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06/24/16

  11:19:00 pm, by MedBen5   , 200 words,  
Categories: News, Prescription, Health Plan Management, Cost savings

Survey: Rx Payments Based on Patient Outcomes Gaining Popularity

pill bottle

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.

06/23/16

  06:02:00 pm, by MedBen5   , 271 words,  
Categories: News, Health Care Reform, Taxes

ACA Replacement Plan Would Cap Tax-free Employer Contributions

Capitol building

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after the introduction of federal health care reform, House Republicans have formally unveiled a replacement for a repealed Affordable Care Act, The New York Times reports.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:

  • Promote the use of health savings accounts and other consumer-driven plans;
  • Allow for sales of insurance across state lines;
  • Offer a flat tax credit to each person or family in the individual insurance market;
  • Provide high-risk pools for individuals who have a break in coverage;
  • Gradually increase the eligibility age for Medicare to 67;
  • Give each state a fixed amount of money for each Medicaid beneficiary or a lump sum of federal money for all of a state’s Medicaid program;
  • Preserve employee wellness programs.

06/20/16

  11:02:00 pm, by MedBen5   , 250 words,  
Categories: News, Wellness, Cancer

Health Panel Reiterates Need for Colon Cancer Screenings

cancer definition

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 bfargus@medben.com.

06/15/16

  09:09:00 pm, by MedBen5   , 278 words,  
Categories: News, Health Care Reform

HHS Conducting Minimum Value Survey of Employers

Health & Human Services Logo

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 cfraker@medben.com.

06/13/16

  10:33:00 pm, by MedBen5   , 220 words,  
Categories: Reporting, Hospitals, MedBen Analytics, Bundled Payments

MedBen Analytics Converts Data to Insight, Harden Says at Bundled Payment Summit

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."

Kurt Harden at Bundled Payment Summit

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 kharden@medben.com.

06/10/16

  08:38:00 pm, by MedBen5   , 197 words,  
Categories: News, Wellness

Hand Sanitizers Reduce Cold, Flu Claims, Study Suggests

hand sanitizer

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:

  • a 24.3% lower incidence of hand hygiene preventable insurance claims compared to the control group; and
  • a 13.4% fewer sick episodes or unscheduled paid-time-off (PTO) in 2014-2015 in the intervention group compared to the previous year.

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.

06/08/16

  10:53:00 pm, by MedBen5   , 244 words,  
Categories: Wellness, Heart

Women's Heart Disease Risk Requires a Physician Ally

wellness exam

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 bfargus@medben.com.

Read more about hidden heart disease in woman at NPR. Additionally, the Centers for Disease Control offers additional information on their website.

06/07/16

  09:23:00 pm, by MedBen5   , 340 words,  
Categories: News, Discounts, Health Plan Management, Cost savings, Provider Networks

MedBen (and Employers) Not Catching Merger Fever

mergers

The health care industry has become merger-happy in recent months, but many employers want no part of it. Neither, for that matter, does MedBen.

According to Modern Healthcare, "several surveys of Fortune 500 companies and other big employers reveal nervousness that the reduced competition among health insurers will mean higher health care costs for them." In one such survey, 95% of respondents viewed the loss of competition as a negative.

In an industry where mergers and buyouts make headlines seemingly every week, MedBen is something of an anomaly — growing and thriving as a benefits management company while remaining independent for nearly 80 years. And we believe it's that very autonomy that has allowed us to thrive, by allowing us to make changes quicker, to try new ideas sooner, and to respond to customer requests faster.

Moreover, because MedBen is a private company and not beholden to a parent or partner, we have the freedom to negotiate provider network discounts with the sole purpose of saving clients money. "We make decisions based on what is best for the customer, not what is best for the stockholders," said MedBen Chairman & CEO Doug Freeman.

Finally, MedBen has prospered in a climate where the Affordable Care Act is essentially rewriting the benefits management playbook on a regular basis. But rather than look for answers from other companies, we've embraced the challenge and responded with new product offerings and additional ways to save clients even more money.

