Healthcare

Telemedicine – Impact your health care costs

Group health insurance premium are expected to rise 15-18% in 2019 and Telemedicine can be an important cost containment tool, for both employer and employee.

In a study of 17,000 telemedicine participants, hospital admissions dropped by 30% and doctor visits were reduced by 60%, for a savings of 45% in unnecessary doctor and emergency room visits. The American Medical Association states that 70% of doctor visits can be handled over the phone, and 50% of the emergency room visits are non-emergencies. Telemedicine’s savings in claim costs range from $300 for a single employee to more than $1,000 per year for a family of 4.

Telemedicine provides 24/7 medical access to employees as part of their benefit package. Advances in communication technologies make accessing professional medical opinions easier. This is particularly important if the network is strictly local, employees live in rural areas, or employees are worried about access to doctors while traveling.

In addition to the obvious convenience – patients/employees do not have to take time away from work for a medical appointment, sitting in the doctor’s waiting room, eliminating travel time – patients/employees have increased access to medical experts in many fields. Telemedicine puts the employee in touch with US Board Certified physicians in their state to treat common ailments; cold/flu, sinus infections, allergies, pink eye, etc.

What can employers do? – Employee Benefit Advisors recommends companies build a communication program to educate employees. In addition to informing employees the services that can be accessed via telemedicine be sure to include instructions on downloading your health insurance carrier’s app and login.

Interestingly, a bill submitted in New York proposes creating a task force to study how telehealth and telemedicine might help employees in workers comp. The task force would examine how connected health technology could improve outcomes for workers on worker’s comp, increase access to care providers and enable those providers to improve compliance with worker’s comp guidelines. The committee would also explore how telehealth and telemedicine could help employers and reduce fraud.

 

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

Group health insurance premiums to rise by 15-18% in 2019

Actuaries are predicting group health insurance premiums to increase 15-18 percent increase in 2019 due to a rise in health inflation.

Medical inflation is in the range of 18-24 percent across the country due to a rise in costs for medicines, medical equipment and hospitalization. Inevitably this will lead to a direct impact on the insurance costs for companies.

The premiums under group health plans are significantly lower than those of individual health insurance products. This is because of the number of people covered under the master plan and because the incidence of claims are lower.

Group health insurance loss ratios are almost 140 percent since some insurers were involved in heavy discounting to retain clients.

Increased non-communicable diseases are expected to increase employer-sponsored healthcare costs over the next three years. These diseases include heart disease, cancers, stroke, chronic respiratory diseases, diabetes, Alzheimer’s disease, mental illness and kidney diseases.

 

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.

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

IRS Guidelines – Indexed for 2018

FICA
Social Security Tax is 6.2% on income up to $128,400 up from $ 127,200
Medicare Tax unlimited 1.45% to Unlimited

High Deductible Health Plans
Minimum Annual Deductible (Individual/Family) $1,350 / $2,700
Maximum Out-of-Pocket Limit (Individual/Family) $6,650 / $13,300

Health Savings Accounts
Individual / Family $3,450 / $6,900 IRS announced change to $6,850 March 5, 2018
Catch-up Contribution $1,000

Flexible Spending Accounts
Health Care Flexible Spending Account Maximums $2,650
Dependent Care Spending Account Maximum $5,000

Mileage & Transportation
Standard Mileage Rates
54.5 cents per mile for business miles driven
18 cents per mile for medical or moving purposes
14 cents per mile driven in service of charitable organizations

Parking (monthly) $260
Mass Transit Passes (monthly) $260

Compensation
Compensation Limit $275,000
Highly Compensated Employee Salary Amount $120,000
Annual Compensation for Key Employee $175,000
Defined Benefit Plan Limit $220,000
Defined Contribution Plan Limit $55,000

Retirement Plans
401(k) $18,500
401(k) Catch-up $6,000
403(b) $18,500
457(b)(2) and 124(c)(1) $18,500
457(b) Catch-up $6,000
IRA Limit $5,500/$6,500 for age 50+
Simple IRA Limit $12,500/$3,000 Catch-Up

 

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

Obamacare Driving New Wave of Hospital Bankruptcies

Health-care bankruptcy filings have more than tripled this year according to Bloomberg, and an index of Chapter 11 filings has reached record highs (industry companies with more than $1 million of assets). It’s expected that for 2018 the trend will increase; hospitals and other medical companies are likely to restructure their debt or file for bankruptcy.

How is Obamacre contributing to the hospital failures?  Obamacare’s architects were so certain their legislation would completely eliminate uninsured citizens in the U.S., they decided to offset the costs of the “Affordable Care Act” by eliminating subsidy payments to hospitals that had previously been used to cover losses from treating uninsured patients. Regulatory changes, technological advances and the rise of urgent-care centers have created a “perfect storm” for health-care companies.

