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 firstname.lastname@example.org.
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 email@example.com.
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.
Important news for employers looking ahead to 2017 benefit planning: The U.S. Department of Health and Human Services has raised the maximum out-of-pocket amount that health care plans can require plan members to pay next year, based on final regulations recently released by the agency.
Starting in 2017, the maximum out-of-pocket expenses employers can require employees enrolled in group plans to pick up will be $7,150 for single coverage and $14,300 for family coverage. That compares with 2016 limits of $6,850 for single coverage and $13,700 for family coverage.
According to Business Insurance, the proposed boost in the out-of-pocket limit is based on a methodology laid down by the Affordable Care Act (ACA) and is tied to increases in group health care plan premiums.
While we're on the subject of benefit planning, we'll take this opportunity to remind you of two notable ACA fees for the rest of 2016:
2016 PCORI (Patient-Centered Outcomes Research Institute) Fee
2016 Transitional Reinsurance Fee
MedBen clients who have questions regarding their plan's out-of-pocket maximums or ACA fees are welcome to call their Group Service Representative or Caroline Fraker, Vice President of Compliance & Chief Privacy Officer, at firstname.lastname@example.org.
MedBen University (MBU) launched its 2016 series of benefits management seminars with a well-attended session that offered an extensive look at the current state of the Affordable Care Act.
Entitled "Navigating the Health Care Reform Storm" and presented by MedBen Vice President of Compliance Caroline Fraker, the session covered a variety of topics, from 2016 plan design considerations to potential employer penalties and fees. Fraker also touched briefly on 1094 and 1095 reporting, a topic with she dealt with in depth at an MBU event last October.
One of the items discussed in some detail was ACA guidance offered to health care plans though the latest in a series of FAQs released by the U.S. Department of Labor. "These are sort of informal, 'this-is-what-we-really-meant-when-we-wrote-the-law' clarifications," Fraker said.
The 29th FAQ is something of a "pot luck" of health care reform issues. One noteworthy clarification pertains to preventive services: Any ancillary services to the preventive care, such as a follow-up to a mammography, must also be covered at 100%. "And they went even further to say that you can't impose a general exclusion in your plan that would impact a recommended preventive service," Fraker added.
The FAQ also requires that non-grandfathered plans must not only cover screenings for obesity in adults at 100%, but weight management services as well. However, Fraker noted, the guidance does allow for "reasonable medical management techniques," such as prior authorization and ensuring that a proposed treatment matches the diagnosis.
A new series of studies show that employer health plans can save thousands of dollars by encouraging the use of outpatient facilities for certain medical treatments, Forbes reports.
The studies examined four common medical procedures – hysterectomy, lumbar/spine surgery, angioplasty and gallbladder removal – that cost health plan members and their employers $11 billion in 2014. Once performed strictly in hospitals and necessitating inpatient stays, advancements in medical technology now enable physicians to offer these procedures on an outpatient basis, saving plan and patient alike from the added costs associated with hospital stays.
As the table above demonstrates, the total per-procedure costs in 2014 for outpatient care was substantially lower compared to inpatient treatment, ranging from $4,505 for hysterectomies to $17,530 for angioplasties. Moreover, patients who chose the outpatient option also realized significant out-of-pocket savings.
While not all medical treatments are available on an outpatient basis, the number of procedures has grown in recent years, likely contributing to the slower rise in health care spending during the past decade. The ongoing shift away from fee-from-service care to a value-based system has also encouraged the health care industry to find more efficient methods of delivering medical services.
The U.S. Justice Department has made its final round of settlements with hospitals suspected of excessive use of implantable cardiac devices (ICDs) following a five-year study. Meanwhile, MedBen has been protecting clients from this expensive practice for nearly a decade.
According to Modern Healthcare, 51 more hospitals – several leading hospital systems among them – will pay the government $23 million to end their probe into suspected overuse of ICDs. This follows a similar settlement in 2015 by 457 hospitals for more than $250 million.
ICDs are implanted near the heart to detect and treat arrhythmia – fast, life-threatening heart rhythms – by delivering a shock to the heart. Medicare allowed their for primary prevention of arrhythmia beginning in 2005, with the caveat that it wouldn't pay for devices implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty. Even so, upwards of 40% are implanted contrary to clinical practice guidelines, when a less expensive pacemaker, or even medication, may have been sufficient to treat the condition.
MedBen follows research-based clinical criteria for appropriate placement of ICDs. Since 2007, we have employed cardiologists to perform clinical reviews on these devices on behalf of our clients, as a standard part of our clinical review process – and have saved clients $2.5 million in the process.
