As in years past, all self-funded employer health plan sponsors are required to file and pay their Patient-Centered Outcomes Research Institute (PCORI) fee no later than July 31, 2016. All self-funded plan sponsors are required to pay a fee based on the average number of covered lives under their eligible plans — including employees, retirees, spouses and dependents. Self-funded plans subject to the requirements include self-funded medical benefit plans, including most non-ERISA self-funded plans and retiree-only plans. Other self-funded plans subject to the fee include self-funded HRAs and FSAs which are not integrated with a plan sponsor’s self-funded major medical plan. Dental-only, vision-only, EAP, disease management, and wellness plans are exempt.
All plan sponsors must use the IRS Form 720 dated April, 2016 to record and remit the amount due. This year, the IRS Form 720 has been modified to include the payment amounts due under the schedule shown below. Make sure to complete the correct section of Part II for “Applicable self-insured health plans” and that you select the correct payment amount based on your plan’s year end date. The form is available on the IRS website, or simply perform a search for "IRS Form 720."
This year’s payment schedule is as follows. If your plan year ended on October 31, 2015, November 30, 2015 or December 31, 2015 you will owe $2.17 per covered life. All other plans years owe $2.08 per covered life.
MedBen clients who need more information about how to count covered lives under their plan or how to prepare and remit their payment are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or email@example.com.
Over half of all stop-loss reimbursements can be traced to a mere ten ailments, finds a new study that highlights the importance of stop-loss coverage for self-funded employers. MedBen is here to help groups with stop-loss carrier advice and cost control strategies.
Benefits Pro reports that, between 2012 and 2015, self-insured employers covered by Sun Life stop-loss insurance paid out 53% of stop-loss claims reimbursements for just ten catastrophic claim conditions. Of these, various forms of cancer made up 26.6% of reimbursements, due in part to new treatments and high-cost medications.
For self-funded employers, numbers like these serve as a stark reminder to have a stop-loss carrier that not only serves as a safety net for catastrophic claims, but balances quality coverage with cost considerations. Toward this goal, MedBen shops multiple carriers to ensure that clients retain the desired level of specific and aggregate protection, and negotiates the best possible rates.
Moreover, while stop-loss insurance helps to limit potential losses, MedBen reduces client risk even further. Our cost containment solutions range from advanced claims management to plan language expertise for specific catastrophic conditions, including chronic renal disease (ranked #3 in the Top Ten) and transplants (#6).
Learn more about MedBen stop-loss services and savings solutions by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
The complete Top Ten:
Vision care is typically described as an ancillary benefit, but its advantages make it more than just an add-on. MedBen VisionPlus offers a great complement to your group medical and pharmacy coverage.
HealthDay News reports that, according to a new study, after receiving routine eye exams more than half of people with no new symptoms or vision problems receive new prescriptions or treatment changes. Meanwhile, 16% were diagnosed with a new eye condition and 31% had a change in their ongoing care.
Furthermore, regular vision checkups do more than correct eyesight and reduce the risk of eye diseases — they also can potentially detect such chronic conditions as diabetes, hypertension and high cholesterol. Conversely, people with these conditions are more prone to losing their eyesight. So the benefits of vision care extend well beyond simply getting a fashionable pair of eyeglasses.
MedBen VisionPlus puts your employees’ eyes first. By emphasizing regular exams and early detection and treatment of visual impairments, our group vision product enhances your overall health care plan. It's an affordable benefit that pays for itself in multiple ways.
Learn more about the advantages of quality vision care through MedBen VisionPlus by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
The Centers for Medicare and Medicaid Services recently projected that U.S. health care spending trend will continue to outpace the economy over the next decade. But MedBen uses its proven saving strategies to keep client cost trend as low as possible.
From 2011-2015, MedBen's five-year average claims cost trend for its overall block of business was only 4.9%. That compares to a 9.5% trend nationally during the same period.
