Month: June 2017

Selerix

Selerix Systems produces software (BenSelect) to facilitate communication, enrollment, and end-to-end benefits administration for both core and voluntary insurance products. This software is licensed to and used by carriers, brokers, and employers.

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TAGCO Provides Retiree Healthcare Solutions for Employers

The TAGCO Multiple Employer Trust offers employers the benefits and advantages of buying Retiree Medical through the pooling of statewide Retiree Medical risk(s). The program serves residents of Arkansas, California, Louisiana, Montana, Oklahoma, South Carolina, Texas, Virginia, Colorado, Illinois, Iowa, Michigan, Nebraska, North Carolina, New Mexico, Tennessee, Utah, and Wyoming.

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Why Employers Need To Offer Retiree Healthcare Benefits

Take a total benefits approach. This approach could help minimize liabilities while maximizing total benefits spend. Additionally, savings in one benefits area could allow additional funding for new retiree healthcare solutions……………….Coupling retirement healthcare with Reference Based Pricing strategies may accomplish this goal…………..

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4 Mistakes Businesses Make When Managing Health Care Expenses

 Mike Dendy

I recently met with a Fortune 100 company and posed the question, “how much are you paying for hospital services within your PPO network”? They had absolutely no idea. I was not at all surprised, as the actual cost of services is well hidden within a labyrinth constructed by big healthcare companies, their PPO organizations, and their “partner” hospitals.

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How An Industry Shifted From Protecting Patients To Seeking Profit

In 1993, before the Blues went for-profit, insurers spent 95 cents out of every dollar of premiums on medical care, which is called their “medical loss ratio.”

The average medical loss ratio is now closer to 80 percent. Some of the Blues were spending far less than that a decade into the new century.

The medical loss ratio at the Texas Blues, where the whole concept of health insurance started, was just 64.4 percent in 2010.

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Employers May Become Their Own PBM

Another form of direct contracting is when a plan sponsor outsources the administrative systems and support functions required to operate as a PBM, to a third-party vendor. These vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services.

The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsor’s of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.

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Sun Life Reports +$1 Million Claimants Up 26%

“The total of all Sun Life Stop-Loss claims reimbursements from 2013 to 2016 was $2.7 billion. If those stop-loss claims reimbursements are added to first-dollar catastrophic claims costs (the amount that employers pay before reaching the stop-loss deductible), the overall cost for catastrophic conditions was $6.1 billion…. Million-dollar+ claimants were up 26% compared to 2012-2015. In 2016, this group represented only 2.2% of claimants but accounted for 23% of all stop-loss claims reimbursements.”

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How To Reduce Health Care Costs & Improve Benefits At The Same Time

davechasebook

We learned back in 2007 that we can reduce health care costs for our clients by 40-50% while improving benefits at the same time. Few listened then, afraid to break away from the status quo. Now we find articles like the following one by Dave Chase. This, and his upcoming book, is a Must Read for employer sponsored health plans – Bill Rusteberg

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Fiduciary Duties – You Mean that Stuff Applies to the Health Plan I Sponsor, Too?

poyner

In the summer of 2016, over 100 of CIGNA’s self-insured health plan clients were sued with the complaint alleging breach of the defendants’ fiduciary duties under ERISA for engaging in widespread fraudulent behavior involving the use of plan funds. This case should serve as a wake-up call for employers sponsoring health plans nationwide – this will not be the last case of its kind to be filed.

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Texas Bill To Address Unconscionable ER Prices Fails To Pass

shocked

TEXAS HOUSE BILL 3867 – AN ACT relating to unconscionable prices charged by certain health care facilities for medical care.

For purposes of Section 17.46(a), the term “false, misleading, or deceptive acts or practices” includes an emergency facility taking advantage of an individual’s medical condition by:

(1)  providing emergency care at an unconscionable price; or

(2)  demanding or charging an unconscionable price for or in connection with emergency care or other care at the facility.

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Half Of All U.S. Retail Jobs Could Vanish

checkout

“For the record, C-suite executives are actively engaged in reducing health care costs in the US, not by what they consider penny ante changes in plan design, but by replacing workers with robots and automation, self checkout machines, push button ordering in restaurants and drive thru food serves, etc etc etc. That not only cuts benefit costs but wages, workers comp, payroll taxes, sick leave, life insurance, training, on and on.  This is not to mention the rush to send US jobs to India and Mexico.  That’s how the c-suite is engaged.” – Tom Emerick  (www.emerickconsulting.com)

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