U.S. drug spending witnessed another sharp jump in 2015... but MedBen drug spending came in at just one-third of the national trend.
The Wall Street Journal reports that total spending on prescription drugs in the U.S. rose 12.2% to nearly $425 billion in 2015. Much of that increase can be attributed to expensive new drugs for cancer and infections, as well as price hikes for older drugs, according to research by IMS Health.
In contrast, MedBen pharmacy plans experienced only a 4.1% trend last year, based on amount paid per member per month. And while clients faced many of the challenges associated with higher prescription costs and the increased use of specialty drugs, they were able to keep overall spending in check through the smart use of generics and alternative medications.
Of course, a large part of the savings come from simply returning to customers what is rightfully theirs. Many third party administrators withhold part of a pharmacy rebate, whereas MedBen gives 100% of the rebate back to the client and passes through all of the generic discounts.
U.S. pharmacy spending continues to outpace all other types of medical care, but MedBen is committed to keeping client Rx costs well under national trends. Learn more about how we do it by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
Health Affairs recently analyzed the responses of 2,010 adults to questions about the relationship between health care prices and quality, such as “Would you say higher prices are typically a sign of better quality medical care or not?” In a majority of cases, respondents stated that they didn't associate price with quality. But what people say and what they do are sometimes two different things.
MedBen has seen group health plans in which nearly half of members who require inpatient care migrate to high-profile metropolitan hospitals, even though comparable – and often, substantially less expensive – care is available from a facility much closer to home.
For employers in which plan members have a choice of local or metropolitan hospitals that offer a comparable quality of care, MedBen can help to design a plan that incentivizes patients to receive the same high level of care at the most affordable price available.
As an established health benefits manager, MedBen has extensive experience in guiding clients to the best care at the best cost. To learn how we do it, we invite you to contact our Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
More evidence that a focused worksite wellness program like MedBen WellLiving can promote better health and save your business money: According to a new analysis, the cost of insulin to control diabetes more than tripled over a decade.
Stat reports that between 2002 and 2013, insulin prices spiked from $231 to $736 a year per patient. Currently, about one in four diabetes patients use insulin to manage their blood sugar, with the balance using pills or other injectable medicines.
The rising cost of insulin comes during a period of worldwide growth in diabetics. Data from the World Health Organization indicates that excess weight and obesity are among the factors that have led to nearly fourfold increase in diabetes cases over the last three decades.
MedBen WellLiving places an emphasis on helping your employees reduce their odds of developing Type 2 diabetes. Health plan members who are found to be at risk for the disease based on their claims history receive customized counseling from a RN Health Consultant via our Specialty Care Program.
Through one-on-one coaching, complemented by educational materials and other resources, plan members can reduce their chances of developing diabetes and the complications that accompany it. For more information about Specialty Care through MedBen WellLiving, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
MedBen publicly-funded clients have experienced a cost trend of just 9.3% from 2011 to 2015, according to information gathered as part of MedBen's annual benchmark work for clients. Brian Fargus, MedBen Vice President of Sales & Marketing, presented the data on medical costs at the company's 10th Annual Municipality Roundtable on Thursday, April 7 at the C. Arthur Morrow Conference Center in Newark, Ohio. The trend breaks down to only a 1.9% average per year.
"Municipalities traditionally have higher costs per employee than private sector health plans," Fargus said. "Working together, we've managed to narrow that gap considerably in the last five years."
Publicly-funded employers face special challenges in keeping health care costs down, such as union contracts that often require more benefit-rich health plans than typically offered by other businesses. But through strategic use of cost controls, the 18% plan cost difference in 2011 between MedBen's municipality block and its overall block shrunk to just 10% in 2015.
Throughout the roundtable, participants learned how simple changes made by municipalities have improved health care costs. In his discussion of pharmacy benchmarks, MedBen President & COO Kurt Harden showed how by covering the costs of prescribed over-the-counter drugs, an employer effectively minimized its pharmacy spending. And Regional Sales Manager Lindsay Kirk shared a success story in which a client has seen a significant three-year decline in health care costs after introducing financial incentives to their wellness program, MedBen WellLiving.
Frank Dosch, President of The Forker Company, described how one of his clients lowered health care spending by steering their plan members away from costlier metropolitan hospitals to facilities closer to home. "By offering better coinsurance for regional hospitals, you still give employees the choice to go where they want, but provide additional incentives for using local care, and save significant dollars,” Dosch said.