ICDs are among the most expensive devices to treat abnormal heart rate, costing $40,000 or more per unit, and need to be replaced every 5 years. Therefore, MedBen believes it essential to rely on expert physician reviewers to review charges like these that aren't caught by coding software and standard claim payment reviews.
MedBen's surveillance system flags claims for possible clinical issues like ICDs, in addition to a variety of other reasons, such as large loss potential for the employer or inappropriate provider billing. We focus on ensuring that our clients pay only for appropriate care, saving money for employer and patient alike.
Clients with questions regarding MedBen’s clinical review procedures are welcome to contact President and COO Kurt Harden at 888-633-2364.
A hospital in Los Angeles made national headlines recently when, following a cyberattack that disabled the facility's computer devices for over a week, it paid a $17,000 ransom to regain system access. However unusual the circumstances may seem, the threat of this type of attack is genuine, and it's the reason that MedBen employs multiple safety protocols to guard against it.
MedBen maintains constant vigilance against cyberattacks, using a series of external, internal and physical safeguards. Among the keys to our cybersecurity strategy are multiple layered hardware devices which prevent access to our internal networks. Additionally, all incoming and outgoing emails are scanned by a hardware device to detect and quarantine malware, and all devices accessing the Internet must pass through a hardware device that scans the traffic in either direction.
As a further measure of security, MedBen is subjected to an annual penetration test from an outside auditing firm. The timing of these tests and the manner in which they are executed is unknown to anyone at MedBen. The most recent breach attempt in 2015 proved unsuccessful – the same result as all previous tests.
The security and privacy of client information is of paramount importance to MedBen, as is ensuring uninterrupted systems operation. We make it our mission to earn your continuing trust in every way possible.
MedBen clients with questions regarding our cybersecurity measures are welcome to contact Vice President of Information Systems and Chief Privacy Office Rose McEntire at email@example.com.
The introduction of state and federal insurance marketplaces through the Affordable Care Act has not deterred most U.S. employers from offering group health care coverage, Healthcare Dive reports.
According to a recent Kaiser Family Foundation survey, employers today still provide health care coverage to 147 million people, over half of the working-age population – virtually unchanged from 2015. A handful of smaller employers (4%) have switched some full-time employees to part-time status, but even more (10%) have done the opposite.
“Employers are very hesitant to drop health benefits,” said Paul Fronstin, director of the health research and education program at the Employee Benefits Research Institute. “They don’t want to be the employer that did so in a tight labor market.”
Large employers – those with 50 or more employees – must, under ACA rules, offer health insurance to 70% of full-time employees or pay a penalty. But that fact notwithstanding, employers cite other reasons for continuing to provide coverage, including the slow growth in health care costs during the past few years and concerns about provider availability through the public marketplaces.
Offering a customized health care plan also allows employers to promote wellness and ensure that employees have access to necessary benefits, said Fronstin: “They want them to come to work healthy and to be productive, and they may have their doubts about the public exchanges’ ability to give the kind of care that they think their employees need to get.”
A new Columbus Business First survey reveals that MedBen is Central Ohio's leading third-party administrator, as ranked by local TPA employees. With 147 TPA employees residing in Licking, Franklin and surrounding counties, MedBen employs over 100 more local workers than the closest competition.
"As our home office has been based in Licking County for nearly eight decades, we've seen first-hand what a tremendous talent pool there is in Central Ohio," said Kurt Harden, MedBen President & COO. "And we're doubly fortunate that so many of them have chosen to work here and stay with MedBen for many years."
MedBen introduced third party administration in 1989, at a time when it specialized in traditional group health insurance. As the company evolved, it expanded its focus to cost-saving solutions for self-funded employers. The employee count grew accordingly, from about 25 employees in the late 1980's to its current number.
Harden says that employee growth is not merely a matter of needing more people to serve an ever-growing number of clients. "Over the years, MedBen has implemented a variety of ways to help clients save money, such as physician-directed claims surveillance and a groundbreaking pass-through prescription drug program. As such, we now have dedicated employees to ensure that our clients see the greatest financial return possible from these services."
Being that heart disease and stroke are the nation’s numbers one and five causes of death, MedBen WellLiving encourages individuals to seek proper care for their hearts. This includes at least one yearly visit to your family physician for a wellness exam, to monitor any changes with your heart or other areas of health.
According to the American Heart Association, 150 minutes of moderate (75 minutes of vigorous) physical activity per week reduces your risk of heart disease and stroke. Don’t be alarmed if you’re thinking, “I don’t have time for that” – physical activity is considered to be anything that gets your body moving and burns calories.
