“The recommendation from this audit is that your certification continues.”
That’s the conclusion of SAI Global following its most recent audit of MedBen’s compliance with ISO 9001:2008 standards. Conducted September 19, the audit examined the company’s internal procedures in the development and processing of health care benefit plans, and found no issues in their execution by employees.
In the evaluation report, the ISO auditors praised MedBen’s employees and “support from top management” – compliments that pleased Chairman & CEO Doug Freeman.
“ISO quality standards only work if there is a companywide effort to follow the processes we’ve put in place,” Freeman said. “So it’s important to me that the auditors see that our commitment starts at the top… but everyone here plays an equal role in that commitment.”
During the audit, the ISO review team also commended members of the MedBen staff who were asked about specific processes used in their jobs, noting their professionalism and knowledge.
MedBen earned ISO 9001 Certification in September of 2005 – one of the first benefit companies in the world to achieve that distinction. By using this proven quality system, the company works to ensure its claims processing, customer service and other daily practices exceed customer expectations.
In addition, semi-yearly audits enable MedBen to confirm that work procedures are continually followed and revised as necessary. This latest audit – the company’s 16th since the initial certification – produced the same outcome as all previous ones: A verification that its promise of quality performance continues to be upheld.
It is not precisely clear what causes breast cancer. Research has suggested age, gender and estrogen exposure may contribute. While anyone can get the disease, older women are at a greater risk.
Non-invasive (stage 0) and early stage (I and II) breast cancers have a better prognosis than cancer in its later stages (III and IV), and can typically get treated at a much lower cost – sometimes, hundreds of thousands of dollars less. Screening is the best way to find breast cancer in its earliest stages, and the most effective method is an X-ray of the breast called a mammogram. Visit your gynecologist regularly and have an open discussion about what tests you should be having.
One key to proper prevention – and, in turn, keeping your health care costs down – is knowing when your next test is due. That’s where MedBen Worksite Wellness can help.
MedBen Worksite Wellness plan members can track their mammogram compliance by visiting MedBen Access. To see recommended screening dates, or double-check if you missed a test, simply go to medben.com, click on “MedBen Access” and select the “iHealth Information” link under “My Plan”. MedBen Worksite Wellness also provides annual guidelines for cancer prevention and early detection, personalized for age and gender.
Effective today, the federal government is closed for business. Not totally, mind you – just selected bits and pieces not required by law to continue operations or deemed “non-essential", such as national parks, U.S. Capitol tours and free museums. And the closure will continue until Congress agrees on a spending bill.
The government shutdown occurs on the same day that open enrollment is scheduled to begin for health insurance Marketplaces offered under the Affordable Care Act (aka “Obamacare") – the law that just happens to be a huge sticking point in Congress, and a major reason for the shutdown.
The initial spending bill, approved by the Republican-led House of Representatives, included a provision to cut off Obamacare funding for the next 12 months. Ultimately, that demand was replaced by a one-year delay in the implementation of the “individual mandate", which requires individuals to carry health care coverage or pay a penalty. This final bill was quickly rejected by the Democrat-majority Senate.
So until the two parties find some middle ground on the health care reform law, the federal government will remain shut down. But not, ironically, the Marketplaces, which went live this morning (albeit not without numerous glitches).
How come? Because Obamacare is a permanent entitlement, similar to Social Security or Medicare. And as such, it isn’t subject to annual funding by Congress.
A common conviction of the “bigger is better” line of thinking is that large metropolitan hospitals offer superior care than their smaller regional counterparts. But as Partners Community Health Plan members are discovering, size doesn’t tell the whole story.
To be sure, most big hospitals do provide an excellent standard of service. But almost all types of care available from major metro facilities can also be obtained from regional hospitals, and at the same outcome levels. Further, comparable treatment is often available from these smaller hospitals at a significantly lower cost.
With Partners, you can reduce your health care costs by getting treatment from area facilities, while sparing yourself the burden of extra travel time. Here are several examples of the saving differences typical of metro vs. Partners-member community hospitals:
We will be happy to provide additional price comparisons for all areas in which we currently offer Partners Community Health Plan. To learn more, please contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com. To see if Partners is available in your area, visit partnerschp.com.
Knowledge, as they say, is power… and in the case of health insurance, the more you know, the better your odds of staying healthy and saving money. At MedBen, it’s our goal to keep clients informed about all aspects of their coverage.
