Author Archive

Become a Mountain Man – A worthwhile New Years Resolution!

We can learn a lot from Mountain Men. Like taking the time to sharpen our saw.


The saw is like business operations. If you don’t take time to sharpen your methods and skills it could dramatically affect your business. Don’t be so focused on current day activities they don’t take time to evaluate operations to enhance results. Creating operational efficiencies is crucial to success.

As a Health Care Consultant / Broker and SCORE Volunteer I see it all too often. Here are two recommendations that I can help with that will pay long term dividends.

Health Care Consumption Audit – Health insurance is usually a company’s second highest operational expense. Creating a savings strategy for health insurance can create a significant contribution to the bottom line. Why not perform a Health Care Consumption Audit?

SCORE – Mentoring, workshops, turnaround consulting and advisory boards are all available through SCORE to help start and/or grow your business. SCORE mentors are experienced executives from diverse business backgrounds.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Why do hackers want your health care data?

Health care information has a much longer shelf-life than other targets like credit cards, which become useless once a consumer gets a new card. Medical and insurance information has value for years.

Employers, if an employee is hacked that employee will be totally engaged restoring their accounts. Employee Benefit Advisors strongly recommends offering Credit/Identity Monitoring and Restoration as a voluntary employee benefit.

How can you protect yourself? We asked Bryan Barnhart, President of Infiltration Labs www.infiltrationlabs.com, Cyber Crimes Investigator,  and Digital Forensic Specialist, and primary instructor for the U.S. Secret Service Network Intrusion Response course. As a retired Police Detective and U.S. Secret Service Electronic Crimes Task Force Investigator (in short, he knows his stuff) he has a few basic tips.

Cyber Security for the Masses
Use strong passwords and don’t reuse passwords
Change passwords frequently
Use a password manager
Check if your email/password has been compromised: https://haveibeenpwned.com
Use Two-Factor Authentication (2FA) for all accounts: https://twofactorauth.org
Don’t use open Wi-Fi or networks you can’t vouch for
If you must open Wi-Fi, use a VPN – Think before you click: Don’t click links or open attachments in suspicious emails

Uncertain about the various cyber security monitoring services available? Contact Bryan or Myself, we don’t have a horse in the race, however we use the same service.

Cologuard vs Colonoscopy

Concerned about being at risk for colon cancer? Don’t like the idea of a colonoscopy? You may want to consider learning more about Cologuard, an at-home testing kit that screens you for colon cancer.

 What it is.
Cologuard is a noninvasive, prescription-only test. It’s designed for adults 50 years or older who are at average risk for colon cancer.

What it’s not.                 
Cologuard is not a replacement for diagnostic or surveillance colonoscopy in high risk individuals. If you have a medical history that includes colon cancer, polyps, or related cancers, it isn’t right for you.

How to tell if it’s for you.
The first step is to discuss the Cologuard testing kit with your healthcare provider. Once your healthcare provider approves the prescription, your kit can be ordered. It will be delivered right to your door.

How effective is it?
In 10,000 testing cases, Cologuard screenings discovered 92% of colon cancers and 42% of high-risk pre-cancers. Since both false positives and false negatives occur, Cologuard encourages positive-results patients to follow-up with a diagnostic colonoscopy. Negative-results patients are encouraged to participate in additional screenings at intervals.

 Will your insurance cover it?
Preventative Care / Screenings are covered at no cost under the Affordable Care Act. Cologuard is covered by most insurers with no co-pay or deductible for eligible patients (ages 50-75; at average risk for colon cancer; without symptoms). Cologuard is covered by Medicare and Medicare.

If your insurance provider doesn’t cover it or only covers part of the costs, Cologuard’s appeal department will assist you in creating an appeal letter to send to your insurance company.

The Cologuard screening is FDA-approved and has been in use since 2014.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

New Rules for Short-Term Health Plans may help employees in transition

The new rule will allow individuals to purchase short-term, limited-duration health insurance coverage for a period of less than 12 months, and renew coverage for up to 36 months. Under current law, the maximum coverage period is less than 3 months, and cannot be renewed.