MedBen uses a variety of claims management tools to help clients realize long-term savings — chief among them, a surveillance systems that calls on the expertise of over 125 medical specialists. When the system flags a claim, panel members quickly review it to determine potential clinical problems and work with the provider to reach a proper resolution. All of this is taken care of before the plan pays money out, so clients don’t have to recoup expenses later.
In 2015, MedBen's claim surveillance measures saved an average of $13.61 per employee per month. And the savings hardly stop there — our plan design and plan language solutions, network discounts, medical management and other cost controls all benefit the bottom line.
MedBen is committed to beating national cost trends today and in the future. Learn more about the ways we save our clients money by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
"Pharmacogenetics" — it's a big word that could make a huge difference in how doctors prescribe drugs, while helping self-funded employers see long-term savings on pharmacy costs. And MedBen is rolling out a new service that will allow clients to take advantage of this important new form of personalized medicine.
MedBen now offers an innovative pharmacogenetics test that determines personal compatibility with over 300 commonly prescribed drugs in a variety of therapeutic categories. Plan participants receive reports that provide clear, concise guidance on which medications will work and which ones to avoid, greatly reducing the "trial and error" approach common to prescribing.
So what is pharmacogenetics? Simply put, it concerns how a person responds to a drug based on inherited characteristics. Because every individual is unique, the ways our bodies react to a medication can vary greatly. What works well for one person may be less effective for another, or may not work at all.
Studies show that the average efficacy rate for drugs treating the most prevalent diseases is estimated to be only 50%. But regardless of whether a medication works or not, the pharmacy bill is the same to the health plan. So having a way to know in advance if a drug is right for a patient reduces wasteful spending.
MedBen works with a state-of-the-art laboratory that studies DNA variants to determine if and how well an individual's body will metabolize various medications, and makes its report based on scientific evidence. In this way, the patient gets better quicker, the physician saves time, and the employer saves money.
MedBen is now in the process of contacting clients about the benefits of personalized medicine through drug compatibility testing, but if you'd like to get additional information about the technology today, just contact your Group Service Representative. And if you're not a current client but want to learn more, contact our Vice President of Sales & Marketing Brian Fargus at email@example.com (888 623-2364).
Chronic health conditions are often closely linked ‒ that is, one existing condition contributes to the development of another. It's a major reason that MedBen WellLiving places such a great emphasis on the ongoing doctor-patient relationship.
According to the Centers for Disease Control and Prevention, about half of all American adults have one or more chronic conditions. One of four adults have two or more conditions.
Conversely, too much bad cholesterol raises your odds of developing diabetes, hypertension, and heart disease, and even asthma may lead to other health problems. Suffice it to say, chronic conditions are seldom isolated occurrences ‒ and as the conditions add up, so does the risk of even more serious, and costly, diseases.
The solution to multiple chronic conditions is to stop them from getting a foothold in the first place... and here, MedBen WellLiving can help. Our program's "physician first" approach encourages members to get wellness exams from the same family doctor every year. These visits also serve as a perfect opportunity to review health history and address the symptoms of a chronic condition before it progresses further ‒ or sows the seeds of additional conditions.
MedBen WellLiving focuses on chronic condition prevention while cultivating a healthier workplace and long-term cost savings. Learn more by contact Vice President of Sales & Marketing at firstname.lastname@example.org.
As bundled payments and other alternative payment methods become more commonplace, hospital readmission rates and costs are dropping. MedBen Analytics has been working to ensure that hospitals realize the benefits of bundled payments ‒ benefits that will ultimately carry over to commercial health plans as well.
From HealthLeaders Media: "From 2007 to 2011, the all-cause 30-day hospital readmission rate for Medicare fee-for-service beneficiaries held steady at about 19% to 19.5%, according to the Centers for Medicare & Medicaid Services. But those rates fell to 18.5% in 2012 and 17.5% in 2013, CMS reports."