Going further than regular exercise, maintaining a hearty diet is also a necessity for a healthy heart. Eating foods such as fruits and vegetables, whole grains, or low-fat dairy products will help you to maintain an overall healthy diet. WebMD confirms that foods such as salmon, black beans, oranges, low-fat yogurt, and walnuts are proven to help save your heart.
Having a healthy diet and exercising regularly also help to improve or maintain one other major factor of your heart’s health: weight. There are many ways to check your BMI (Body Mass Index), which calculates an ideal weight range based on your height, but WellLiving suggests speaking with your physician about what a healthy weight means specifically for you.
The U.S. Department of Health and Human Services (HHS) is taking bold measures to move Medicare payments from the traditional model to alternatives based on the value of the services given. MedBen Analytics is currently working with providers nationwide to help them make this transition in a performance-efficient and cost-effective manner.
At the World Economic Forum Annual Meeting in Switzerland last month, Secretary Sylvia M. Burwell said HHS will meet their goal of moving 30% of fee-for-service Medicare payments to bundled payments and other value-based arrangements by year end. The agency has also set the goal of tying 50% of Medicare payments to alternative payment models by the end of 2018, Healthcare Dive reports.
HHS states that the use of alternative payment models has:
As bundled payments and other value-based payment models become more commonplace, and an ever-greater number of older Americans become eligible for Medicare, providers need to have the tools required to make informed decisions about the delivery of care. Toward this goal, MedBen Analytics turns claims data into actionable insights necessary to improve performance.
MedBen Analytics' proprietary analytics software takes the numerous and disparate Medicare files available to bundled payment initiative hospitals, health systems and physician practice participants and creates straightforward, interactive reports to benefit the provider of care as well as the recipient.
Organizations interested in discussing MedBen Analytics' services can call President and COO Kurt Harden at 888-633-2364 or email him at firstname.lastname@example.org.
Prostate-specific antigen (PSA) testing has declined as a standard wellness screening in recent years... but the likelihood of a recommendation depends largely on whether your doctor is a primary or specialty care provider.
In 2011, the U.S. Preventive Services Task Force advised against routine screenings for all men over 50, instead suggesting that men discuss options with their family doctor and make an educated decision about testing based on family history, lifestyle and symptoms. The American Cancer Society (ACS) and MedBen WellLiving also support this recommendation.
HealthDays News reports that, according to new research, PSA testing by primary care physicians decreased from 36% to 16% between 2010 and 2012, but testing by urologists fell only from 39% to 34% during the same period. The study authors suggest this discrepancy may be due to different perceptions of the benefits of the test among doctors, conflicting prostate cancer screening guidelines, and differences in patients' demographics or expectations.
"Moving forward, this finding emphasizes the need to continue interdisciplinary dialogue to achieve a broader consensus on prostate cancer screening," the researchers from Brigham and Women's Hospital in Boston concluded.
To reduce the risk of prostate cancer, the ACS recommends eating a diet rich in vegetables and fruits (at least 2½ cups each day), staying physically active, and maintaining a healthy weight.
In hopes of salvaging the Affordable Care Act's unpopular "Cadillac" tax, President Obama has proposed revising it as part of the 2017 federal budget, using individual health insurance marketplace plans as a new threshold yardstick.
According to Business Insurance, administration officials revealed that the proposal would change the threshold for the 40% employer excise tax from an across-the-board amount to one that would vary based on regional individual health care costs. In any state where the average marketplace premium for "gold" coverage exceeds the current threshold, the tax trigger would be set at the level of that average gold premium.
“This policy prevents the tax from creating unintended burdens for firms located in areas where health care is particularly expensive, while ensuring that the policy remains targeted at overly generous plans over the long term if health costs rise faster than the tax thresholds,” Jason Furman, chairman of the administration's Council of Economic Advisers, and Matt Fiedler, the council's chief economist, wrote in a New England Journal of Medicine article.
The threshold value is currently set at $10,200 for individuals or $27,500 for families, based on the tax's original 2018 start date. With implementation now pushed back two years, these amounts will likely increase before the tax takes effect.
Employer groups say that the change is appreciated but insufficient. “Its impact in high-cost areas is just one of its many problems,” James Klein, president of the nonprofit American Benefits Council, said in a statement. “It also unfairly hits health plans that cover large numbers of women, older workers and families suffering catastrophic health events. In short, the Cadillac tax cannot be fixed. It must be repealed.”
