Healthcare Services

PBM – Looking for transparency?

Are you contracting with a large PBM because they offer great discount? You might want to rethink your strategy and look to smaller PBMs with complete transparency. Perhaps it’s time to consider a pharmacy benefits administrator that offers the following:

  • A straight forward pricing model with no hidden revenue generators such as spread pricing. Look for invoice of the exact amount that reflects retail contracts. No spread should be retained for brands or generics.
  • Minimum retail guarantees, not maximums or estimates. If better rates are negotiated during the contract term, the PBM should pass through those discounts.
  • Mail order prescription charges based on the actual acquisition cost.  The amount billed should match the invoice cost, plus a fixed dispensing fee. Is your BPM willing to provide mail order purchasing invoices to validate their actual acquisition cost?
  • “Generic” and “Brand” defined exactly as Medispan does– no change in definitions.
  • No financial interest in any pharmaceutical manufacturer. BPM should pass through 100% of rebates received associated with a client’s brand utilization.
  • Fulfilled promises.  Annual reconciliation occurs and the BPM will make up any loss where the guarantee is not met by paying clients back for each dollar over the amount that was guaranteed.

Who is Employee Benefit Advisors describing? Contact us and make a referral on your behalf.

 

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

Rx Refills made easy!

Don’t like lengthy waits to refill your prescriptions? Prefer to have refills delivered to your door? Prefer someone else troubleshoot insurance & renew refills for you? Let me introduce you to Phil.

Phil is a service that manages your ongoing prescriptions. Phil partners with top-rated, locally-owned pharmacies that are licensed by the Pharmacy Board. These pharmacies will deliver your medications to you on time and answer any questions over the phone. Using the Phil app, you are able to refill on your own terms by scheduling when your medications arrive, ordering vacation refills etc.

Welcome to Phil – Smarter Prescription Refills: same copay, free delivery and a real time saver.

 

Phil takes 3 easy steps.
Step 1 – Sign Up and add your existing prescriptions to Phil.
Step 2 – Phil does the rest, they contact your old pharmacy and do the paperwork.
Step 3 – Receive your meds. Partner pharmacies deliver meds to your doorstep every month.

All partner pharmacies are rated 4-5 stars on Yelp®

Delivery is free. Phil will guarantee your copay will be the same as what you pay at your current pharmacy. Some rare exceptions may apply; in those cases, you’ll be contacted for approval. If you don’t have insurance, Phil partner pharmacies will quote you the lowest price they can obtain for you.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

Predictive Modeling – GRx

Many health insurance companies are looking at prescription usage to underwrite and rate group health insurance. It’s called predictive modeling.

GRx uses complete and current prescription histories. Details include drug name, dosage, fill date, pharmacy and physician information. This Healthcare Intelligence allows carriers to make risk assessment decisions with confidence and more accurately develop premiums. New group rates are quickly and more accurately developed. GRx turns group census data into a risk score. Health plans use the GRx risk score to more accurately predict the group’s future claim costs.

It’s good for the health insurance carrier and the group. Both get a more accurate quote potentially avoiding large rate fluctuations.

 

Employee Benefit Advisors provides employee benefits, tax-advantaged healthcare, compliance guidance for ACA and Health & Welfare DOL Audits, and PEO Advisory & Consulting Services. We can customize a wellness plan for your budget and culture.

The Future of Vision

6 eye care and eye wear innovations that will alter your view of vision benefits

    1. Accu-Fit Technology – reads the shape of your eyes and automatically recommends the best prescription
    2. Glasses.com – takes a 3D image of your face and allows you to look at up to four pairs of frames from every angle
    3. Onsite or pop-up clinics – setting up a store right in your office/plant, offering onsite exams; promotes both the importance of regular eye exams and your company’s wellness program
    4. “Healthy” wearable tech – your glasses will be your hub for your personal health and wellness providing you with your blood pressure blood sugar levels, etc… and automatically share the data with your doctor
    5. Smart Contacts – contact lenses that use tears to measure blood sugar levels for patients with diabetes (no more pricking your finger); for glaucoma patients lenses that measure intraocular pressure sending an alert to your smartphone that it’s time to administer eye drops
    6. Online Exams – emerging technology that allows for a refraction (used to determine the level of correction) to be tested online

Thank you Shauna Whittingham, Eyemed.

