Affordable Care Act rules and regulations are a minefield that can trick up even a seasoned HR professional... and it's why MedBen Compliance is always ready to guide clients, brokers, and consultants through the details, via phone calls, meetings, webinars, and educational materials. And every year, ACA updates are an essential component of our MedBen University events.
A recent Benefits Pro article notes that since the introduction of the ACA, employers have been put "in the position of becoming compliance officers." And while it may be true that health care reform has loaded human resource departments with new and unwanted responsibilities, the MedBen compliance team makes every effort to lessen HR burdens as much as possible.
As the article notes, the potential fines for non-compliance of ACA laws are as varied as they are costly: "Employers will have to pay $2,160 per employee (after the first 30) if not providing health insurance or for an incorrect plan, and $3,240 for each employee getting a subsidy through the marketplace. Penalties for not filing certain documents in time, such as form 5500 or form 1094C, can add up to $1,100 per late day."
If you're a MedBen client, you never have to take on health care reform single-handedly. Any time you have a question, just contact our Vice President of Compliance Caroline Fraker at 800-851-0907 or firstname.lastname@example.org.
A new study suggests that women turning 40 may benefit from regular mammograms, challenging other recent recommendations that women can wait until the age of 45 or 50 to begin screenings. Findings from the research were presented at the American Society of Breast Surgeons annual meeting in Dallas earlier this month.
MedBen's worksite wellness program, WellLiving, continues to recommend that women start getting mammograms at age 40 every two years until their physician decides not to order the screening.
According to HealthDay, the review of female patients between the ages of 40 and 44 found that 50% had an above-average risk for breast cancer, and therefore would be eligible to begin screening mammography at age 40. The study also found a significant percentage of women would qualify for other breast screening methods, including breast MRI and genetic testing.
"We believe formal risk assessment is essential for women ages 40 to 44 in order to identify those who require screening mammography to start at the age of 40, and those who would qualify for screening MRIs and genetic testing," said Dr. Jennifer Plichta, a breast surgery fellow at Massachusetts General Hospital and Brigham and Women's Hospital in Boston.
MedBen WellLiving clients can access a wellness compliance page via MedBen Access to check if they are due for mammograms and other cancer screenings.
On April 21, MedBen concluded a multi-day Indiana trip with a MedBen University (MBU) event in Lawrenceburg. Entitled "Taking Charge of Your Health Care Costs" and cosponsored by Pinnacle Advisory Group, this free seminar touched on a variety of innovative ways that employers can control their group health spending.
Attendees at the event learned about some of the latest advancements in group health care cost containment – among them, genetic tests that can determine drug compatibility and eliminate wasteful spending.
In his presentation, MedBen Vice President of Sales & Marketing Brian Fargus offered cautionary advice on avoiding false claims of guaranteed discounts, creative repricing gimmicks and other tactics used to make self-funded employers believe that they're not getting the best value for their health care dollar. He emphasized the fine print and disclaimers sometimes found on repricing reports, such as "aggregate results may vary signifcantly by geographic area" and "results are not a forecast of projected claims costs."
Equally important to controlling costs is having a basic knowledge of health care reform and how the Affordable Care Act affects your business. MedBen Vice President of Compliance completed the MBU with an update on ACA regulations, planning for 2016 reporting, and preparing for the 2020 introduction of the Cadillac Tax.
Fraker also discussed recomended changes to plan subrogation language following a Supreme Court decision that allowed an accident victim to retain payment from his health plan even after he received a court settlement. MedBen clients who would like additional information about this case are welcome to contact Fraker at 800-851-0907 or email@example.com.
Members of the MedBen sales team continued their mini-tour of Indiana with a stop at the Evansville-Area Human Resource Association (EHRA) Spring Conference. Vice President of Sales & Marketing Brian Fargus and Regional Sales Managers Brooke Hupp and Mike Ketron attended this day-long gathering of area HR professionals.
Not only do events like this afford the opportunity for MedBen to promote its growing line of benefits management services for employer groups, they also provide a valuable opportunity to speak with experienced HR representatives and learn from their day-to-day experiences. In this way, we can better ensure that our service offerings meet the needs of employer and employee alike.
In addition to the trade expo, the conference features discussions on a varity of HR-related workplace topics, including disability issues and labor matters. EHRA is an affiliate chapter of the Society for Human Resource Management (SHRM) and the leading professional association for HR professionals in the tri-state area of Southwestern Indiana, Kentucky, and Southern Illinois.
Again, we remind you to follow Twitter and this blog for information about upcoming events that MedBen is schedule to attend!
Members of the MedBen sales team were pleased to represent the company at the 52nd Annual Human Resources Conference and Expo on April 19. The event, presented by the Indiana Chamber of Commerce and held this year in downtown Indianapolis, is the state’s longest-running HR conference.
At the expo, Vice President of Sales & Marketing Brian Fargus and Regional Sales Managers Brooke Hupp and Mike Ketron met with HR professionals from Indiana and other Midwest states to discuss third party administration, worksite wellness, and bundled payment reporting, in addition to other group benefit management services available through MedBen.
Attendees also had the opportunity to learn about regulatory compliance, conflict management and other relevant HR topics, and participate in training workshops.
MedBen plans to participate in additional HR expos in 2016, including the Ohio Human Resource Conference on September 21-23. We'll announce other upcoming events on this blog as well as Twitter... and we hope to speak to you in person soon!
Health care security concerns continue to capture the media's attention, as the term "ransomware" has quickly entered the vernacular. It's a growing problem that demands constant attention... which is why MedBen maintains a multi-pronged response to cyber threats.
In 2015, ransomware attacks increased by 35% from the prior year. Even before the recent surge, MedBen already had numerous security measures in place to thwart malicious software, but we're never content to simply stand in place.
In addition to continually evaluating our internal protocols, MedBen regularly consults with security professionals to ensure that we are taking every possible preventive action to safeguard your information and stay ahead of looming dangers. Moreover, an outside auditing firm conducts unscheduled attempts to breach our security, all of which have been unsuccessful.
Equally important, the MedBen staff is trained to remain vigilant to possible attacks. Suspicious-looking e-mail attachments and questionable sales calls are reported to Vice President of Information Systems and Chief Privacy Office Rose McEntire, and notices of potential viruses, spyware, and phishing threats are posted on our Intranet site.
MedBen has had an in-house information systems team in place since the introduction of our internal mainframe network in the late 80’s. Even back then, long before the Internet turned cybersecurity into a 24/7 job, we made client security and privacy a priority. And while the sheer volume of malware – 430 million new variants in the last year alone – constantly presents new challenges, we stay committed to protecting your personal information.
MedBen clients with questions regarding our cybersecurity measures are welcome to contact McEntire at firstname.lastname@example.org.
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.