MedBen Analytics is helping hospitals make the transition to value based payments, through an advanced reporting system that takes raw Medicare claims data and converts it into actionable reports. Using the insights offered, providers can make informed choices necessary to improve services.
When hospitals can see where opportunities for improvement lie, they benefit from higher returns on bundled payments. Patients and health plans benefit, too... from more focused care and lower costs.
Organizations interested in a demonstration of the MedBen Analytics system or additional information are welcome to contact MedBen President and COO at 888-633-2364 or email@example.com.
Recently, we discussed here how MedBen helps to keep self-funded, non-grandfathered plans compliant with new preventive care requirements under the Affordable Care Act (ACA). However, it's not enough to just monitor new recommendations — we also continue to watch for any clarifications on existing recommendations.
As you may know, under the ACA, non-grandfathered health plans are required to cover preventive care recommendations at 100% when services are obtained through an in-network provider. The recommendations come from the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices, and guidelines supported by the Health Resources and Services Administration that are applicable to women and children.
From time to time, the Departments of Labor, Health and Human Services and the Treasury (the “Tri-Agencies”) will release joint FAQs that address commonly asked questions relating to federal acts, including the ACA. It is the goal of the Tri-Agencies to shed light on existing issues and regulations by offering clarifications on recommendations already in effect. Because these are clarifications and not new recommendations, the Tri-Agencies expect these changes to be made to health plans right away, unlike new recommendations which have a future implementation date.
For example, colonoscopies must be covered at 100% in-network under the ACA and have been for some time. A recent FAQ, released in April of 2016, specifies that any medically appropriate bowel preparatory medications that precede the colonoscopy must also be covered at 100%, when prescribed by a health care provider.
MedBen’s Compliance and Group Service Departments work together to make sure your self-funded plan complies with these requirements. Additionally, we will help you to understand the requirements and notify any necessary vendors, such as your pharmacy benefit manager, if applicable.
FAQs can be reviewed on the Department of Labor website.
A complete list of recommendations can be found at the following websites:
MedBen clients who have any questions about the requirements under the ACA are welcome to contact Compliance Supervisor Erin Kelly at firstname.lastname@example.org.
A recent Benefits Pro article explores how the use of predictive analytics can help to reduce wasteful health spending. At MedBen, this statistical approach serves as the foundation of our reporting platform — an approach that helps our clients to know in advance where potential risks are and act accordingly.
As the article notes, the use of data and algorithms by the health care industry to predict particular events benefits plan sponsors in a variety of ways, such as minimizing wrong diagnoses and steering patients toward the most affordable care. For MedBen clients, predictive analytics serves an equally valuable purpose, enabling them to determine and mitigate clinical as well as financial risk.
MedBen reporting offers patient-level drill-down functionality, so clients can identify and target high-risk plan members in need of clinical interventions. When risks are found, we work with the client to chart an effective course of action. This can range from making strategic plan benefit changes to simply encouraging members to get their cholesterol checked.
Moreover, the MedBen reporting platform tracks group medical and pharmacy spending trends using existing claims data, and analyzes them against appropriate benchmarks. If changes are deemed necessary, our tools compare various plan alternatives and visualizes the financial impact of those changes on future costs and coverage.
With predictive analytics, MedBen helps clients identify risks and develop solutions to reduce health risk and spending, while maximizing the overall value of their health plans. Learn more about how our intelligent reporting features can save your health plan money by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
Drinking soda has no nutritional benefits for our bodies, but we already knew that. It isn’t the healthiest choice, nor does it provide much hydration. The taste is generally why Americans consume more than 44 gallons per person per year. So what really happens when you drink a 12 oz. can of, let’s say, Coke?
