Staying Safe in the Sun

sunscreenSummer is the season for getting as much outdoor time as possible. But, it is critical to protect your skin from the sun while you’re at it. Choosing sunscreens and knowing how different SPF levels will affect your skin can be tricky, so here are some fool-proof steps you can take to protect yourself and your children.

  • Limit your midday sun exposure; the most damaging rays are between the hours of 10am and 2pm.
  • Pay attention to your clothing. Loosely woven clothing and hats let UV rays through to your skin. However, these days there is specially designed SPF clothing available.
  • Choose sunscreens that protect from both kinds of ultraviolet light – UVA and UVB (labeled as “broad spectrum”). SPF between 30 and 50 is ideal.
  • Apply sunscreen 20 minutes before going outside and be generous with it!
  • Remember your lips and ears! A waxbased sunscreen stick can protect these areas well.
  • Be especially careful around water and snow, as the damaging sunrays are reflected by these surfaces and increase your exposure.
  • Sunscreen sprays are fine, but be careful to not inhale the fumes (especially when using on children).

Be sure to throw away last year’s sunscreens as it decays over time and can be less effective. If you plan on being in the sun often this summer, consider using a vitamin D supplement. You always want to make a conscious effort to have a good balance of being in and out of the sun. And, always remember to ask your doctor about regular screenings for skin cancer.

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Integrated Health Network of Wisconsin Partners With EBSO

ebso-ihn-wisconsin-blogWisconsin, August 15, 2016 – EBSO is one of four Third Party Administrators (TPAs) recently chosen to offer the Integrated Health Network of Wisconsin (IHN) to self-funded employer groups and brokers throughout the state. The synergy created between IHN’s comprehensive network and care model as well as the proven disease management capabilities of EBSO was cited as a key advantage of the partnership.

EBSO has over 35 years of TPA experience, founded in 1977. As a privately owned company and full service TPA, they have the ability to offer objective, independent solutions and innovative products and services to their employer groups and broker partners. They provide a range of self-funded and fully insured benefit plans in addition to Human Resource and Finance support, compliance and auditing services and retirement plan options. They also offer a Chronic Disease Management program that helps their clients improve the overall health of their workforce.

IHN is a broad-choice value network of major Wisconsin health systems working together to deliver high quality, affordable health care. Founded in 2010, it includes eight Owner Member health systems, 53 hospitals, 8,400 providers, 1,180 clinical locations and more than 100 Associate Member resources. IHN’s care model enables it to offer flexible health care solutions for employers, producers and insurance companies that result in excellent health care plus immediate and sustainable health plan savings.

EBSO strives to form relationships with trusted partners and the best networks whose business priorities align with theirs, which is why they were happy to partner with IHN. To learn more about EBSO and how they are prepared to work with every client, in every situation, every day visit their website at http://www.ebsobenefits.com/.

HSA Act of 2016

hsa-fsaLegislation expanding health savings accounts (HSAs) and flexible spending accounts (FSAs) has been introduced in Congress and assigned to committee in the Senate. Just a few of the proposed changes contained in the bills include renaming “High Deductible Health Plans” to “HSA-Eligible Health Plans”; allowing Medicare recipients to contribute to their HSAs and use their funds to cover a hospital admission deductible; and allowing distributions to be used for over-the-counter medications as well as prescription drugs.

While these proposed changes and others included in H.R. 4469 and Senate Bill S. 2449 have received a good amount of support from legislators and industry trade groups such as the American Bankers Association (ABA) and the ERISA Industry Committee (ERIC), no action has yet been taken.

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Physician-Owned Hospitals and the ACA

levelfundingEven though doctors currently have an ownership interest in just 5% of the 5,700 hospitals in the U.S., the ACA will not allow physicians to increase their ownership interest or pursue ownership in additional hospitals. The potential for conflict of interest and concerns about physician owners “cherry picking” the more profitable patients were the impetus behind Section 6001 of the Affordable Care Act that was passed in 2010.

Challenges to the law continue to come along, including a House bill sponsored by Representative Sam Johnson of Texas that would suspend the moratorium on expansion of physician-owned hospitals (POHs) for 3 years and grandfather in several POHs that were under development when the Affordable Care Act was passed. The legislation is based on a recent study that reviewed patient populations, quality of care, costs and payments in 2,186 hospitals, 219 of which were partly physician-owned. The study showed little difference in patient care between POHs and non-POHs, in fact 7 of the top 10 hospitals receiving quality bonuses in the new Hospital Value-Based Purchasing Program were physician-owned hospitals.

One study by the Centers for Medicare and Medicaid Services showed that a majority of physician owners have less than a 2% interest in their institution. As healthcare continues to evolve from fee-for-service to more value-based, there is no doubt that the debate over physician-owned hospitals will continue.

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A Dose of Reality: PBM’s Job is Rarely To Save Costs

Article as seen in MyHealthGuide Source, written by Ron E. Peck, Esq., Sr. VP & General Counsel, The Phia Group, LLC, The Self-Insurer July 2016 – pages 10-15 Full Text

Utilization review. Precertification. Medical case management. It seems as if health plans have been, for lack of a better word, micromanaging how medical care is sought and obtained by plan participants, for decades upon decades. It makes sense. Whether I’m a fully insured carrier or a self-insured plan sponsor, I know that a complicated pregnancy, chronic illness, cancer diagnosis, or any other number of conditions will seriously hurt — if not sink — my plan.