Bloomberg View columnist Megan McArdle adds that applying a different criteria to the tax will ultimately prove self-defeating: "If you want to control costs, the areas you want to target are the ones with higher average costs. Instead, the administration is perversely giving those areas a special exemption from the tax."
The White House released the federal budget on February 9.
(Post updated February 10 to reflect proposal's inclusion in budget.)
High-cost brand-name drugs are a frequent topic of discussion, but recently a different wrinkle on pharmacy pricing has joined the conversation: huge price increases in typically lower-cost drugs. And it's another reason that MedBen makes controlling drug spending a priority.
Turing Pharmaceuticals made headlines last year when it raised the price of its anti-parasitic drug Daraprim more than 5000%, from $13.50 a pill to $750. But while that's an extreme example of spiking drug costs, it's hardly the only one. According to Bloomberg Business, a new survey of about 3,000 brand-name prescription drugs found that prices more than doubled for 60 and at least quadrupled for 20 since December 2014. Overall, the cost of many drugs has continued to rise at annual rates of more than 10%.
As the U.S. winds its way to choosing a new president, the question of how to best control drug prices will undoubtedly pop up in many a debate and campaign ad in 2016. But rather than hold out for a government solution, MedBen is doing its part right now to help clients keep prescription drug costs in check.
Because MedBen believes a high dispense rate for generic drugs is key to controlling spending, our average discount on generics regularly exceeds 77%. Generics are available in nearly every drug class, and each increase in the generic dispense rate results in a 2% decrease in cost.
MedBen finds intelligent ways to reduce drug spending while ensuring that patients have access to the medications they need. Learn more about our Rx advantage by contacting Vice President of Sales & Marketing Brian Fargus at email@example.com.
The percentage of U.S. babies that get flu shots has risen dramatically in the past decade... but the numbers still come in well short of expectations, according to a new study.
HealthDay reports that about 45% of babies aged 6 months to 23 months got vaccinated against the flu during the 2011-12 flu season. While that's a vast improvement over the 2002-03 rate of just 5%, that U.S. Centers for Disease Control and Prevention recommends that most children 6 months and older get a flu shot every year. (MedBen WellLiving guidelines advise clients to consult their pediatrician or family physician regarding childhood influenza immunizations.)
"While flu vaccination for children has gone up, there is still a long way to go to protect every child," said study lead researcher Tammy Santibanez, an epidemiologist with CDC's National Immunization Program. She added that special emphasis should be placed on encouraging black and Hispanic parents to get their children a flu shot, as their vaccination numbers are typically lower than those of white children.
On average, 20,000 children under 5 years of age are annually hospitalized because of complications from the flu. During last year's flu season, more than 140 children died from flu, the CDC said.
"Both parents and doctors can work together to do a better job at ensuring that children are fully vaccinated and protected against the flu," Santibanez said.
The 2016 season of MedBen University will soon be in session! For the 15th straight year, MedBen will be offering a variety of events that provide attendees with information they can use to be smarter consumers of health care.
If you’ve never had the opportunity to attend a MBU, we encourage you to join us at an upcoming session. Not only will you receive practical guidance about health care planning and timely updates about regulatory developments, you’ll have the opportunity to pose questions to a team of benefit management professionals and discuss coverage concepts with other self-funded employers. And you're welcome to attend even if you're not a current MedBen client!
The following sessions will be held at the C. Arthur Morrow Conference Center, 1821 W. Main St., Newark, Ohio (located next to the MedBen home office):
Navigating the Health Care Reform Storm
Thursday, February 25
The delay of the "Cadillac" tax and other recent changes to the Affordable Care Act have further complicated an already confusing law. We'll bring you up to date on the current state of health care reform and explore what's to come in 2016 as another presidential election nears. In addition, we'll share important cautionary information regarding the growing use of ACA scare tactics on self-funded employers.
Thursday, March 24
Thursday, April 7
These industry-specific events offer employers a unique opportunity to learn how health care spending trends affect their bottom line, and get strategies they can use to keep medical and pharmacy costs in check. Plus, attendees can see first-hand how their plans compare with those of other businesses.
And we're just getting started! Once again, we'll take MBU on the road to conduct sessions throughout the Midwest. We’re currently planning additional events in multiple states for the first half of 2016. If you're a MedBen client and we’re coming to your area, we’ll be sure to see that you get an invitation to attend.
To register for one or more of the MBUs listed above, or to receive additional information about upcoming events (whether you're a MedBen client or not), please contact MedBen Sales Analyst Sally Wood at (800) 423-3151, Ext. 502 or firstname.lastname@example.org. We look forward to seeing you at a future MBU!