About 20 minutes in, your body receives 100% of its daily intake of sugar (that’s ten teaspoons!). The only reason you don’t instantly vomit from the sugar overload is because the phosphoric acid cuts the flavor. With so much sugar at one time, your blood sugar spikes, creating an insulin burst, and your liver starts turning all sugar into fat. Within 40 minutes, the caffeine absorption is complete. Your pupils dilate, your blood pressure increases, and your liver is now dumping all of the sugar it can grab into your bloodstream.
The final 20 minutes, dopamine is released in the brain, and a compound in your lower intestine is created to further boost metabolism. But before that compound can make its way to your bones (along with the sodium, electrolytes, and the minimal water consumed), it will be excreted via the urinary track. You are now only left with the irritable and drowsy feeling known as a sugar crash.
Not only are the short-term effects of drinking a can of soda less than appealing, so are the long-term effects. Some studies have shown there is a connection between drinking soda and conditions such as stroke, weight gain (linked to type II diabetes), kidney stones, liver damage, and much more.
Is that taste still worth it?
Happy Independence Day from MedBen!
In observance of the holiday, our home office will be closed on Monday, July 4 and reopen at 8:00 a.m. on Tuesday, July 5. Hopefully your day off is all about cookouts with friends & family and community fireworks... but should you need claims or benefits information, our online customer service center, MedBen Access, is open for business!
MedBen Access offers a number of useful management functions, such as ordering ID cards, monitoring claims activity and reviewing change of information requests. Plan members can check a claim's status, review Plan Document coverage and download forms, to name just a few of the 24/7 services available.
The entire MedBen team wishes you a safe and relaxing 4th!
The use of bundled payments in commercial settings can reduce costs and help self-funded plans rely less on networks, MedBen Vice President of Compliance Caroline Fraker commented during the "Administering Physician Claims with Bundled Payments" webinar on June 23. The webinar was sponsored by the Society of Professional Benefit Administrators (SPBA), of which Fraker serves as a board member.
"Plan sponsors are looking for lower cost and consistency while providers are looking for administrative ease and market share," Fraker said. "Bundled payment models will stimulate quality improvement and push forward alternative payment methods."
Currently used primarily to reimburse Medicare claims, bundled payments serve as a pricing "middle ground" between fee-for-service and capitation. The Centers for Medicare and Medicaid Services has set a goal that 50% of payments will originate from alternative payment models by 2018, and it's expected that private health plans will follow in turn.
Fraker noted that the transition in the commercial sector has already started. "Large employers in your communities are already experimenting with some form of bundled payment models. And because hospitals want to rid themselves of PPO network contracts, they'll likely move all services in that direction once they become comfortable with Medicare bundled payments," she said.
MedBen already has a head start on working with the bundled payment concept. Through our MedBen Analytics service, we're helping hospitals take raw Medicare claims data and convert it into actionable insights that improve quality of care, while controlling costs.
Our growing experience in this area, combined with our proven benefits administration expertise, will soon allow commercial employers to benefit from alternative payment models as well. MedBen is in the process of rolling out commercial bundled payment services to clients.
Despite the hope that an influx of new insureds through the Affordable Care would reduce the rate of emergency room (ER) visits, new data indicates that patients still seek care there at disproportionately high numbers. It highlights the need to offer benefits that promote ER visits for real emergencies, while encouraging those with less urgent needs to contact their family doctor first.
According to the Centers for Disease Control, in 2012 the ER visit rate in the United States was 42 visits per 100 persons, and about 20% of children and adults visited the ER at least once during the year. Private insurance was the most common form of payment, at 29%.
ER benefits can be tricky, as no health plan wants to discourage individuals from visiting an ER when the need is vital. But the relative convenience of the ER results in a large number of patients who could be better served by a primary care physician, ultimately costing the client much more for the same care. MedBen help clients to find the right benefits balance.
As with all aspects of plan design, MedBen works with clients to help them offer ER benefits that properly address employee population needs. Demographics, geography and claim history all factor into the plan design process, and MedBen is experienced in considering all of these elements.