Short-term, limited-duration health insurance is:
• Not required to comply with the Affordable Care Act’s ban on pre-existing condition exclusions and lifetime and annual dollar limits.
• Not required to comply with the Affordable Care Act’s essential health benefits requirement, which requires individual health insurance policies to cover, among other things, hospitalizations, emergency services, and maternity care.

The short-term health plans are typically much less expensive than fully-insured plans found on the marketplace or coverage provided through an employer’s COBRA continuation option. An employee with pre-existing conditions may not be interested, however health employees may find the short-term policies much less expensive and opt for the coverage.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Dietary Impact on Health

Meet Jeanette, she has lupus. (A chronic autoimmune disease in which the body’s immune system becomes hyperactive and attacks normal, healthy tissue. This results in symptoms such as inflammation, swelling, and damage to joints, skin, kidneys, blood, the heart, and lungs.)

(Jeanette mentions PatientsLikeMe in her video. PatientsLikeMe is a free website where people can share their health data to track their progress, help others, and change medicine for good. It’s an online community with over 2,500+ conditions.)

Now, the rest of the story.

Jeanette says she turned to dietary changes when she stopped taking Plaquenil due to severe side effects, including retina damage. She started logging her food intake for a few weeks, she noticed how some of her favorite foods were causing issues ranging from stomach pains to full inflammation. That’s when she started paying close attention to what her body was telling her and realized she needed to do something about it.

Jeanette didn’t go on any specific diet at first, she started eliminating certain foods like sugar (which was causing major fatigue and pain), garlic (causing major inflammation in her knees), eggplants (fatigue and pain in her feet), bean sprouts (stomachaches) and alfalfa (full inflammation and full flare) — some of the known foods that lupus patients shouldn’t eat [learn more at lupus.org].

Then Jeanette noticed how meat was causing fatigue and noticed inflammation directly in her knees. She gave up red meat for two weeks, felt good and noticed a reduction of pain. Then she gave up chicken the following two weeks and felt even better. “It was so amazing that I decided to give it up for good.” After the first few months without meat, my doctor started noticing my blood work was improving drastically, so she began reducing her medications since she was no longer flaring or feeling pain. After a full year she reduced all medications to zero and even stopped infusions.

(Everyone is different, so these foods and dietary changes may not affect you the same way. Talk with your doctor or a registered dietitian about finding foods that work for you.)

COBRA Check

Who is administering your COBRA? If it’s an insurance carrier they may not be administering all aspects of the eligible benefits. Read and make notes, better yet verify your COBRA plan is being properly administered. The fines for failing to do so can be staggering.

COBRA provides former employees, spouses, and dependent children the right to temporary continuation of health coverage at group rates. But you knew that. And most likely you know it covers dental and vision. However, did you know it covers EAP, GAP (group, not individual), Telemedicine, FSA and HRA plans?

The tricky administration comes FSA, the rules are based the 12-month plan year, which might not be the calendar year. If an employee has funds remaining in their FSA account at the end of the plan year they may not be able to use it in the next plan year. i.e. If the FSA is a December 1 to November 30 and an employee terminates on June 5, 2018, if they elected COBRA, that participation would end on November 30, 2018.

HRA accounts can also cause issues. HRA dollars must be available to COBRA participants. Employer’s may not like paying medical bills of former employees, it drives up their utilization rate.
Remember, COBRA was set up to protect employees, not employers.

Thanks to Susan Luskin, Diversified Administration www.div125.com, for her excellent CE class “If we have an Individual Mandate, why do we still need COBRA?” The above is a small, but important, part of her class.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Association Health Plans – An update from the DOL

The DOL issued a new rule that allows employers to join together to offer group health insurance coverage. The rule allows association health plans to be formed based on industry or geography, such as by state, city, county, or multi-state metropolitan area.

The association health plans will be subject to the large group coverage nondiscrimination rules. These rules prohibit discrimination based on a health factor or within groups of similarly situated individuals. The rules however do provide plans to impose different eligibility provisions and costs based on employment-based classifications, full-time versus part-time.

