Know Your Numbers

numbersHave you tried to monitor your health by counting carbs, calories or protein? While health can feel like a game of numbers, it can help to know measurements that matter most. Here are a few numbers that may help:

50%. That’s the proportion of your plate that should contain vegetables. The rest of your plate should include 25% whole grain, such as brown rice and 25% of protein rich food, such as fish, beans or chicken. Using a plate model can be much easier than counting calories.

25-35 grams. Aim to take in 25 to 35 grams of fiber a day. Most Americans only take in 16 and low fiber can cause issues with high cholesterol and blood sugar levels, increased risk of certain cancers and digestion problems.

7-8 hours. Sleep is necessary for a healthy lifestyle, so try to get 7 to 8 hours. A lack of sleep can increase risk of Type 2 diabetes and obesity, and lead to complications such as loss of focus, impaired memory retention and irritability.

150 minutes. Aim for 150 minutes of activity per week, spread throughout each day, with a minimum of 10 minutes per session. Activities you enjoy are the ones you’re more likely to do regularly.

120/80. Blood pressure is called the “silent killer,” as it can often be present without any symptoms. Unchecked or untreated, high blood pressure can increase the risk of heart attack or stroke. Monitoring is key, as well as frequent exercise and a healthy diet.

controlling-costs

Self-Funding: More Than a Means to an End

self-fundingIn an effort to take control of their healthcare spend, more employers continue to move to self-funding. But as those who have used this funding mechanism for some time have learned, designing a self-funded health benefit plan is just the beginning. When a health plan is self-funded, the entire healthcare supply chain is unbundled, giving everyone a clear, unobstructed view of the healthcare spend. An experienced Third Party Administrator will help you identify exactly where your healthcare dollars are going. Providers can be evaluated. Opportunities to achieve quality outcomes and lower costs can be explored. Best of all, unlike fully-insured health plans that are carrier-based, employers who self-fund their health benefits have the flexibility to act.

Target Cost Transparency

According to the Centers for Medicare and Medicaid Services, healthcare costs have increased by more than 260% since 1999. One of the biggest problems is costs for the same service can vary drastically from one provider to the next, even when the providers are located in the same marketplace. One way to attack this problem is with Reference Based Pricing, which typically allows qualified self-funded health plans to pay for medical services based on a percentage of Medicare, rather than by applying a percentage discount to a facility’s billed charges. Using an accepted index such as Medicare has enabled a growing number of health plans to bring cost transparency and consistency to hospital billing, since Medicare sets prices for every procedure.

Communicate with Purpose

From mobile cost transparency tools to telemedicine, employers are doing more than ever to help plan members utilize their benefits. Engagement rates, however, often tell a disappointing story as many employees are reluctant to use these new features. Experience tells us that whether we’re talking about a published provider directory or an online member portal, most people are confused by healthcare coverage.

Whether your company decides to place colorful posters in gathering spots, hold employee meetings or distribute email newsletters, emphasizing the steps you’re taking to make healthcare more accessible and affordable is critical. In this time of full employment and intense competition, health benefits can play an extremely important role in attracting and retaining valued employees. Don’t miss this opportunity to enhance your company culture and improve your employees’ quality of life.

ebso-self-funding-works

 

Traditional Plans Decrease

stethescope for healthcareSince 2007, adults ages 18 to 64 with employment-based coverage have increasingly chosen High Deductible Health Plans (HDHP), both with and without Health Savings Accounts  (HSA), over traditional plans.

In 2017, the number enrolled in HDHPs without an HSA rose to 24.5%, while HDHPs with HSAs rose to 8.9%. Some employers are choosing to only offer HDHPs, helping shift employees away from traditional plans.

controlling-costs

Troubleshooting Telemedicine

ebso-telehealthThe healthcare landscape is changing as providers increasingly offer virtual care options, and naturally it’s taken some getting used to. A recent study by the Deloitte Center for Health Solutions found that while patients who have used virtual care reported a 77% satisfaction rate, only 44% felt that their wait time was reduced compared to an in-person office visit. Some offices are designating doctors for virtual care on specific days of the week to circumvent wait times caused by healthcare professionals bouncing between in-person and virtual patients.

ebso-self-funding-works

Employers Investing More in Benefits

stethescope for healthcareHealth and wellness are integral to employee performance, which helps explain why employers are investing more in their employee benefit offerings.