MedBen will be conducting additional seminars throughout the Midwest in 2016, with topics ranging from self-funding basics and worksite wellness to health care reform updates. If you're interested in attending an upcoming MedBen University, please contact MedBen Sales Analyst Sally Wood at (800) 423-3151, Ext. 502 or firstname.lastname@example.org to be added to our mailing list.
Healthcare Dive recently pondered the question, "What happens if Obamacare is repealed?"
The idea of repealing the controversial Affordable Care Act is nothing new – nearly from the get-go, members of Congress have introduced bills calling for repeal. Even six years removed from the law's passage, the drumbeat for repeal remains strong, with presidential candidates Donald Trump and Ted Cruz both vowing to make it a priority.
But as HealthCare Dive points out, the odds of a full repeal grow more remote with every passing year. Many of the regulations, such as coverage for children to age 26 on their parent’s plan and the elimination of pre-existing condition limits, are too ingrained to simply overturn them overnight. And of course, uninsuring the roughly 20 million people who have purchased coverage from the government marketplaces would be problematic, to put it mildly.
However, perhaps the biggest obstacle for repeal is a political one. For there to be any chance of repeal, Republicans would need to gain control of the White House, the Senate and the House of Representatives.
Moreover, the likelihood of a Senate Democrat filibuster to a repeal bill means that Republicans would need 60 Senators to vote to end the debate. Not impossible... but certainly a high hurdle to overcome. As such, revising the ACA is a more probable outcome than repeal at this point.
Prices for four of the nation's top 10 drugs more than doubled from 2011 to 2014, according to a new Reuters analysis of proprietary data. The six others went up more than 50%.
The highest price jumps among the top 10 drugs include the arthritis drugs Humira (a 126% increase) and Enbrel (118%), and multiple sclerosis drug Copaxone (also 118%). But the list also includes medications used to treat chronic conditions like high cholesterol and asthma, as well as other common problems.
Sales for the top 10 drugs went up 44% to $54 million, even though prescriptions for the medications dropped 22%. Reuters observes that "the increases help explain federal data showing overall spending on drugs rose faster than doctor visits and hospitalization over the past five years."
Several of the top-selling drug companies that reviewed the analysis noted that it failed to capture negotiated discounts and rebates. But even after discounts, pharmacy benefit managers told Reuters they pay annual price increases on top medications of up to 10%.
As rising drug prices continue to challenge group pharmacy plans, MedBen helps employers by offering superior discount rates that keep member prices lower. While our plan encourages the use of generics, we also also offer competitive discounts on the average wholesale price of brand-name medications as well. Plus, we pass through 100% of negotiated discounts and delivers 100% of paid rebates back to the client.
To learn more about the MedBen Rx Advantage, please contact Vice President of Sales and Marketing Brian Fargus at (888) 627-8683.
April 1 marked an important day for U.S. hospitals, as Medicare makes a major shift from fee-for-service medicine to value based payments in 67 metropolitan statistical areas (MSAs) across the country. MedBen Analytics has an innovative system in place to assist participants with the transition.
With the introduction of mandatory bundled payments for Medicare knee and hip replacements, selected hospitals will be accountable for the quality as well as the costs of care from the start of the surgery through 90 days post-discharge.
For nearly two years, MedBen Analytics has been working to provide a bundled payment analysis and reporting program that turns Medicare claims data into actionable insights necessary to improve services. Our current hospital clients are already realizing the benefits of our analytics engine, by using the reports to see where opportunities for improvement lie and modifying their clinical pathways accordingly.
MedBen Analytics will be participating in the Sixth National Bundled Payment Summit on June 7-9, 2016 at the Grand Hyatt in Washington, DC. If you plan on attending this event, we encourage you to stop by and say hello.
For a demonstration of our system or additional information, please contact MedBen President and COO Kurt Harden at 888-633-2364 or email@example.com. We also invite you to visit the MedBen Analytics website to learn more about our solutions to succeed with value based payments.
A new study provides yet another good reason for promoting wellness in the workplace through MedBen WellLiving: A disturbing downward trend in health habits.