"We have good people, some of whom have been with us for decades," Freeman said. "And they bring a combination of experience and great instincts that enable MedBen to stay proactive at a time when other companies are taking a 'wait-and-see' attitude, or looking for help elsewhere."

In short, to paraphrase a popular 1980's ad campaign, MedBen doesn't buy your business... we earn it. (Bonus memory points if you heard that in your head with John Houseman's voice.)

Learn more about the MedBen Advantage by visiting our website or contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

06/03/16

  11:08:00 pm, by MedBen5   , 341 words,  
Categories: Wellness

Excessive Sitting Linked to Major Health Risks

standing desk

So, you love your job, but it requires you to sit for 7-8 hours per day. What can you do? It’s not unordinary, especially in a workplace, to sit for long periods of time. As we do, we find our bodies losing muscle mass, and gaining the opposite… fatty tissues. “Deskercise” – or exercise at your desk – can help!

As funny as the term may seem, deskercising is fairly simple and the results can help to reduce your health risks while improving your mood. MedBen WellLiving promotes, for overall health, a person get regular exercise of at least 30 minutes, 3 days a week. Though deskercising will not account for all aspects of “regular exercise” it’s a good place to start.

And start soon! The University of Chicago revealed that those who live sedentary work lives averaged a Body Mass Index (BMI) of 3.3 greater than those who were active and are twice as likely to be overweight. Even more shocking than physical appearance, WebMD states that studies have also linked excess sitting to worse mental health, higher risk of heart disease and heart attack, and even a higher risk of being disabled. YIKES!

Getting started is simple and discrete. Below you’ll find some examples of how you (and anyone at your office) can start deskercising today.

Full story »

06/02/16

  05:56:00 pm, by MedBen5   , 271 words,  
Categories: News, Wellness, Preventive care

The Zika Virus: Causes and Prevention

mosquito

If you've been paying attention to the news lately, you've likely heard and read stories about the Zika virus disease. While the virus has been known of since 1947, it had until recently remained largely confined to outbreaks in tropical Africa, Southeast Asia, and the Pacific Islands. But in the last year, incidences of local transmission have been reported in many other countries, including the U.S.

The Zika virus disease is rarely fatal, and if contracted is unlikely to reoccur. However, Zika virus infection during pregnancy can cause a serious birth defect called microcephaly (which is characterized as a smaller-than-normal head for a baby), as well as other severe fetal brain defects.

The most common symptoms of Zika are fever, rash, joint pain, or red eyes. Other common symptoms include muscle pain and headache. Symptoms can last for several days to a week.

Zika virus spreads to people primarily through the bite of an infected Aedes species mosquito, but can also be contracted through intercourse as well as from a pregnant woman to her fetus. If you live in a state or area with the mosquito that spreads the Zika virus and you are concerned about it, you can build your own Zika Prevention Kit. It should include:

  • A bed net
  • Insect repellent
  • Permethrin spray
  • Standing water treatment tabs
  • Condoms

The Centers for Disease Control has put together a Zika Basics document which is available for download at their website. The CDC site also features a dedicated Zika section with detailed information about the disease and preventive steps to take.

PHOTO: By Muhammad Mahdi Karim (www.micro2macro.net) Facebook Youtube - Own work, GFDL 1.2, https://commons.wikimedia.org/w/index.php?curid=11185617

06/01/16

  12:06:00 am, by MedBen5   , 210 words,  
Categories: News, Wellness, Research

Obesity is a Chronic Disease, Physician Group Says

obesity

The growing number of obese adults in America is sometimes referred to as an "epidemic," even though medical efforts to address the problem tend to be more isolated in nature than cooperative. Now a major physician group is encouraging doctors to work together to find a solution, MedPage Today reports.