These insurance plans would not be subject to requirements under the Affordable Care Act (ACA) which included mandatory coverage for a set of 10 essential health benefits, such as maternity and newborn care, prescription drug costs and mental health treatment. However, they are expected to be considerably less expensive than Obamacare plans. The warning from health providers, insurers and medical groups is the plans could drive up premiums by siphoning off healthy consumers who want cheaper coverage, leaving behind a sicker patient pool with higher medical costs in Obamacare plans.

States and the Federal government would share regulatory oversight of the plans, with states retaining their current authority.

Click here for more information from the DOL.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

HealthKOS is Health in Your Hands

With a click of a button, patients have access to their health history from any mobile device and share it with physicians or patient care members.

HealthKos is a solution which shares information via automated interactions, within the patient care network. The processes optimizes medication use and care coordination. Health data points can be recorded and monitored for around the clock assistance. This includes all vital signs, weight and BMI, health wellness activities, and a complete updated medication list. The stored data on the HealthKOS platform allows for automated and timely communication with the health care team and family members to provide critical help in time of need, thus preventing an urgency from becoming an emergency, or even worse, an emergency from becoming a catastrophe.

HealthKOS empowers the patient to monitor their health through Bluetooth enabled devices and empowers the health care team to monitor patient progress outside the physician’s office, leading to timely interventions and preventing unnecessary disease progression and hospitalizations.

“Better Engagement → Leads to Better Compliance → Better Quality of Care”

HealthKOS, developed by doctors, allows the workflow to become patient centric, easy to use and provides lower cost quality health-care.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Zocdoc: Find & Book Doctors

New to the area and don’t know anyone? Download the app and within 2 minutes find the perfect PCP, Specialist or Pediatrician. Zocdoc is the beginning of a new healthcare experience. Find doctors you love, read real reviews, book appointments instantly, and more with this award-winning app.

Features
• See neighborhood doctors in your insurance network
• Book appointments with over 50 different medical specialties, including dentists, primary care doctors, allergists, OBGYNs, dermatologists, family doctors, urologists, psychologists, ophthalmologists, podiatrists, optometrists, pediatrists and more
• Read verified reviews from other patients
• See open appointment times and book instantly and keep track of your medical calendar. No phone calls necessary, even for same day bookings!
• Algorithm lets you search by specialties and conditions, like diabetes, obesity/weight loss, cancer, yellow eyes, bleeding, cysts, sore throat and more.
• Check in on the app to complete your paperwork and save time at the office
• Receive text reminders before your appointments

More Features
• Find doctors near your location with a convenient map
• Read doctors’ professional statements, learn about their education, and see what languages they speak
• Keep track of your physicians and easily schedule follow-up appointments from your Medical Team homepage
• Stay on top of important checkups with Wellness Reminders

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services.

Rx Management – CoPay Accumulator Programs

With Accumulator Programs the manufacturer’s payments no longer count toward a patient’s deductible or out-of-pocket maximum. Employers and health plans could potentially save big money because accumulators shift a majority of drug costs to patients and manufacturers.

Normally, a manufacturer’s payments from a copay program count toward a patient’s deductible and annual out-of-pocket maximum. Once these annual limits are reached, the plan pays for all subsequent prescriptions.

Problem is the Accumulator Programs will lower a plan’s drug spending by discouraging the appropriate utilization of specialty therapies and reducing adherence.

You may recognize Copay Accumulator by other names; UnitedHealthcare uses the term “Coupon Adjustment: Benefit Plan Protection program,” Express Scripts uses the term “Out of Pocket Protection program.” Choose your poison, both are misleading, especially to the patient.

For a deep dive into the potential impact of CoPay Accumulator Programs I recommend reading the article (link below) from Adam J. Fein, Ph.D. (Drug Channels) that highlights many potential concerns to Copay Accumulator Programs. Copay Accumulators: Costly Consequences of a New Cost-Shifting Pharmacy Benefit

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