As insurance has expanded beyond comparatively simple major medical plans into preventive care and consumer-driven offerings, it’s not surprising that more people aren’t sure how health care coverage works. According to WebMD, a recent health insurance literacy poll by the American Institute of CPAs found that more than half of Americans can’t define such basic terms as premium, deductible and copay.
To ensure that plan members understand how to navigate their coverage, or know where to turn when they need specific information, every new MedBen self-funded groups receives a customized New Group KIt. Included with the kit is a CD containing “MedBen Basics” – a series of documents covering such topics as using the member ID card, reading explanations of benefits (EOBs) and logging on to MedBen Access, our claims and benefits information website. The Plan Members area of MedBen.com also offers several of these Basics in addition to forms, provider directories and other resources.
Of course, our customers can get answers to any of their health care coverage questions by calling the MedBen Customer Service Department. Representatives are available Monday through Friday, 8:00am-6:30pm EST, by calling (800) 686-8425 or e-mailing firstname.lastname@example.org.
Money talks – and, apparently, motivates people to walk as well. But at MedBen, we’ve learned that positive wellness reinforcement comes in many varieties.
According to MedPage Today, a recent review of wellness incentive studies by University of Toronto researchers showed that attendance at exercise classes increased by an average of 12% for individuals who received financial rewards for participation. In most of the studies, the money – which varied anywhere from $3.00 a week as high as $47.00 – was held until the end of the program, but this lack of immediate gratification didn’t appear to be a drawback as long as participants were kept informed of their “reward status".
“This is consistent with findings from previous systematic reviews that generally observed improved dietary behaviors, smoking cessation, and weight loss, respectively, in the short term and while financial incentives remained in place,” the researchers wrote
So while it may come as no surprise that a monetary carrot can spur people to change their behavior, MedBen has found with its Worksite Wellness program that cash enhancements need not be large – or even necessary for incentivizing.
On the one hand, our experience has shown us that wellness plan members respond well to such rewards as time off, reduced health insurance premiums or employer contributions to a personal HRA. But if promoted properly, smaller rewards like gift cards and catered lunches can be equally effective.
And then there are the incentives that cost little to nothing, such as conducting an internal competition or giving recognition through the company newsletter or intranet. With the support of management and the multiple worksite wellness tools provided by MedBen, even the smallest gesture can have a powerful impact.
To learn more about how MedBen Worksite Wellness can help you motivate your workforce to better health, contact Vice President of Sales and Marketing Brian Fargus at email@example.com.
MedBen has offered consumer-driven health plans for nearly 15 years… and in that time, we’ve seen it transform from a niche product into a valuable tool for employer cost savings, as well as a way to give employees a greater role in health care spending choices.
And not only are businesses using CDHPs as an alternative or complement to a regular PPO plan, more and more are employing it as their sole source of coverage. According to Business Insurance, a National Business Group on Health survey recently found that over 20% of employers say CDHPs will be the only plan design they offer to employees in 2014.
So what is it about the consumer-driven plan option that appeals to employers? Lower costs are one reason. A Kaiser Family Foundation report released last month found that the average cost of family coverage through CDHPs was nearly $1,500 less per employee than PPO coverage.
The Affordable Care Act also increasingly factors into the decision-making process. Some of the costlier provisions, such as the “Cadillac tax” that will impose a penalty on higher health costs, can be avoided through a greater emphasis on CDHPs.
With options ranging from FSAs and HRAs to the administration of a HDHPs tied to individual HSAs, MedBen can put together a CDHP solution that’s equally effective for self-funded or fully insured employers. And we’ve got the experience, backed by demonstrated employer savings, to ensure that your group’s plan satisfies both your coverage and your financial needs.
To learn more about MedBen CDHP options and how they can benefit your business, contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.
With the rollout of health insurance Marketplaces (previously referred to “Exchanges") just a few months away – and enrollment for them, mere days – it’s possible you may not fully understand their purpose, or if you’re a business owner or human resources representative, how they affect you. To address these questions, MedBen Vice President of Compliance Caroline Fraker recently conducted a webinar on the topic “Exchanges and Your HR Department".
Fraker also spoke on a number of other topics pertaining to the Affordable Care Act and its affect on employers, all of which are available on the MedBen TPA YouTube page. Clients with questions regarding these webinars, or the health care reform law in general, are welcome to contact Caroline at email@example.com.