In June of 2018, the average cost of benefits rose by 2.9%, while wage costs rose by 2.7%, according to data released by the Bureau of Labor Statistics. Also on the rise is paid leave, which has seen a 4% cost per employee increase since 2017. This includes paid parental leave, which allows time off for a birth, adoption or foster placement of a new child.

controlling-costs

More Patients Texting

Healthcare professionals that aren’t utilizing text communications are failing to meet their patients where they are. A 2018 survey found 11% of patients would rather communicate via text message, a number that is expected to grow as the Millennial population begins to outnumber Boomers. Text alerts and communications can be used for a variety of services, including preventative care such as periodic appointments and flu shots, post-treatment care information, remote health monitoring and chronic disease management.

ebso-self-funding-works

Healthcare Consumers About to Have Their Day

ebso-giantsFrom Amazon, Berkshire Hathaway and JP Morgan to Walmart and Humana – disruption is all around us. The future of our healthcare system is unfolding right before our eyes and regardless of how this giant chess match turns out, health plan participants just may be the biggest winners.

The Retail Effect
While many healthcare plans have done well under Obamacare, they need to review what many retailers have experienced since Amazon began building its Prime subscriber base of 100 million plus. When you consider the scope of Walmart, their potential for retail clinics is virtually unlimited. Whether by Amazon, Walmart or others, home delivery of prescriptions could make things very difficult for brick and mortar pharmacies. No matter what area you examine, these mega-partnerships have the potential to impact access to care in ways that most traditional healthcare providers have never imagined. And, if recent retail history means anything, healthcare consumers are sure to benefit.

Self-Funding Will Rule
Most working Americans are already covered by self-funded health plans, and we would expect the new Amazon, Berkshire Hathaway, JP Morgan family to offer at least one self-funded option. Studies show that self-funded plans offer employers far more flexibility than fully insured counterparts and Berkshire Hathaway’s Specialty Services unit certainly has the resources to provide the required stop loss insurance.

A Transparency Opportunity
With a little creativity, the transaction processing infrastructure of JP Morgan could make real-time claims processing a reality for fellow plan members. Real-time payments may encourage providers to discount more. Add telehealth and enable physicians to view electronic medical records and patients may know what to expect from their visit and what they will pay before they make the appointment. The bottom line is that as the level of information sharing increases, cost transparency and the potential for savings will grow.

As a TPA dedicated to controlling costs for self-funded health plans and members, we know these deals will keep more people out of the hospital and increase competition for outpatient care. Technology will move forward, actionable data will be more accessible and consumers will have their day as costs become more transparent and delivery more user-friendly.

controlling-costs

Four Ways to Avoid Diabetes

diabetesThe time to think about diabetes is not when it’s diagnosed. It’s important to take steps to prevent diabetes and prediabetes before they ever develop. While more than 100 million American adults live with diabetes or prediabetes, there are easy, proven ways to prevent it. Here are just a few:

Eating better: the breakdown. Though we often hear that we should “eat better” it’s not always clear what that means. Whole, fiber-rich foods are what you should be consuming. Fill your plate with vibrant foods, having natural color and fiber, such as quinoa, brown-rice, blueberries and garbanzo beans. These foods are slow-burning, providing longer term energy and maintaining sugar levels more steadily. When eating a meal containing slow and fast burning foods, eating slower-burning foods first will slow the absorption rate of faster-burning foods.

Water is your best friend. While the call of sugary drinks such as juice, packaged iced tea and soft drinks can be hard to resist, water is always the best choice. Even diet or low calorie drinks can increase the risk of diabetes, potentially causing changes in gut bacteria that affect metabolism. Water eliminates stripped carbs and provides the hydration your body needs.

Keep moving. Exercising regularly, doing both cardio and resistance activities, not only lowers your blood sugar but makes your cells more sensitive to insulin. That’s really a two-for-one diabetes prevention action! Choosing activities that you and your family enjoy makes exercise fun.

ebso-self-funding-works

Economies of Scale for Small Businesses

ebso-embIn late June, the Department of Labor introduced final rules on Association Health Plans (AHP), which will allow bonafide associations to offer healthcare plans to member companies. While we had hoped for a different approach to regulating these plans, association health plans will be regulated by states as MEWAs.