As specialty drugs, implants and other devices usher in an age of skyrocketing costs, not enough attention is being paid to this area in dire need of improvement.

Drug costs already make up 25% of all healthcare expenses. Indeed, a recent study revealed that large employers spent — on average — almost a thousand dollars per covered life, on pharmacy costs in 2014.

  • Specialty and Compound drugs accounts for between 25% and 35% of total drug spending.
  • Further, the costs associated with specialty drugs is increasing at nearly double the 10% rate attributed to other drugs; meaning a 20% jump per year.
  • Even more startling, more than 50% of drugs in the later stages of FDA approval are specialty drugs.
  • Some existing medication have increased substantially, with some increases exceeding 47%.
  • All of this adds up to a total pharmacy spend projected to double by 2020.

The Role of the PBM

A report says that eighty percent (80%) of employers agree or somewhat agree that their Pharmacy Benefit Manager (PBM) is sufficiently managing drug costs. I’m sure — if asked about medical expenses in general — the same respondents would be full of complaints. Yet, when we focus on drug costs which — as described above — are one of the (if not the) fastest growing drivers of plan expense, 80%+ of plan sponsors are satisfied. Someone isn’t getting the memo!

  • PBMs are not necessarily the problem. The issue is that we — as an industry — don’t recognize their role, limits and mission. People assume PBMs exist to contain drug costs. This is simply not the case (with a few exceptions).

Plan sponsors contract with PBMs directly or through their third party claims administrator, to decide what drugs are covered, what the costs shall be and, as it relates to payment to pharmacies, the where, when and how much. Further, plans rely upon their PBM to set the participant cost-share and establish pharmacy networks. PBMs therefore serve many important roles; none of which are — first and foremost — dedicated to identifying cost containment opportunities.

  • Understanding the role of a traditional PBM, what they do to create revenue for themselves and recognizing the pros and cons of said arrangement, is the key to devising independent cost controls.

Some plan sponsors think that they simply pay the PBM for the cost of any drugs actually dispensed and usually an administrative fee for managing the prescription drug program. Little do they know, but many other costs — and conflicts — impact the bottom line when it comes to prescription drug purchasing and distribution, above and beyond the problem of rising drug costs.

The costs of the drugs purchased are exploding. Plans, however, are not only contending with the rising cost of the drugs themselves. They must also worry about lost refunds, PBMs pocketing spreads (the difference between what the plan pays and the pharmacy receives) and other revenue bolstering tactics, such as up-charging and therapeutic shifting. Continue reading

Apps and Wearables Double

mobileAccording to studies by Accenture, the number of U.S. consumers using wearables or mobile apps to manage their health has doubled in just the past 2 years. One interesting fact is that while the vast majority of users are willing to share the data collected with their doctors, and many with their health plans, fewer than a third want the information shared with their employer.

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Game Show Education

quizzify-2Healthcare education is rarely all fun and games, but a new approach might be succeeding at making it just that! They’re being called online education programs – offered to employees as both mobile and online applications.

One popular program called “Quizzify” promises to save money, boost morale, improve health and engage employees by making learning about medical care fun and interesting. And, it promises to do this all without requiring any medical data from participants. Using a game-show contest format, the program asks participants to click through questions as they compete with co-workers for prizes. Not only do people get the chance to receive wellness information, but they also learn about taking care of themselves and even avoiding costly treatment when it may not be needed at all.

And, while this particular service is not free, it may offer a fun, refreshing approach to traditional wellness communication.

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Drugs Drive Rising Costs

prescriptionWhile all treatment costs have risen consistently in the past 2 decades, the pharmaceutical sector has put up some amazing numbers. In 2011 alone, Americans spent an average of $985 per person, approximately twice the amount spent in other developed countries for the same benefit. In 2015, aggregate prescription drug sales in the U.S. totaled $374 billion – $190 billion more than other industrialized countries would have spent for a similar population.

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How to Withstand a Road Trip

Remote road at dusk

Plenty of people are more than familiar with long driving commutes to work. But, what they may not realize are the negative effects that excessive sitting can have on their bodies. Any expert will tell you how important movement is to one’s cardiovascular health. So, when long driving commutes and desk jobs are combined, the risk of cardiovascular disease certainly increases.

When we sit, not only does the heart have to work harder to circulate blood and oxygen through our systems, but our hips also bend which shuts off the core and sends our bodies into a passive state relying on our structural system to hold us up. Over time, this can lead to spine compression and to your back going out.

So, how do you save your posture without having to find a new job? Experts suggest getting a standing or treadmill desk, if your employer allows. Otherwise, setting a reminder to get up and walk around every 30 minutes can help immensely. If you’re taking a driving vacation or sitting in the car for more than two hours, be sure to find a rest stop so you can walk around and stretch your legs or even do a quick set of kneeling lunges to loosen your muscles. It might also be wise to have an expert look at the seat of your car or your desk chair to make sure you’re doing everything you can to help your posture.

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Health Conscious Hotels

fitnessTrade associations report that to respond to growing requests from fitness-minded travelers, hotels are moving well beyond basic spas and fitness rooms. 84% of hotels offered fitness facilities in 2014, but the number of hotels offering in-room fitness equipment has doubled in the past 10 years. Some chains now offer rooms with a stationary bike, elliptical or treadmill plus free workout wear and sneakers delivered to your room. Yoga mats and videos, healthy minibars and room service menus including stir-fried veggies and tofu are growing trends.