In new evidence-based guidelines for treating obesity, The American Association of Clinical Endocrinologists (AACE) states that obesity is a chronic disease and should be treated as such. While the association first recognized obesity as a disease in 2012, the new guidelines provide a comprehensive model to diagnose and treat the condition.

"The thrust of the final recommendations is to recognize that obesity is a complex, adiposity-based chronic disease, where management targets both weight-related complications and adiposity to improve overall health and quality of life," wrote the guideline authors.

The guidelines incorporate waist circumference, body mass index (BMI) and other measures to determine individuals that should be screened for obesity and related conditions. Physicians can then use that data to determine individual treatment plans including options such as lifestyle and behavioral modification, diet changes, pharmacological solutions, and bariatric surgery.

The AACE is a professional community of physicians specializing in endocrinology, diabetes, and metabolism, and is the world’s largest organization representing clinical endocrinologists.

05/27/16

  07:50:00 pm, by MedBen5   , 210 words,  
Categories: Announcements, Prescription, Health Plan Management, Consumer-driven Health Plans, Online Services

MedBen Closed Memorial Day... Online Services Always Open!

American flag

The staff of MedBen want to wish you and your family a happy and safe Memorial Day!

Our home office will be closed on Monday, May 30 in observance of the holiday. We will reopen at 8:00 a.m. Tuesday, May 31.

During this time, please remember that clients can use the 24/7 online services of MedBen Access to check on benefit coverage and the status of any pending claims. Simply go to MedBen.com and select "MedBen Access". For those who use Pharmacy Data Management (PDM) as their pharmacy benefits manager, you can check on prescription claims and find lower cost drug options through MedBen Access by clicking on the "Rx" button located in the "My Claims" section of this website.

If you're a MedBen Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA) participant in addition to having other coverage, you also can use MedBen Access to see your FSA/HRA balances, claims submissions and payments. When you log in to MedBen Access, you'll find an "FSA/HRA Online Inquiry" option (visible only to groups offering MedBen FSAs/HRAs) under the "My Plan" section located on the left sidebar. By selecting this option, users are automatically taken to the MedBen FSA/HRA Online System.

Once again, have a good holiday... and thanks for your continued relationship with MedBen!

05/26/16

  10:31:00 pm, by MedBen5   , 254 words,  
Categories: News, Prescription, Discounts, Health Plan Management, Reporting, Cost savings

Health Plan Savings Strategy Requires Rx Focus

pills

One risks sounding like a broken record (or a corrupted MP3 file), but it really is important to the long-term financial health of your pharmacy plan to stress the large and ever-widening gap between brand-name and generic drug costs. As drug costs continue to rise, MedBen believes that an emphasis on generic prescriptions is key to keeping plan costs in check. Toward that goal, we encourage clients to promote generic usage whenever possible... and plan members appear to be in agreement.

MedBen prides itself on keeping client drug costs well below national spending trends. A recent report by S&P Global found that while overall national health care cost rose 6.5% in 2015, drug costs alone increased by 15.8%, and brand name drugs jumped 19.2%. By contrast, MedBen pharmacy plans experienced only a 4.1% trend — due in no small part to the smart use of generic medications.

It's also worth pointing out that, while generics typically cost substantially less than than their brand-name equivalents, MedBen strives to lower generic costs even further. Last year, our average discount on retail generic drugs was 76.9%, and 82.3% for mail order generic drugs. Given these numbers, it should come as no surprise that when a generic version of a brand-name drug is available, the average substitution rate by plan members is an impressive 97.7%.

As prescription drug use increases, a savings strategy must focus on ways to control pharmacy costs. To learn about the methods MedBen employs to help clients achieve their Rx spending objectives, contact Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

05/25/16

  05:26:00 pm, by MedBen5   , 497 words,  
Categories: Wellness, Health Plan Management, Health Care Reform, Preventive care

MedBen Helps to Keep Your Preventive Care Benefits Compliant

Erin Kelly

With all the Affordable Care Act (ACA) regulations self-funded employers have to follow, it's easy to overlook regular updates to required preventive care. But MedBen keeps a close eye on the latest recommendations so you don't have to.

