEOC Wellness Program Rules

checkup

“When you’re finished changing, you’re finished.”

Ben Franklin’s words ring true for those still struggling with the EEOC’s workplace wellness incentive rules. The EEOC’s May 2016 final rules outline how employers are permitted to offer wellness program incentives to employees and when those programs are considered voluntary. The rules were complex and often difficult to reconcile with the less complicated HIPAA wellness rules (which were in effect at the time and remain in effect today). However, in December 2017, a Washington D.C. Federal Judge vacated the EEOC rules in response to a lawsuit brought by the AARP (AARP v. EEOC, D.D.C. 1:16-cv-02113).

Judge John Bates’ ruling sides with the AARP, which has argued that the EEOC's wellness incentive rules (permitting health plans to include incentive penalties of up to 30% of the cost of coverage) are not a sufficient remedy for categorizing the wellness programs as voluntary.

But before running out to change your wellness program you should know two things about the Judge’s order. First, the Judge vacated the current EEOC wellness program rules – but not until January 1, 2019. The Judge reasoned that employers wouldn’t have sufficient time to re-design their plans for 2018 (“on they fly” as described by the Judge). Second, the Judge ordered the EEOC back to the drawing board, requiring that the Agency propose new rules by August 31, 2018. The EEOC must provide a reasoned explanation for considering workplace wellness programs voluntary even if those programs apply penalties.

What does this mean for your wellness program? It means that everything stays the same until it changes. That could be in the Fall of 2018 or in January 2019. Either way, it is important to note that none of this means making changes now and that any future changes may be ones we haven’t even imagined yet. So like Ben says, we’re not finished changing until we’re finished!

In the meantime, if you have any questions about the EEOC’s wellness program rules, the HIPAA wellness program rules, or any other aspect of wellness program design, feel free to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

01/12/18

  02:55:00 pm, by MedBen5   , 221 words,  
Categories: Dental, Research, Preventive care

Benefits of Dental Care Go Well Beyond Clean Teeth

dental chair

Dental checkups do much more than giving your teeth a good cleaning. Through twice-yearly exams, a dentist can monitor the condition of the teeth and gums to spot subtle changes that may need attention.

But that's only the half of it. Research shows that people who get their teeth professionally cleaned on a regular basis reduce their risk of heart attack and stroke.

Nor do the benefits end there: Many dentists also use these routine visits to check for signs of cancers of the lips, tongue, and cheek, in addition to other oral cancers, says Todd Coy, DMD, Director of Cleveland Clinic’s Department of Dentistry.

“Evaluation of the oral cavity, including the soft tissues, is part of my exam when patients are in the office for a checkup,” he says. “There are very few downsides to more frequent screening.”

In the first quarter of 2018, MedBen will be rolling out an enhanced version of its dental plan. MedBen PreceDent will offer lower costs through network care, as well as such value-added enhancements as dental implants and periodontal scaling. And of course, preventive care (which includes those twice-yearly exams) is covered in full.

If you'd like to get more information about how MedBen PreceDent promotes dental care that goes beyond the obvious, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

01/10/18

  06:11:00 pm, by MedBen5   , 233 words,  
Categories: Announcements, News, Wellness, MedBen Employees

MedBen Takes an "Encompassing" Approach to Employee Health

MedBen is taking its company wellness efforts to another level, offering employees tips and tools for living a better life, while earning them extra vacation time in the process.

In 2017, MedBen introduced "enCompass," a complement to our internal WellLiving program. Through enCompass, we bring together six distinct components that contribute to one's personal wellbeing – physical, intellectual, financial, social, occupational, and emotional. Each of these components offered a unique set of activities, from workout classes and nutritional seminars to software training and stress management sessions.

By participating in enCompass presentations and activities, MedBen employees earned points that could be used toward extra vacation time. Those who achieved this goal represent over 10% of our employee population. In total, nearly one-third of our employees participated in the program in 2017.

enCompass reward winners

MedBen employees who earned a full day vacation include: Caroline Fraker, Sheri Gutridge, Tammy Jones, Erin Kelly, Brenda McLean, Tiffany Ricket, Stacey Spring and Kay Williams.
Half-day vacation earners include: Robin Becker, Ashlyn Degler, Cindy Dittoe, Janice Harris, Abbie Hughes, Lindsay Kirk, Becky McCune and Jackie Turner.

In 2018, MedBen will continue to promote the total wellbeing of its employees, in mind as well as body, with expanded enCompass programming. Congratulations to every MedBen employee who earned time off or participated in enCompass!

MedBen can work with WellLiving clients to offer similar activities and incentives to expand their wellness program. For more information, contact your Group Health Representative.