Employee Benefit Advisors provides employee benefits. We are a broker helping companies with their Health & Welfare Benefits. We also help companies revaluate PEO Services, deciding if a PEO is a good choice and if so selecting and implementing the PEO.

Obamaco$t – Rate Increases for 2016

Health insurance companies were seeking rate increases of 20 percent to 40 percent or more. Reason cited, new customers under the Affordable Care Act are seeking more treatment than expected. Increases of approximately half the amount requested is generally what state insurance agency approved. Some states fairing better than others.

The proposed increases indicate health carriers are still adjusting to the impact of the Affordable Care Act. The proposed increases, supported by reams of actuarial data, are fueling debate about the effectiveness of the health law.

A study by the Kaiser Foundation suggests that consumers would see relatively modest increases in premiums if they were willing to switch plans. However, to get low premiums, consumers may need to accept a more limited choice of doctors and hospitals and if they switch plans, there is no guarantee that they can keep their doctors.

 

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

Pre-Active Medicine – CompanionDx

Anywhere between 40 and 75 percent of drugs are ineffective for individual patients. That means a large portion of patients may not only be wasting their money—but they may not be receiving the treatment or the results they seek.

Pre-Active medicine is a new diagnostic discipline that uses genetic insights to help prevent adverse drug reactions, misdiagnosis or other negative consequences of inadequate medical discovery.

CompanionDx™ is one of the only providers of both pharmacogenomics evaluations and cancer companion diagnostic testing. When used separately or in conjunction, these two types of tests are giving physicians the resources they need for more comprehensive patient treatment profiles—and that means more certainty when it comes to effective therapeutic decisions.

Tests include:
Pharmacogenomics testing
Cancer companion diagnostics testing
Colorectal cancer screening
NextGen Sequencing testing (in development)
 
You’ll receive easy-to-read test reports within 3-7 days.

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

Medical Detectives…Need help with that difficult diagnoses?

Is your doctor having trouble diagnosing your illness? Look into CrowdMedwww.crowdmed.com. – I first learned about this on the Fox News Medical Report one Sunday morning.  Their doctors gave it very positive reviews.

CrowdMed connects you with thousands of medical experts who have collaborated to solve hundreds of medical mysteries that had stumped individual doctors for years.

How does CrowdMed work?

1 Register and Submit Your CaseSubmit your case anonymously and be instantly connected to thousands of medical experts who collaborate to get you the answers you need.

2 You Get More Attention from the Crowd Crowdsourcing enables anyone with applicable expertise, anywhere in the world, to collaborate on solving even the most difficult problems. Most of CrowdMed’s Medical Detectives are people with professional careers in medicine, healthcare, and science, devoting their time and expertise to help you get answers.

3 Collaborate with Medical Detectives Medical Detectives can access your case once it’s active on our site. Medical Detectives may also use chat and discussion features to ask questions, request additional details, and discuss your case.

4 Get Your ResultsAt the end of this process, you’ll receive a report which includes the top diagnostic suggestions and solutions, along with supporting medical references. You and your doctor will then use this report to help determine your final diagnosis and treatment plan.

Compensation for services?  You can always submit your case without Medical Detective Compensation, but they recommend that you offer a cash incentive to be shared by the Medical Detectives who contribute the most to your case. Many Medical Detectives donate these proceeds to charity. If the top diagnostic suggestions you receive are not confirmed to be accurate by your doctor, you can get a full refund of your compensation offer per the Money-Back Guarantee. In addition to a free case submission option, CrowdMed offers three paid packages: Lite ($99), Standard ($299), and Premium ($499) packages, each providing unique benefits. All are eligible for the full Money-Back Guarantee.

Useful App: Medfax (Listed as One of the Best New Apps)

Need an independent, unbiased source of medical information about doctors, drugs, medical devices and hospitals?

MedFax can be used to verify doctors, prescription drugs, medical devices and hospitals. It provides reports that allow consumers to make well-informed decisions regarding their healthcare. One of the largest information sources of its kind, MedFax has combined and cross-referenced information from hundreds of sources, including state and federal agencies, the FDA, state health departments, county and federal courts and more. The result is over 1.5 million reports that present vital information right at the consumer’s fingertips.