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), an independent panel of experts that assigns an "A" or "B" letter grade to the care based on its balance of benefits and harms.

Additionally, the ACA requires non-grandfathered plans to cover immunizations recommended by the Advisory Committee on Immunization Practices and guidelines supported by the Health Resources and Services Administration that are applicable to women and children. Your MedBen plan document addresses all these recommended services, including screenings, counseling, medications, and immunizations.

The USPSTF continuously researches and reviews data, leading to the release of new or updated recommendations. When a new recommendation is released, it is required to become effective on the first day of the first plan year following one year from the date the recommendation was finalized. So if a new recommendation was released in October 2015, it would not need to be implemented until the first plan year following October 2016.

Every year, the MedBen compliance department assembles a checklist tailored to your health plan and containing possible modifications that need to be addressed in the upcoming plan year, including both ACA and non-ACA related items. For example, in addition to the newly required A or B recommendations, the checklist may suggest updating certain language in the plan document to provide more protection to the health plan or list possible cost-saving techniques.

Once your plan administrator advises on what changes should be adopted by completing the checklist, MedBen moves forward with implementation and preparation of the necessary amendments and SBCs (Summaries of Benefits and Coverage).

Full story »

05/24/16

  11:06:00 pm, by MedBen5   , 269 words,  
Categories: News, Wellness, Cancer, Research

Primary Prevention Push Helps Reduce Cancer Risk

doctor and patient

It's no secret that cancer risk is closely linked to lifestyle choices. But the possibility that nearly half of cancer-related deaths may be due to bad habits is still a sobering thought, and a strong argument for encouraging healthier behavior.

AFP Relax News reports that a Harvard Medical School review of health data revealed that 20-40% of cancer cases and around 50% of cancer deaths could potentially be prevented by adopting healthy lifestyles. Conversely, females who met the criteria for such lifestyles — drinking only in moderation, not smoking, exercising regularly and maintaining a proper weight — reduced their risk of getting cancer by an average of 33% compared to those who didn't meet the criteria, and healthy males reduced their risk by an average of 25%.

Adopting a healthier lifestyle and focusing on prevention "should remain a priority for cancer control," the study authors advised.

MedBen WellLiving focuses on primary prevention, including annual wellness exams and screening for cancer and other chronic diseases. But however essential these regular tests may be, they make up only half of the equation. Equally important is the professional relationship between the family doctor and patient, which can provide education and motivation to make critical lifestyle changes... the first step to lowering cancer risk.

Of course, in addition to helping prevent long-term complications from unmanaged health conditions, primary prevention through MedBen WellLiving helps to reduce medical costs through reduced health care utilization and claims. Learn more about how worksite wellness can benefit your group by contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

You can also read more about the Harvard study at the Pittsburgh Tribune-Review.

05/20/16

  09:55:00 pm, by MedBen5   , 479 words,  
Categories: News, Wellness, Incentives

Attention WellLiving Clients: EEOC Releases New Wellness Rules

checkup

The Equal Employment Opportunity Commission (EEOC) recently released final rules regarding the use of incentives to promote participation in corporate wellness programs — and if you offer MedBen WellLiving, you may need to make critical changes to your program to meet the new regulations, says Vice President of Compliance Caroline Fraker.

"The new EEOC rules go into effect in 2017, and place a limit on how much financial incentive employers can offer to their employees to encourage healthier habits," Fraker noted.

The rules, which provide guidance to ensure that wellness programs comply with the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA), are as follows:

The ADA Rule

  • Corporate wellness programs that ask questions about employee health or include medical examinations can only offer incentives up to 30% of the total cost of self-only coverage.
  • Employers may not deny any employee who does not participate in a wellness program access to health care or prohibit any employee from choosing a particular plan.
  • It also specifies that employers must give participating employees a notice that explains what information will be gathered in a wellness programs, who will see it and for what purpose.