According to Health Essentials, researchers reviewed nearly 4,000 Cleveland Clinic patients who were treated for the most severe and deadly type of heart attack. They determined that, despite greater awareness of the risks of obesity, type 2 diabetes, and high blood pressure, more people now suffer from these conditions at a younger age — and are seeing a rise in heart attacks as a result.
The study results showed that, from 1995 to 2014, patients experienced proportional increases in diabetes (from 24% to 31%), high blood pressure (from 55% to 77%), and chronic artery disease (from 5% to 12%). Additionally, the number of patients who had three or more major risk factors jumped from 65% to 85%.
Obviously, unhealthy habits can't be fixed overnight. But employers are in a unique position to provide their team with a nudge in the right direction — and MedBen WellLiving can help.
The WellLiving Specialty Care Program identifies members at high risk for diabetes, high blood pressure, chronic artery disease and other diseases, and contacts them to provide individualized nurse coaching with an RN Health Consultant. Through early intervention, coupled with the program's emphasis on regular wellness exams and lifestyle changes, plan members can significantly improve their health while lowering health care costs.
The Affordable Care Act recently celebrated the 6th anniversary of its passage. In the ensuing years, we've been subjected to a myriad of new regulations, amendments, clarifications and delays... not to mention, assorted taxes, fees and potential monetary penalties.
Making heads or tails of the various costs associated with health care reform is a full-time job in itself. Fortunately, MedBen has an experienced compliance team that helps clients stay on top of their primary ACA responsibilities. And to make things easier still, we've compiled "ACA by the Numbers," a handy, downloadable summary of the key financial components under the law.
It's worth noting that while some ACA costs are automatically incurred by all self-funded groups – specifically, PCORI and transitional reinsurance fees for each covered person under the health plan – the biggest potential costs are the penalties for Applicable Large Employers (ALEs) who fail to offer appropriate coverage to their full time-employees. Depending on your group's size, these penalties could add up to hundreds of thousands, or even millions, of dollars... which is why it's essential to have an ally like MedBen who can protect you from unnecessary expenses.
Remember, MedBen is available to assist clients with questions or concerns about ACA compliance. If you're ever in doubt about something, we encourage you to contact our Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
At the 14th Annual MedBen Hospital Roundtable on March 24, Vice President of Sales & Marketing Brian Fargus revealed that in 2015, total medical and pharmacy costs for the company's hospital block increased only 2.8% from 2014. This continues a five-year trend of small cost increases for MedBen's hospital clients.
"From 2011 to 2015, the cost trend was only 4.9%," Fargus said. "That's basically just 1% per year."
Hospitals are unique among the industries that MedBen serves in that they can help themselves keep health care spending down by steering plan members to their own facilities for medical care and prescription drugs. Through these and other cost containment strategies, MedBen's hospital clients have managed to keep average cost increases well below national trends.
In his presentation of pharmacy benchmarks, MedBen President & COO Kurt Harden noted that hospital clients are increasingly taking advantage of "own use" prescription dispensing to benefit their bottom line. "At several of our hospital groups, more than two-thirds of plan members' prescriptions are now filled in-house," Harden said.
MedBen will be conducting a Government Roundtable on Thursday, April 7 from 9:00 a.m. to 1:00 p.m. at the C. Arthur Morrow Conference Center in Newark, Ohio. The event is open to interested municipalities, even if they are not MedBen clients. If you would like more information, please contact MedBen Sales Analyst Sally Wood at (800) 423-3151, Ext. 502 or email@example.com.
A recent U.S. Department of Labor notice gives employers until the first day of the first plan year that begins on or after April 1, 2017 to comply with upcoming regulatory changes to the Summary of Benefits and Coverage (SBC) which they must distribute to their employees.
Effective April 1, 2017, and for all plan years beginning thereafter, employers must revise their SBCs to meet the new requirements and format. If your plan year begins at the first of the year, you will have to begin using the new SBC format effective January 1, 2018. Remember, however, that the revised SBC must be distributed along with any open enrollment materials used prior to your plan year, which means that you will need to have the new SBCs ready at least 30 days in advance to allow for timely distribution.
Late last fall, the DOL reminded employers that SBCs must be given to employees in several different circumstances, not just at open enrollment. Employers must remember to hand out their SBCs to eligible new hires, when an employee has a special enrollment event and any time the plan makes a change that affect the content of the SBC.