  • Doctor Search – How well do you know your doctor? Check licensing, disciplinary record, malpractice history, etc…
  • Drug Search – Get complete information about your medications and their side effects.
  • Device Search – Complete information about the use and safety of medical devices.
  • Hospital Search – Find out how your hospital rates for patient satisfaction and safety.

Medfax brings unbiased, independent data source, Current information, continuous updates, Millions of records at your fingertips.

What Makes a Great EAP?

Most employers now believe Employee Assistance Programs (EAP) are important elements in their total compensation and benefits offerings.  They know the equation:  by helping employees identify and solve personal concerns, EAPs create the opportunity for employees to focus and perform at their highest levels.  The return for employers is proven time and again by staff who are more engaged and work harder to achieve organizational goals.

However, selecting an Employee Assistance Program (EAP) can be a complicated process.  EAP service delivery models vary greatly as do the depth, quality and comprehensiveness of clinical, management consultation and training services offered.  EAP “parent organizations” are also disparate; health plans, life insurance companies, workers compensation and even payroll services now offer EAPs, although usually with limited benefits.  While some large employers choose to offer in-house EAPs, most organizations contract with external providers and offer a broad range of professional and confidential EAP services, from brief assessment and referral models to comprehensive early intervention, counseling, crisis management, education and wellness programming.

Below are some questions to consider when choosing an EAP:

  • Does the EAP provide easy access with 24-hour response?
  • Are employees and family members able to participate in confidential, professional, thorough assessments and face-to-face counseling services with skilled, licensed clinicians?
  • If specialized or ongoing care is indicated, do employees receive well-matched referrals to treatment or community resources?
  • Does the EAP offer expert Drug Free Workplace Programs such as DOT/ SAP assessments, management support and mandated supervisory referrals ?
  • Is there significant follow-up to assure employee satisfaction, compliance and best outcomes?
  • Is the EAP skilled assisting leadership prevent workplace violence and responsive when there is a need for crisis intervention, de-escalation or post-traumatic event management?
  • If a crisis occurs at the workplace, are professional and unlimited crisis intervention services provided?
  • Does the EAP offer FREE and targeted promotion to heighten EAP awareness and utilization, including outreach to engage employees with the most severe problems (many with devastating and costly substance abuse and mental health issues)?
  • Are unlimited EAP promotional materials and employee orientations included?
  • Are on-site services such as employee education, management training, mediation and organizational development core elements of the EAP offering?
  • Is the EAP “all-inclusive”?  A high quality EAP should be comprehensive and not charge extra for management referrals, strong utilization rates, crisis debriefings, EAP orientation or supervisory training programs; these items should be included in the quoted rate.

Selecting an EAP begins, first, with understanding your organizational needs and how an EAP can help you meet them.  Be aware of choosing an EAP that is “free” or “embedded” in another benefit product. This may seem like an economic option, but may not be the best value or quality for your organization or employees. A great EAP should be highly promoted, well utilized by employees and families, and the “go to” resource for employers who want results.

This article was contributed by Melissa Fabrikant, LCSW, CIRS – Director of Project Management from Managed Care Concepts EAP www.theemployeeassistanceprogram.com.

Healthcare Bluebook brings Price Transparency

Healthcare Bluebook provides transparency to consumers to compare healthcare costs and quality. Employers can provide a valuable tool to employees that will enable them to shop for the most affordable high quality care.

How does Healthcare Bluebook work?

  • Employees search for services using common language
  • Employees learn the price range they can expect to pay how much they can save by making cost effective choices
  • Prices are based on your local area network rates
  • Employees can compare specific providers on both cost and quality

Why do employers need a transparency solution?

  • In-network prices for healthcare services vary by 300% to 500%
  • Employees don’t know that prices vary within their network or how to find lower cost quality providers
  • Employers and employees can cut healthcare costs if they have the right information, tools and incentives

Healthcare Bluebook can be paired with both self-funded and fully insured plans. Although it supports traditional plan designs, EBA believes it is a super-value-added support for consumer driven high deductible plans. Healthcare Bluebook says employers have been decreasing total medical spend by 4% to 12%.

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