Content source, ZeroHedge by Tyler Durden.

Pharmacogenetics

Pharmacogenetics allows prescribers and pharmacists to understand how medications react differently in the body based on an individual’s metabolism. Best Practice PBMs are able to apply the results of a fast and easy-to-administer pharmacogenetics test to enhance member safety, improve treatment outcomes and prevent wasteful drug spending.

The science of pharmacogenetics utilizes precision medicine, which evaluates and considers a patient’s metabolism, environment and lifestyle, to develop effective, individualized treatment plans. Pharmacists work with members and their prescribers to coordinate changes in drug therapies, as indicated by testing. This ensures that members receive the most clinically appropriate and effective medications. By proactively identifying which drug therapies will not work, or are likely to cause severe adverse reactions, clients and their members can avoid unnecessary risks and expenses.

Pharmacogenetic testing can have a measurable positive impact for members who live with chronic health challenges such as diabetes or high cholesterol. Pharmacists can help them move quickly onto the most appropriate drug therapy and improve their health with fewer side effects and less risk, based on their unique metabolism.

There are no doctor’s visits required to administer the test. Members can collect and submit the sample from home using a simple cheek swab. The markers identified by pharmacogenetic testing do not change over a member’s lifetime, so repeat tests are not required.

Pharmacogenetics enables a personalized approach to care aimed at reducing costs, improving treatment efficacy and preventing adverse drug reactions.

Please contact me if you would like to learn more.

 

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

Knock Out Blow? – Trump Ends Cost-Sharing Reduction Subsidies

The White House confirmed Thursday that it will stop making federal payments for cost-sharing reductions, payments to health insurers. The Department of Health and Human Services confirmed that the cutoff would be immediate. This action could throw the Marketplace into immediate turmoil as insurers start to evaluate their options for 2018.

Many, certainly democrats, have been calling for a bi-partisan solution to the health care problems in America. However, let’s not forget, it was the democrats that ramrodded the misnamed Affordable Health Care Act through the legislative process, behind closed doors, with absolutely no input from republicans.

Employee Benefit Advisors has blogged several times about legal challenges to the ACA, specifically pin pointing, the Obama administration saying they did not receive, but needed, an appropriation to make these payments to insurance companies. Obama used executive orders to put into place key finance regulations behind the ACA. Problem is, what can be done by executive order can be undone by executive order.

 

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

What is Reference Based Pricing?

With RBP plans are designed to negotiate treatments with high-quality providers at reduced costs and can work in different ways, depending on the insurance carrier or TPA. – Sound like a PPO or HMO? Not quite.

RBP can have no network restriction, a network and use a network within a network. Call it Creative Networking where certain services may require the use of select networks, a Network within a Network.

All reimbursements are based on a fixed amount for a particular procedure, such as dialysis and hospital stays – two biggies, which certain providers will accept as payment in full. Reimbursement is based on a reasonable fee or multiple of Medicare. Under this type of arrangement, reimbursement rates range between 120% and 180% of Medicare.

RBP product could offer you 72-77% savings over traditional PPO plans. (A national survey found less than 1% of providers do not accept this type of health benefit plan.)

 

 

Discover the referenced based pricing solution that offers a significant improvement in savings without compromising quality care. Save on claims costs without provider and facility restrictions.

 

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

Power of THE Pen – Trump holds the key to Repeal!

Many have forgotten that our Congress (Senate and State Representatives) and public employees are not fully subject to Obamacare. President Trump can change that with a stroke of THE Pen.

Congress was initially subject to the ACA. However, after a meeting with Senate Democrats in March 2013, Obama exempted Congress from section 1312(d)(3)(D). That section would have required Congress and their staff to buy insurance through an Obamacare exchange and does not authorize an employer contribution toward their premium. Congress and their staff would lose their taxpayer-funded, gold-plated health care rather than go into Obamacare and pay their own way.

The Office of Personnel Management (OPM), under the instruction of President Obama, ruled “the DC Health Link Small Business Market administered by the DC Benefit Exchange Authority, is the appropriate SHOP from which Members of Congress and staff purchase health insurance in order to receive a government contribution (subsidy). The Congress employees thousands, not the required 50 or fewer required to be eligible for the DC (or any) Exchange.

Federal Employees Health Benefits Program: Members of Congress and Congressional Staff, 78 Fed. Reg. 60653- 01 (Oct. 2, 2013). https://www.gpo.gov/fdsys/pkg/FR-2013-10-02/pdf/2013-23565.pdf

President Trump has the power to end this abuse by directing OPM to rescind the rule and issue a new one that conforms to the statutory requirement the congress and their staff pay their own premiums in the individual Obamacare Exchange.

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

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