With 75 years of health care management under its proverbial belt, MedBen has seen plenty of fluctuations in nationwide health spending over the decades – from periods of relatively slow upticks to the double-digit increases of the early 2000’s. And now, after multiple years of mild growth, experts predict that total health spending will see larger bumps, albeit not nearly as big as those experienced prior to the recent recession.
MedCity News reports that over the next decade, U.S. health spending will go up an average of 6.2% per year, based on projections by government actuaries. Additionally, they estimate that the health care segment of the nation’s economy will amount to a fifth of the nation’s gross domestic product in 2022.
What accounts for the upturn? The auditors attribute it to an improving economy and the rising number of baby boomers moving into Medicare. As for the effect of health care reform, they see only “modest” savings from changes in the law. “It’s a little early to tell how substantial those savings will be in the longer term,” Gigi Cuckler, one of the actuaries, told reporters.
Since health spending will only continue to rise, it’s critical for your business to partner with an ally that looks out for your financial interest. At MedBen, we’ve developed a multi-tiered cost containment strategy, at the heart of which is an advanced claims surveillance system. We use financial and clinical algorithms to determine savings opportunities, loss potential and fraud risk for every claim we process, regardless of size.
To see documented proof of how MedBen claims surveillance saves employers money, contact Vice President of Sales and Marketing Brian Fargus at firstname.lastname@example.org.
No later than October 1, 2013, all employers are required to provide a Notice to their employees providing information about the new health care Exchanges created by the Affordable Care Act (ACA). The Exchanges, now called Health Insurance Marketplaces, provide individuals and small employers access to certain insurance carrier’s health insurance policies. The Notice provides some basic information about those policy options and how to contact the Health Insurance Marketplace.
In order to comply with the ACA requirement, all employers, regardless of size, need to send the Notice to ALL of their employees – including those employees who are not on their health plan and those who do not work full-time. While the Department of Labor (DOL) recently clarified that there is no penalty for failing to send the Exchange Notice (DOL FAQ on Notice of Coverage Options released September 11, 2013), it did not waive the requirement that employers distribute the Notice to employees. The DOL FAQ on Notice of Coverage Options can be found at the DOL website.
In order to assist employers with this task, the DOL released two Model Notices earlier this year – one for employers that offer coverage to their employees, and one for employers that don’t offer coverage. If an employer offers coverage to some employees and not to others, the employer can either provide both notices to the respective employees, or they can provide the “offering” coverage notice and specifically indicate on page 2 who is eligible for coverage and who is not. You should also note the following:
Private sector solutions apparently have no place in today’s brave new health care world, The Wall Street Journal finds:
“[S]elf-insurance is now filtering down to businesses with 199 workers or fewer, as a hedge against ObamaCare’s federal mandates and the danger that costs on its small-business exchanges will soar. Some insurers are now selling popular products that allow groups as small as 25 to self-insure. [Editor’s note: Groups with as few as 20 employees can partially self-fund with MedBen Split Solution.] In a 2012 study, the Urban Institute found ObamaCare’s incentives will cause as many as 60% of small firms to convert without regulatory changes.
“So the White House, liberal pressure groups and state and federal regulators are trying to close what they call the self-insurance ‘loophole’ before more escape. Their political and actuarial fear is that if enough businesses don’t join, the exchanges could fail because too few younger and healthier people will subsidize everybody else.“In a June alarm titled ‘The Threat of Self-Insured Plans Among Small Businesses,’ the liberal Center for American Progress warns that ‘the result of this shift could cause an insurance premium death spiral.’ Note how businesses that pay for their workers’ health care are suddenly a ‘threat.’ Wasn’t coverage the point of ObamaCare?”
One would think with all the free publicity the Affordable Care Act has received in the past several years, the majority of Americans would by now have a pretty good understanding about such concepts as “the individual mandate” and “health insurance exchanges". But based on the findings of a new survey, one would apparently be wrong.
A new USA TODAY/Pew Research Center Poll shows that, among the 19% polled who are uninsured, nearly four in 10 don’t realize the law requires them to get health insurance next year. Among young people, whose participation is seen as crucial for the exchanges to work, just 56% realize there’s a mandate to be insured or face a fine.
The exchanges, which serve as a marketplace for uninsured individuals to buy insurance, are scheduled to begin enrollments on October 1. But only half of those surveyed know there will be a health care exchange available in their state – even less so in states that have refused to participate, defaulting instead to the federal exchange. Likewise, about half are aware that subsidies will be available for lower-income citizens.