The Affordable Care Act requires that group health plans provide a uniform summary of their benefits to eligible individuals to be used in comparing any different coverage options that are available to these individuals. MedBen prepares SBCs as a part of our administrative service to our clients.
MedBen clients with questions regarding their group's SBCs are welcome to contact Vice President of Compliance Caroline Fraker at firstname.lastname@example.org
Participation in a wellness program can help a plan and its members in multiple ways. So when a MedBen WellLiving client expressed concern about the number of employees taking part in their program, it was decided to take a different approach. The plan introduced financial incentives to promote participation – and the results were great.
From 2013 to 2015, with the new incentive in place and plan enrollment holding steady, the group's Claims Experience dropped 36%. Not only that, but Medical Costs Per Employee Per Year (PEPY) fell 34% (see graph).
This is only one example of success through MedBen WellLiving. To hear more information about employer wellness cost savings, contact Vice President of Sales & Marketing Brian Fargus at email@example.com.
U.S. spending on prescription drugs rose 5.2% in 2015, according to Express Scripts, the nation's largest pharmacy benefit manager (PBM). But as is the case year after year, MedBen has bucked the national numbers, with an average pharmacy trend of just 2.5%.
MedBen trend accurately reflects what the employer is paying, unlike other benefit managers whose trend may include part of the rebate that a PBM or third party administrator is actually holding back for themselves. With MedBen, you can be assured that all rebate savings go back into your pocket... and the same applies to pharmacy discounts as well.
To get more information about the ways MedBen saves employers money on Rx spending, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
Just like getting your annual wellness exam, getting your body the right nourishment is also an important factor in overall health. In fact, Medical News Today states that “anything that lives is dependent on energy, which results from the combustion of food” – in other words, the right nutrition.
Proper nutrition can also help to combat against different variances in chronic conditions, such as diabetes and high blood pressure.
There are seven major nutrients our bodies need nourishment from to function. Macronutrients are those we need to ingest larger portions of, including protein, carbohydrates, fiber, water and fats. Micronutrients, those we need smaller portions of, include vitamins and minerals.
Speaking of portions, remember that too much nourishment can be just as bad as not enough. The Portion Plate (shown right), developed by the U.S. Department of Agriculture, is a useful tool that can help to balance your diet. We’ve also included some tips in the green box below.
As always, MedBen WellLiving recommends speaking with your family physician about any concerns you may have regarding balancing nourishment for your body.
Ensuring the Right Portions
Here are some easy-to-remember ways to recognize the right portions on your plate.
A new study suggests that middle-class families will be hardest hit by the Affordable Care Act's unpopular "Cadillac" tax.
Investors Business Daily reports that the study indicates the excise tax — ostensively meant to discourage benefit-rich health plans with the threat of a non-deductible 40% surcharge on insurance premiums above $10,800 for individuals and $29,100 for families — will primarily affect families with incomes between $38,000 and $100,000.
According to study co-author Steffie Woolhandler, because middle-class families benefit the most from the current tax exemption to employer-provided insurance, they'll ultimately bear the brunt of the Cadillac tax.
The Cadillac tax has also been criticized for potentially impacting more modest health plans as their costs continue to rise at a pace faster than overall inflation. For these and other reasons, late last year President Obama approved a two-year delay of the tax's implementation until 2020.
Regardless of the delay, however, MedBen advises that employers continue to make whatever adjustments to their benefits necessary to manage health care cost increases. Clients who would like help determining their probability of being subject to the Cadillac tax are welcome to contact MedBen Vice President of Compliance Caroline Fraker at email@example.com.
New national standards released by the Centers for Disease Control and Prevention recommend the prescribing of opioid painkillers only after other therapies have failed, reports STAT.
The CDC also suggests that if opioids must be prescribed, short-term treatment — from three days to no more than seven — is far more preferable than long-term use, as it reduces the risk of addiction. The guidelines focus on chronic pain except for cancer and end-of-life care.
Two million Americans abuse opioids annually, resulting in about 15,000 deaths by overdose every year. While the guidelines are voluntary, the CDC is hopeful that primary care doctors will follow them.