Because every benefit affects care usage and costs, MedBen takes your plan design seriously. Learn more about how we do it by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
As medical costs continue to escalate, health plans are increasingly exploring payment options that go beyond the traditional fee-for-service structure — and the same may soon apply to prescription drugs.
According to Stat, a recent survey reveals that most health plans would like to pay for many of the highest-priced medicines based on patient outcomes. Either the health plan would receive an extra discount from a drug maker if a medicine does not help patients as much as expected, or conversely, a drug maker may get a credit toward a rebate provided to a health plan if a drug outperforms rival medicines.
The survey of 42 U.S. health plans representing 161 million insured people found that 63% of respondents had a strong interest in outcomes-based contracts for costly hepatitis C treatments. Other expensive specialty drugs in which respondents expressed "high" or "very high" interest in such contracts include oncology medications (53%), rheumatoid arthritis drugs (41%), and multiple sclerosis treatments (35%).
The interest in outcomes-based contracts is “dramatically accelerating right now because the data is available, and it’s getting much easier to track drug performance,” said Dan Mendelson, the head of Avalere Health, which conducted the survey. Growing competition in some therapeutic categories has also fueled the demand.
Some six years after the introduction of federal health care reform, House Republicans have formally unveiled a replacement for a repealed Affordable Care Act, The New York Times reports. Speaker Paul Ryan (R-Wis.) said the plan would slow the growth of health spending and relax federal rules for health insurance, but did not provide a cost estimate or funding mechanism.
Of specific interest to employers, the proposed plan would place a cap on tax-free contributions to employee health coverage, as an alternative to the unpopular "Cadillac tax." House Republicans claim the cap would affect “only the most generous plans.” However, James P. Gelfand, senior vice president of the ERISA Industry Committee, counters that the tax would "threaten the employer-sponsored health insurance that so many Americans enjoy.”
The 37-page white paper does retain several of the ACA's more popular provisions, such as allowing young adults to keep coverage under their parents' health plan to age 26 and forbidding health insurers to charge individuals higher premiums for pre-existing conditions. But it would effectively eliminate federal insurance marketplaces and loosen rules that require Americans to carry health coverage.
Additionally, the plan would:
The U.S. Preventive Services Task Force recently reiterated its recommendation that adults age 50 and over receive regular colon cancer screenings until at least age 75, but did not specify a preferred screening method. MedBen WellLiving promotes similar guidelines while supporting colonoscopies as the best testing option.
In a USPSTF news release, former Task Force member Dr. Douglas Owens said, "There are multiple screening options for colorectal cancer that reduce the risk of dying from the disease. We encourage people to choose the best option for them, in consultation with their clinician."
However, HealthDay News notes that many doctors consider colonoscopy to be the "gold standard" test.
"There is only one test — colonoscopy — that can both diagnose a polyp/cancer and remove or sample it at the same time," said Dr. Arun Swaminath of Lenox Hill Hospital in New York City. "This is key, because a positive stool test plus stool DNA test (such as Cologuard), or a positive imaging test (such as CT colonoscopy) will still require a follow up colonoscopy to confirm and treat the problem."
The MedBen WellLiving program follows the American Cancer Society recommendation that adults get a colonoscopy screening once every 10 years, beginning at age 50. WellLiving members can check their compliance with colonoscopies and other critical wellness examinations by visiting the MedBen Access website and clicking on the "MedBen WellLiving" link under “My Plan”.
To learn more about the advantages of promoting preventive screenings through MedBen WellLiving, contact Vice President of Sales and Marketing Brian Fargus at email@example.com.
As part of an "employer verification study," the Department of Health and Human Services (HHS) is currently contacting employers to determine whether they are offering an "affordable/minimum value" plan to their employees. The Self-Insurance Institute of America reports that the HHS, through a third-party contractor, is conducting the study in order to get a better idea of how many employers offer minimum value plans under the Affordable Care Act.