As for opposition to the health care reform law, it has remained fairly high since its passage in March 2010 – and in this latest poll, the 53% disapproval represents the highest level yet. Moreover, 47% of respondents say the law will have a negative impact on the country as a whole, compared to 35% who expect a positive impact.
At MedBen, we believe that employers both large and small should benefit from the savings achieved by a healthy workforce. That’s why for two decades we’ve offered self-funded solutions for large and smaller employers.
Still, for companies that rely on the stability and security of fully-insured coverage, the prospect of “going it alone” may seem daunting. So what reason would a smaller employer have for risking the status quo? As it turns out, there are several.
Employee Benefit Adviser lays out the rationale as to why an increasing number of groups are exploring the advantages of self-funding:
If you work hard to contain your health care costs, now really is the perfect time to self-fund safely through MedBen. You can share in the savings that come from reduced employee claims and cut your premium costs dramatically.
To learn more about the benefits of self-funding, contact MedBen Vice President of Sales & Marketing Brian Fargus at email@example.com.
Last week, we alerted you to new regulations proposed by the Treasury Department and IRS on information reporting requirements under the employer mandate provision of the Affordable Care Act. As we noted, the agency is requesting feedback in regard to options for simplifying the reporting process, which has come under criticism by employer groups.
While final rules likely won’t be released until late 2013 or early 2014, it’s interesting to look at the specific reguations suggested under the proposal. They include:
The comment period ends on November 8, 2013. In the meantime, clients with questions regarding these proposals may contact MedBen Vice President of Compliance Caroline Fraker at firstname.lastname@example.org.
In hopes of encouraging doctors to exercise more caution in the prescribing of painkillers, the Food and Drug Administration has introduced new labeling guidelines for opioid narcotics, The Los Angeles Times reports. The change will affect OxyContin, Opana and other popular brand names.
Current labels for long-acting and extended-release opioids recommend their use for “moderate-to-severe” pain. The revised language will state that use should be limited to “pain severe enough to require daily, around-the-clock, long-term opioid treatment” for which alternative treatments have failed.
The FDA took the action in response to a recent surge in prescription drug overdoses, which in 2009 surpassed traffic accidents as a leading cause of preventable deaths in the U.S. In addition to changing label language, the agency will also require drug manufacturers to conduct new research aimed at identifying what doses and modes of use are most likely to harm patients.
While acknowledging the moves as steps in the right direction, experts feel more still needs to be done. “People who are in severe pain often take more than is prescribed to them, so limiting the label indication is not going to prevent that from happening,” said Lynn Webster, president of the American Academy of Pain Medicine.
More widely prescribed, fast-acting opioids, including hydrocodone, were not affected by the FDA order.
MedBen pharmaceutical plans encourage the use of generic equivalents whenever possible. Such medicines contain the same active ingredients as their brand-name counterparts, and are sold at a much lower cost.
Understandably, brand-name drugmakers would prefer that patients continue to stick to the pricier originals, and have employed various means to spur loyalty. One such method – offering coupons – has grown in popularity of late. But do such incentives really save the patient money?
A new analysis suggests that even with coupons, generics are still the better deal in the long run. According to Pharmalot, assistant professors from Harvard and Yale reviewed 374 brand-name offers – typically for chronic conditions, with a median savings of $60 – and found that lower-cost generic alternatives were available 58% of the time, while an FDA-approved therapeutic equivalent existed for 8% of the drugs.
“Despite the short-term savings achievable with coupons, they do not offset higher, long-term costs, because they’re nearly always time-delimited,” wrote the authors of the analysis. “Once a coupon program ends, patients with chronic disease face co-payments for these brand-name medications that are higher than for those generic alternatives.”
The authors also correctly noted that the coupons don’t offer true savings, because insurers still have to pay the higher price of the medications – and those extra costs are ultimately reflected in member premiums.
MedBen encourages pharmacy plan members to take advantage of an exclusive online Rx datbase. By logging on to MedBen Access and clicking on “My Rx", patients can enter drug names and see their retail costs, and check if lower-cost alternatives are available.
MedBen follows American Cancer Society guidelines that state women over 40 years of age should get annual mammograms – guidelines the organization has stood by even after the federal government’s controversial recommendation that women can wait until their 50s to begin screenings. And a new study appears to support the ACS’s judgment.
According to MedPage Today, the study of 7,300 breast cancer patients found that 71% of death from the disease occured in younger women with no history of mammography or with intervals of 2 years or more between mammograms. Median age at diagnosis of fatal breast cancer was 49, as compared with 72 for women who died of other causes.