The GINA Rule

  • Maximum incentives for having a spouse participate may not pass 30% of the total cost of self-only coverage, either.
  • Incentives for spouses are allowed for health assessments, biometric screenings, and questions about current health status, but are not allowed if tied to questions about family history or genetic tests.
  • The rule bars exchanges of "current or past health status information" of employees' children for incentives altogether.

Prior to the release of the EEOC rules, the 30% maximum on cost incentives pertained only to “health-contingent” wellness programs, or those that require plan members to meet a specific health-status factor standard (i.e., achieving a specified cholesterol level) to get the cost reward or avoid a penalty. “Participatory” wellness programs, which are generally available without regard to an individual’s health status (i.e., getting an annual wellness exam), were exempt from this limitation, but no longer are.

Because MedBen WellLiving is considered a participatory wellness program, clients who are currently offering cost incentives exceeding 30% will have to modify their program design to comply with the new EEOC rules. In addition, employers who require plan participants to get a WellLiving medical examination in order to be eligible for a certain health benefit plan (a “compliant” plan) will need to modify this strategy.

MedBen will notify clients that need to make changes and work with them to ensure that their programs are compliant with the new rules and offer appropriate incentives. Both of these rules apply to employers beginning on the first day of the first plan year on or after January 1, 2017.

MedBen WellLiving clients with questions regarding the final EEOC rules are welcome to contact Fraker at 800-851-0907 or cfraker@medben.com. You can also read more about the rules at Healthcare Dive.

05/19/16

  08:50:00 pm, by MedBen5   , 181 words,  
Categories: Announcements, News

Corn Completes Chamber Leadership Program

Andrea Corn & Cheri Hottinger

MedBen Director of Data Services Andrea Corn recently completed the Community Leadership of Licking County program, offered through the Licking County (OH) Chamber of Commerce. For completing the nine-month program, Andrea received a Certificate of Achievement at a commemorative ceremony on Friday, May 13.

The Leadership program allows participants to interact with a diverse group of people from various job categories, including professors, nurses and business experts. Those accepted into the program are taught the importance of "strength-based" leadership in which the individual focuses on developing specific attributes at which they excel, while gaining useful exposure to area industry professionals.

When asked about the value of the program, Corn replied, "It offers great opportunities to learn from other participants and get insights from business leaders. Plus, you learn a lot about the Licking County community."

As for how completing the program will benefit her, Corn said, "You get a real push to better yourself at your job as well as life in general." No doubt, MedBen clients will also benefit from the lessons that Andrea has learned!

Congratulations, Andrea... and lead on!

05/16/16

  08:21:00 pm, by MedBen5   , 316 words,  
Categories: Cost savings, MedBen Analytics, Bundled Payments

Bundled Payments Mean Higher Quality, Better Cost, Says Fraker

Caroline Fraker

Bundled payments and other alternative payment methods already popular for Medicare claims will soon be used by commercial group health plans to save money while promoting quality care, says MedBen Vice President of Compliance Caroline Fraker.

In a recent article published by the Society of Professional Benefit Administrators (SPBA) and directed at third party administrators (TPAs), Fraker noted that while bundled payments are currently used primarily for Medicare patients, as their advantages over the traditional fee-for-service model become better understood, the quality-focused approach will eventually become the norm for claims administration to self-funded plans as well.

“The benefits of these alternative payment models are clear — increases in quality of care, decreases in lengths of stay and readmission and the realignment of inpatient and post-acute care,” Fraker writes. “And as these hospitals […] experience how these benefits affect their bottom line, they will seek to apply these same cost-saving, quality-improving methods to their commercial payor models. It is happening already.”

Fraker goes on to observe that as the transition to quality-based payment models progresses, TPAs like MedBen will play an important role in helping hospitals through specialized claims data tracking and analysis. MedBen already provides analytics and processing services for providers participating in the Medicare programs, known as Bundled Payment Care Initiatives (BPCI), and hospitals who are part of a larger mandatory bundle program for lower joint replacements – Comprehensive Care for Joint Replacement (CJR).