01/08/18

  08:10:00 pm, by MedBen5   , 348 words,  
Categories: Wellness, Heart, Diabetes, Preventive care

Crushing Goals and Excess Weight

scale

More than 50% of Americans make a resolution each year, yet only 8% are successful at achieving them. Among the top resolutions made each year are getting organized, saving money, and – at the top of the list – weight loss. By a happy coincidence, January is also Healthy Weight Awareness Month!

According to CDC, roughly 70% of America adults were classified as overweight or obese in 2014. Having excessive weight can pose a serious threat to one’s health, including an increased risk of heart disease, type 2 diabetes, joint problems, and other chronic conditions.

There are three key factors that play into weight: behavior, environment, and genetics. Unfortunately, there isn’t much we can do about genetics, but we can change our behaviors. Having a healthier and moderated diet, physical exercise of at least 30 minutes most days of the week, and setting goals to keep you on track are great ways to help subside excess weight – and they can give you an emotional boost as well!

Environment has a big impact on behavior as it sometimes deters physical activity. Someone that lives in a community without sidewalks is less likely to be physically active. However, keep in mind that malls and outdoor parks, offer great (and free) spaces to walk.

As always, MedBen WellLiving suggests consulting your physician before making any drastic lifestyle changes... even if they are for the better.

Full story »

01/03/18

  08:56:00 pm, by MedBen5   , 259 words,  
Categories: News, IRS

IRS Extends 1095 Form Distribution Period

IRS Building

Happy New Year from the IRS!

On December 27, 2017, the Internal Revenue Service gave employers sponsoring health plans a New Year’s gift. Again this year, the IRS has offered plan sponsors a 30-day automatic extension for the distribution of both 2017 IRS Forms 1095-B and 2017 IRS Forms 1095-C (as applicable) to their employees. Please note that no similar extension is available for filing the forms with the IRS.

The IRS has provided guidance (in IRS Notice 2018-06) and set the new distribution and existing filing deadlines, as follows:

  • March 2, 2018 – Deadline for distribution of IRS Form 1095-B (Health Coverage) or IRS Form 1095-C (Employer-Provided Health Insurance Offer and Coverage) to employees.
  • February 28, 2018 – Deadline for paper filing of IRS Forms 1094-B/1095-B or 1094-C/1095-C with the IRS. (Note: An employer can only file paper copies if it distributes fewer than 250 1095s on or before March 2, 2018.)
  • April 2, 2018 – Deadline for electronic filing of IRS Forms 1094-C/1095-C with IRS. (Note: Employers that distribute 250 or more Form 1095-Cs must file electronically.)

To recap, the Affordable Care Act (ACA) and its supporting regulations require that all employers offering health benefits to their employees report certain health coverage information to those employees as well as to the IRS. And just like last year, employer’s sponsoring health plans must collect, aggregate and distribute this information via Form 1095.

The forms and codes are pretty much the same as they were on last year’s forms. But as always, MedBen clients who have any questions about preparing or distributing these forms are welcome to contact MedBen Vice President of Compliance Caroline Fraker at 800-851-0907 or cfraker@medben.com.

01/01/18

A Note from Our Chairman and President

Doug Freeman and Kurt Harden

To our customers, consultants, and brokers:

Welcome to 2018! For MedBen, the coming year carries a special significance, as we will celebrate our 80th anniversary in May. As with any benchmark anniversary, it gives us a chance to look back at how we’ve grown, and what we’ve learned along the way.

Reflecting on our company’s past, it’s hard to believe that for almost 50 years, MedBen served primarily as a hospital services association, covering hospital room and board, but not physician services. Flash-forward to 1987 and our transition to a mutual life insurer, and it’s remarkable to see how our business has changed in a comparatively short time… both in size (from 25 employees in 1987 to over 140 today) and scope, as we today offer a variety of benefit management services, from third party administration to pharmacy benefits management to worksite wellness to Medicare value-based payment analytics.

MedBen’s growth has coincided with the rising popularity of self-funding. Nearly 70% of U.S. employees are currently covered under employer-funded plans… and with good reason, as we have seen first-hand the flexibility and cost savings this approach offers. So much so, in fact, that our TPA clients – once a small portion of our customers – now make up our biggest block of business.

But regardless of these changes, what has remained constant are the relationships we’ve developed with all of you over the decades. And it’s these connections that make our jobs so fulfilling. It’s our continual goal to find better ways to serve you and earn your business – if we ever come up short, please call us at the numbers below. Rest assured that the trust you place in us is never taken for granted.

On behalf of the entire MedBen staff, we offer you our thanks and very best wishes for a healthy and prosperous 2018!

Sincerely,

Doug Freeman
Chairman & CEO
(740) 522-7339

Kurt Harden
President & COO
(740) 522-7345

A quick reminder: MedBen will be closed on Monday, January 1 and reopen on Tuesday, January 2 at 8:00 a.m. EST. Should you have a claims or benefits question, please visit MedBen Access. Our online customer service center is available 24/7 for your convenience!