MedBen’s industry-leading clinical claim review process saved clients $4.4 million in 2015, using board-certified physicians to identify and eliminate unnecessary procedures and abusive practices, and opportunistic billing practices. MedBen is one of just a few third party administrators or carriers who can claim that 100% of its clients’ claims are scanned after taking available network, repricing and benefit reductions, but before the claim is paid in order to look for potential clinical problems on the claim.
“The difference is that we use over 150 board-certified physicians to look at claims in their area of expertise to ensure they are appropriate,” said Kurt Harden, President and COO of MedBen. “81% of the savings we found for clients were rooted out by a physician who noticed something wasn’t right with the claim.”
Many organizations claim to have coding software or use nurses to find claim issues. MedBen’s approach is very different, using a team of physicians to find everything from inappropriate implantable cardiac devices (ICDs) or pacemaker placements, to chemotherapy abuses and even inappropriate lab testing.
Recent news articles about hospitals settling with the Department of Justice on ICD placements, abusive lab practices, lower back surgery problems, and rehabilitation therapy abuses have highlighted the need for such reviews, but few organizations are able to deliver on the reviews. “Most organizations simply haven’t figured out a way to perform the reviews thoroughly and efficiently while staying within payment timelines,” said Harden. “We have a long-term relationship with many of these physicians along with the data history necessary to move the good claims along while flagging the problems and fixing them before they are ever paid,” Harden added.
A money-saving strategy that many MedBen clients have been using for years appears to be catching on in a big way. A new survey shows that the number of employers that discourage spousal coverage will likely more than double in the next two years.
Business Insurance reports that, according to the 2015 Best Practices in Health Care Employer Survey, 27% of employers reported using spousal surcharges for health care coverage when other employer-provided health insurance is available. That number is expected to rise to 56% by 2018.
Surveyed employers charge a $1,200 spousal surcharge on average, and 56% plan to increase the amount in 2017. Additionally, 3% of employers don't offer or have eliminated subsidies altogether for spousal coverage and another 10% plan to by 2018.
Spousal limitations enable employers to offer their workers a comprehensive health package while still respecting their bottom line. When outside coverage is readily available to many spouses, this strategy does makes good financial sense.
Of course, plan design change is just one of the ways MedBen saves clients money. Our cost control solutions range from leading-edge claims surveillance to an advanced reporting platform – all of which can benefit your business. For additional information about the MedBen Advantage, contact MedBen Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
MedBen is pleased to serve as a local sponsor of the 2016 Licking County (OH) HeartChase. Created by the American Heart Association (AHA), HeartChase is a community game that offers a healthy competition while raising funds to help fight heart disease.
At the event, which will be held April 30, 2016, MedBen and other area businesses will form teams to square off in a chase through the community. Participants will face multiple checkpoint challenges and locate Power Ups all while tracking progress in the HeartChase Mobile Game App, and gaining enough points to win.
"MedBen welcomes the chance to participate in these kind of fun events that bring the community out for a good cause," said MedBen President & COO Kurt Harden. "The prevention of heart disease through check-ups and healthy habits is something we encourage through our WellLiving program, so we're happy to take part in any public forum that spreads awareness."
Registration for HeartChase opens at 8:30 a.m., and game play begins at 10:00 a.m. The event will be held in the courtyard square in Downtown Newark.
If you're a Licking County business, we hope you will join MedBen and other local teams at HeartChase on April 30. And if you're outside Licking County, we encourage you to check and see if the AHA is offering a HeartChase in your area... or contact them to start one yourself!
MedBen was recently informed of the sale of HealthSpan, which many of our clients use as a provider network in Southwest Ohio, Southeast Indiana, and Northern Kentucky. HealthSpan has agreed to sell its network and other lines of business to Medical Mutual of Ohio and will cease operations in January of 2017.
MedBen has talked with both HealthSpan and Medical Mutual of Ohio about this acquisition and has begun evaluating the best options for our clients. We have been a network partner with both organizations for over 15 years and believe this purchase will result in improved options for MedBen clients, along with a greater flexibility in benefit solutions.
Both organizations have indicated that nothing will change for the remainder of 2016, allowing us to work with brokers, consultants, and clients in the coming months to determine the best benefit solutions.
MedBen clients that currently offer the HealthSpan network can expect to hear from MedBen soon. In the meantime, clients with questions regarding the acquisition are welcome to contact MedBen President and COO Kurt Harden at (888) 633-2364.