At MedBen, we can use our proven benefits administration expertise in a variety of areas, from reconciling different plan designs to employee engagement issues and employer strategies. And ultimately, the benefits from the smart use of bundled payments will translate to lower plan costs for employer and employee alike.

In her concluding comments, Fraker writes: “[The Centers for Medicare & Medicaid Services] and [Capability Maturity Model Integration] are handing us the keys to the future of claims payment. Go ahead and unlock the door.”

05/13/16

  02:33:00 pm, by MedBen5   , 359 words,  
Categories: News, Health Care Reform

SBC Changes Affect Self-funded Plans

Sierra See

The federal agencies overseeing the Affordable Care Act have recently finalized changes to the existing Summary of Benefits and Coverage (SBC) template in order to improve the readability for consumers, and to expand the amount of information that the consumer receives from this document. Self-funded health plans and insurers are required to provide a SBC, which includes a description of what the plan covers, cost sharing responsibilities, and a glossary of commonly used coverage and medical terms, in order to help individuals make more informed choices among plan options and to better understand their coverage.

The new template includes more information about cost sharing, such as enhanced language to explain deductibles and a requirement that plans address individual and overall out-of-pocket limits.

All SBCs include coverage examples that demonstrate the cost sharing amounts for which an individual might be responsible. Currently, the SBC contains two such examples, which focus on diabetes care and childbirth. The new template adds a third example addressing coverage for a foot fracture, so that a consumer understands the services and expenses that a plan will cover in an emergency scenario.

Use of the new template will be required for plans and insurance policies with plan years beginning on or after April 1, 2017. This also means that the new template should be used for SBCs that will be distributed for any open enrollment period preceding the April 1, 2017 plan year.

There are no changes to the existing SBC distribution requirements, which are:

  • 30 days prior to the plan year;
  • on the first day of the plan’s open enrollment period;
  • 60 days prior to an “off” plan year change;
  • within 90 days of a special enrollment event;
  • to newly hired employees; and
  • within 7 days of a plan participant’s request.

If you are a MedBen client, please make sure to provide us with enough time to update your SBC and send it to you for timely distribution. It is important that you inform us in advance if you will be making changes to your plan documents which require changes to your SBC.

Should you have any questions about SBCs, please contact Compliance Specialist Sierra See, J.D., in MedBen’s Compliance Department at ssee@medben.com.

05/11/16

  05:50:00 pm, by MedBen5   , 241 words,  
Categories: News, Wellness, Research, Hypertension

Knowing Blood Pressure History Can Be a Lifesaver

HealthDay recently reported that a two-decade study of hypertension found that the ability to review a patient's blood pressure patterns is more effective in determining the risk of stroke or early death than simply relying on individual readings. "Our study suggests that looking at someone's blood pressure over time and whether it increases slowly or steeply may provide additional information above only the level of blood pressure at a certain time," said researcher Dr. Marileen Portegies of the Erasmus University Medical Center.

blood pressure

MedBen WellLiving emphasizes the importance of plan members establishing and maintaining a professional relationship with a primary care physician — the logic being, the longer the doctor-patient relationship, the greater the odds that the doctor can detect individual anomalies that may suggest a possible health problem. This new study demonstrates just how useful such information can prove.

Hypertension is the number one risk factor for stroke, but a notable drop in high blood pressure after age 65 is also linked to the condition. In such cases, WellLiving believes it's essential for the family doctor to have easy access to a detailed health history.

In addition to promoting the "physician first" approach, WellLiving also provides specialty care for plan members identified at high risk for hypertension and other chronic conditions. Those identified receive customized and confidential coaching from an RN Health Consultant.

Learn more about MedBen WellLiving by visiting MedBen.com or contacting Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.

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