According to the final rules, an association that wants to establish a healthcare plan must already exist for another purpose. In other words, an association cannot be formed for the exclusive purpose of offering healthcare plans to its members. Another stipulation is that new self-funded association health plans cannot be established until April 1, 2019.

Association Health Plans will be exempt from the federal mandate on essential health benefits, but will remain consistent with popular Obamacare rules such as coverage of pre-existing conditions and bans on lifetime limits.

While reserve requirements will vary from state to state, we expect that these plans will be quite costly to establish and closely monitored by state regulators. Nonetheless, for large associations with significant cash reserves, we expect this option to make it possible for thousands of small businesses to lower their cost of employee health benefits.

controlling-costs

Employees’ health care burden growing 8 times faster than wages

This article was published on October 3, 2018 on BenefitsPro, written by Emily Payne.

When the Kaiser Family Foundation started tracking employer health benefits 20 years ago, employee deductibles weren’t a concern. Over the years, though, the survey has adjusted to reflect not just the growing percentage of employees with a deductible (85 percent in 2018) but the growing amount of that deductible ($1,573 for an individual in 2018) .

In fact, according to the 2018 KFF Employer Health Benefits Survey, the burden of deductibles has tripled in the past decade and increased eight times faster than wages. Among small employers, 42 percent of workers pay a deductible of $2,000 or more.

ebso-graph-premiums

“Rising health care costs absolutely remain a burden for employers, but they’re a bigger problem for workers, as cost-sharing has been rising much faster than wages in recent years,” KFF president and CEO Drew Altman said in a press briefing.

This year’s survey shows no dramatic shifts in the employer-sponsored health care space but continues to illuminate a number of trends, including increasing health care premiums, greater focus on employee wellness and alternatives to traditional health care providers.

Premiums have increased five percent this year, costing a family for four an average of $19,616. Of that cost, employees contribute $5,547, and employers pay the rest. For single-coverage, premiums increased 3 percent to $6,896.

“Premium growth is important, but it’s only part of the story,” noted Altman. “The bigger issue is rising cost-sharing. What happens with wages can be as important to closing that gap as what happens to cost-sharing itself.”

Almost half of employers continue to offer PPO plans, while three in 10 offer a high-deductible plan with a savings component. Some employers (13 percent) offer an incentive to encourage employees to opt for one plan over another.

HDHP adoption is stagnating, comprising 29 percent of all plans. Part of this slowdown may be due to the uptick in the economy. “Given the economy is good and health care costs are relatively tame, I think employers don’t have a strong incentive at the moment to push people into plans they may not be as comfortable with,” said Gary Claxton, KFF vice president and director of the Health Care Marketplace Project. “I think we’ve stalled a bit on the growth of HDHPs. Things will get more interesting if we move into a recession.”

Wellness is getting more of employers’ attention. Seventy percent of large firms now offer health-risk assessments, and 81 percent use data from those assessments to better understand health risks, target their wellness program promotions, design new programs and/or measure health care costs. “As employers have gotten more involved in trying to develop programs to encourage employees to be healthy, having the info is necessary to determine what kind of programs to sponsor and what employees need information about,” Claxton said.

More employers are looking at workers’ activity data–21 percent now collect information from a wearable device as part of their wellness program, an increase from last year’s 14 percent.

Interest in telemedicine and retail clinics continues to grow. Among large employers, 74 percent offer telemedicine services, an increase of 63 percent since last year. In addition, 76 percent cover retail clinic services, and some offer employees a financial incentive to choose these services.

A number of factors, including wages and the economy, will continue to impact the employer health care space in the coming years. Ten percent of employers expect that the elimination of the individual mandate will result in fewer workers purchasing employer-sponsored coverage.

Another factor asked about during the briefing was the increase in prices by health care systems and providers. Consolidation among major health care systems continues to shift the balance of power when it comes to price negotiation. “We’re in a competitive health care system,” Claxton noted. “We rely on private insurers and employers to mediate prices. They haven’t been very successful in recent years. It is hard because most workers work for fairly large employers with multiple locations. It’s hard to develop narrow, efficient networks that would cover all of your employees, and the large health plans don’t really have an incentive to create these options.”

controlling-costs