  10:05:00 pm, by MedBen5   , 377 words,  
Categories: Prescription, Cost savings

The “Cost Plus” Approach to Rx Benefits

pharmacist

A recent New York Times story identifies a fundamental problem in the pricing of medicines in our health care system today: It is difficult to determine what “cost” is for a medicine.

What a given pharmacy actually pays to stock a medicine in the pharmacy to sell may change from one order to the next based on a variety of factors. This is complicated by the fact that the amount a pharmacy is allowed to charge or what the pharmacy is paid for a medicine is determined by a contract between the pharmacy benefits manager (PBM) that manages the network of pharmacies (ex. Express Scripts, CVS/Caremark, Optum, etc.) and the pharmacy (Walgreens in the NYT article).

In the article’s example, the Walgreens pharmacy was allowed to charge $0.93 per pill for the cholesterol drug rosuvastatin – the network agreement between the PBM and Walgreens. In contrast, online Rx discounter Blink Health charged $0.51 per pill. But while Blink’s price was better, it was also able to secure a sizeable gross profit on this prescription. The data that follows is important in this determination.

AAWP – Average of Average Wholesale Price
AWAC – Average of Wholesale Acquisition Cost
ACA FUL – Affordable Care Act Federal Upper Limit
NADAC – National Average Daily Acquisition Cost

The NADAC price, in this case, is the price that matters and why Blink could sell at such a low cost and still make money. But how do employer health plans take advantage of this pricing approach for their plan members? We have the answer to the problem.

MedBen is launching a new Rx program that bypasses the industry standard of “AWP less discount and MAC pricing for generics” approach to drug pricing in favor of a “Cost Plus” basis of pricing.

The MedBen Rx program model will pay the pharmacy the average cost of the drug based on a proprietary national retail pharmacy survey (like NADAC, above) plus a dispensing fee that reflects the pharmacy services in filling a prescription. This method of pricing will provide MedBen groups with a pricing methodology that eliminates the “margin manipulation” that is possible in the current PBM AWP discount approach to pricing.

For more information on this money-saving pharmacy program, contact MedBen Vice President of Sales & Marketing Brian Fargus at 888-627-8683 or bfargus@medben.com.

12/29/17

  09:50:00 pm, by MedBen5   , 212 words,  
Categories: Wellness, Reporting, Diabetes, Hypertension, Cholesterol

Nearly One-Third of Adverse Health Tied to Chronic Conditions

checkup

Hypertension, diabetes, and high cholesterol are among the chronic conditions responsible for 30% of adverse health nationally, according to a recent report from Moody’s Analytics... conditions that can be better controlled through a focus on preventive care through worksite wellness.

The report also suggests that these conditions can be significantly impacted by a person's environment, upbringing, and other social determinants. But here, too, is where a wellness program like MedBen WellLiving can have a positive effect: Offering the same program participation incentives to all plan members – coupled with other trade secrets– improves the likelihood that a higher proportion of the employee population will get regular wellness exams and screenings regardless of individual differences.

Additionally, WellLiving emphasizes "family doctor first." By establishing and maintaining a physician-patient relationship, the family doctor is better positioned to detect an increased risk of hypertension, diabetes, and high cholesterol. All of these in addition to other conditions the report cites as primary contributors to adverse health, such as depression and substance abuse.

Better health and lower health care costs begins with a wellness program that promotes preventive care and condition management for all employees, and MedBen WellLiving was designed with those goals in mind. Get more information by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

12/21/17

  04:01:00 pm, by MedBen5   , 357 words,  
Categories: Wellness

The Most Wonderful or Stressful Time of Year?

ugly sweater

Though known as “the most wonderful time of the year,” a study by Greenberg Quinlan Rosner Research found that people are more likely to feel increased stress during the holiday season. This could be due to increased financial burdens, pressures of gift buying, finding time to attend or host events, and seasonal depression.

When you’re in a stressful situation, your hypothalamus, a tiny region at the base of your brain, sets off an alarm system. Through a combination of nerve and hormonal signals, this system prompts a release of hormones, including adrenaline and cortisol. This causes your heartbeat and breathing to speed up and your muscles to tense.

The body can usually recuperate quickly from a single stressful situation. However, it’s when the condition becomes chronic that it poses a serious health threat, leading to heart conditions, depression, and rapid aging.

Knowing what causes your stress is the first step in fighting it. Then, do what you can to reduce it, or eliminate it completely. No, we’re not saying that you should cancel the holidays, but we are suggesting that you take it easy (see tips on how to manage holiday stress below) and be aware of signs such as fatigue or insomnia, irritability, or just a constant feeling of worry that indicate you may be dealing with stress. Be sure to see your family physician for any evidence of chronic stress.

Full story »

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