The reason behind the survey concerns premium subsidies available through ACA Exchanges. If an individual wishes to enroll in a health plan sold through an Exchange and receive a subsidy to cover a portion of the cost, the Exchange must first determine whether that person was offered a minimum value plan by an employer. Those who could get a minimum value plan through their job are ineligible for the subsidy.
The task of determining subsidy eligibility was supposed to be simplified through the use of an "electronic data source" proposed by the ACA. However, to date no such source is available, meaning that the Exchange will have to call an employer directly — hence the agency's interest in ascertaining the percentage of employers that don't offer minimum value plans.
If you do get a call from HHS's third-party contractor, understand that you are under no obligation to answer any questions — but if you do, the survey should take no longer than 15 minutes to complete. The study began in April and is scheduled to conclude at the end of June.
If you're a MedBen client and not sure whether your plan provides minimum value to your employees, you are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
MedBen President and COO Kurt Harden was among the presenters at the Sixth National Bundled Payment Summit in Washington, DC on June 9. Speaking at the event's Innovation Showcase, Harden discussed Comprehensive Care for Joint Replacement (CCJR) bundled payment solutions developed by MedBen Analytics, the company's value based payment administration service.
"Hospitals are drowning in data and starving for insight," Harden said. " MedBen Analytics works very hard to take that enormous amount of raw data, draw out insights. We provide it to clients so they can make informed choices."
During his presentation, Harden showed examples from MedBen Analytics' portal-based reporting system, highlighting its drill-down functionality. "We focus on the data so our clients can focus on decisions. All they have to do is log in and look at the reports," he said.
Harden also noted that because MedBen has decades of experience at third party administration, that knowledge was a key advantage in developing the MedBen Analytics platform. "Our system design ensures accurate bundled payment parameters, in part because we assume nothing about the group. Rather, the reporting is based solely on the specific needs of the hospital."
Harden attended the summit with Wendell Crain, Director of Security, Infrastructure and Web Development for MedBen Analytics.
Organizations interested in discussing MedBen Analytics' services can call Harden at 888-633-2364 or email him at email@example.com.
Sometimes, it's the simple things that can make a big difference. Case in point: A new study suggests that offices equipped with alcohol-based hand sanitizers can reduce provider claims related to cold, flu, and other preventive illnesses by nearly one-quarter.
According to Drug Store News, the study found that, in comparing an office environment in which hand sanitizers were placed strategically throughout the workplace (including desks) to one which limited their availability to bathroom dispensers, there was:
Now, it must be noted that the study was clearly intended to promote the effectiveness of hand sanitizer products, so the results have to be judged in that context. Moreover, hand sanitizers shouldn't serve as a substitute for soap and water if they're available.
The Centers for Disease Control says that sanitizers with an alcohol concentration between 60–95% are more effective at killing germs than those with a lower alcohol concentration or non-alcohol-based hand sanitizers, which may just reduce the growth of germs rather than kill them outright.
Heart disease is too often thought of as a condition that affects men more than women. But women are equally at risk, and as such, are equally well-served by developing a professional relationship with a primary care physician.
The connection between breast cancer and women's health rightfully gets a great deal of media and public attention. However, you may be surprised to learn that, when mortality rates are compared, roughly 10 times more women die each year from heart disease. In fact, the condition claims the life of 1 in every 4 women.
Nor is the condition limited to the elderly. Young and middle-aged women also are at risk for heart disease ‒ in particular, those who smoke, are obese, or have a family history of heart disease. Moreover, symptoms tend to be less pronounced than in men, making it harder to diagnose.
MedBen WellLiving emphasizes the importance of annual wellness exams. But equally important is the accumulated knowledge that comes from yearly visits to your family doctor... knowledge that improves the odds of detecting the warning signs of heart disease before they become life-threatening.
Primary prevention through the MedBen WellLiving program helps employers save money, but it's greatest benefit is its potential to improve lives, and in some cases, save them. Learn more by contacting Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.