“Even with effective adjuvant therapies, the best method for women to avoid death from breast cancer is to participate in regular mammography screening,” the authors concluded. “Regular screening increases the likelihood of detecting nonpalpable cancers, and annual screening further increases the likelihood relative to biennial screening.”
“Furthermore, detecting and treating breast cancer in younger women to prevent death may further increase the disease-free life years saved,” they added. “Our findings suggest decreasing the intensity of efforts to screen women older than 69 years while concomitantly emphasizing efforts to screening young women in particular.”
Female members of the MedBen Worksite Wellness program can monitor their compliance with mammograms and other critical wellness examinations by visiting the MedBen Access website and clicking on the Wellness Plan link under “My Plan”.
Following complaints that employer reporting requirements under the Affordable Care Act were too complicated, the U.S. Treasury Department has proposed new rules, the Associated Press reports. The agency seeks comment on options to reduce or streamline reporting by employers, insurers and health plan administrators.
In July, the Obama administration delayed the start date of the so-called employer mandate until 2015 to give the Treasury additional time to simplify the reporting process. Of particular concern to business groups was the redundancy of reporting the same employee information to multiple government agencies.
“Retailers are not interested in being overly burdened by bureaucratic red tape or time-wasting, duplicative reporting requirements,” Neil Trautwein, the top health policy official for the National Retail Federation, said in a statement.
Even with the delay, the administration still hopes employers will voluntarily begin reporting next year to ease the transition.
When the final employer reporting rules are released, MedBen will provide guidance to clients on how to proceed. In the meantime, clients with questions regarding the proposal are welcome to contact Vice President of Compliance Caroline Fraker at email@example.com.
In June, the United States Supreme Court handed down its ruling in United States v. Windsor – the highly publicized Defense of Marriage Act (DOMA) case. While the Supreme Court’s ruling was very specific regarding changes required in the areas of the law it addressed (i.e., inheritance tax issues for same-sex spouses), there are still many questions as to the application of this decision to employee benefit plans – predominantly group health benefit plans.
The Supreme Court’s opinion dealt only with the constitutionality of Section 3 of DOMA – the section that defined marriage as “between one man and one woman” – and the application of that definition to inheritance taxes. What is missing is clear guidance as to how this decision applies to spousal coverage under employee benefit plans – particularly whether or not health and retirement plans must be amended to make same-sex spouses in these plans eligible for coverage. This question is particularly vexing in states that already recognize same-sex partners. Several entities, including the American Benefits Council, have made formal requests of the Tri-Agencies (HHS, IRS, DOL) to issue interpretive guidance on this very issue.
Making things even more confusing are the many attorney newsletters and blog postings interpreting the Supreme Court’s decision for group health plans. In some cases, these firms have indicated that, for self-funded plans in states that do NOT recognize same-sex spouses (such as Ohio), plan sponsors will now be forced to decide whether they will cover any spouses at all. It is their contention that if these employers do cover ’spouses’ but continue to exclude same-sex spouses, the employer may risk litigation or discriminatory action – particularly if the plan specifically states that only opposite-sex spouses are covered. Such language could be determined, through litigation, to violate the Supreme Court’s ruling.
While we await further guidance on the spousal eligibility question, there are a host of other issues that will have to be reviewed in light of the decision. These are as follows:
Among the keys to reducing health care costs is reducing the “care gap” that results from plan members missing recommended wellness exams and screenings. MedBen, in conjunction with Verisk Health, offers a unique reporting platform that calculates a group’s Care Gap Index (CGI) – a score that assesses the type and degree of care gaps for individuals in a population.
Using a Predictive Modeling System, MedBen clients can see for themselves the potential economic impact of closing care gaps. The smaller the CGI, the higher the likelihood of a healthier workforce – which, in turn, increases productivity while improving your bottom line.
Furthermore, reducing the care gap can theoretically add years to the lives of your employees. A new report from the Centers for Disease Control and Prevention (CDC) says that nearly one-quarter of the deaths from cardiovascular disease could be prevented with basic lifestyle changes. By knowing where care gaps exist and encouraging plan members to schedule regular checkups, you can help your employees avoid heart disease, stroke and other serious conditions.
To learn more about how MedBen can help your group detect and close care gaps – and how advanced reporting tools will allow you to calculate the resultant savings – please contact Vice President of Sales & Marketing Brian Fargus at firstname.lastname@example.org.