House Passes Legislation Protecting Access to Affordable Health Care Options

Press Release from Education and the Workforce Committee Chairwomen Virginia Foxx on April 5, 2017.

The House today passed the Self-Insurance Protection Act (H.R. 1304), legislation that would protect access to affordable health care options for workers and families. Introduced by Rep. Phil Roe (R-TN), the legislation would reaffirm long-standing policies to ensure workers can continue to receive flexible, affordable health care coverage through self-insured plans. The bill passed by a bipartisan vote of 400 to 16.

“By protecting access to self-insurance, we can help ensure employers have the tools they need to control health care costs for working families,” Rep. Roe said. “Millions of Americans rely on flexible self-insured plans and the benefits they provide. Federal bureaucrats should never have the opportunity to limit or threaten this popular health care option. This legislation prevents bureaucratic overreach and represents an important step toward promoting choice in health care.”

“This legislation provides certainty for working families who depend on self-insured health care plans,” Chairwoman Virginia Foxx (R-NC) said. “Workers and employers are already facing limited choices in health care, and the least we can do is preserve the choices they still have. I want to thank Representative Roe for championing this commonsense bill. While there’s more we can and should do to ensure access to high-quality, affordable health care coverage, this bill is a positive step for workers and their families.”

BACKGROUND: To ensure workers and employers continue to have access to affordable, flexible health plans through self-insurance, Rep. Phil Roe (R-TN) introduced the Self-Insurance Protection Act (H.R. 1304). The legislation would amend the Employee Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code to clarify that federal regulators cannot redefine stop-loss insurance as traditional health insurance. H.R. 1304 would preserve self-insurance and:

  • Reaffirm long-standing policies. Stop-loss insurance is not health insurance, and it has never been considered health insurance under federal law. H.R. 1304 would reaffirm this long-standing policy.
  • Protect access to affordable health care coverage. By preserving self-insurance, workers and employers will continue to benefit from a health care plan model that has proven to lower costs and provide greater flexibility.
  • Prevent bureaucratic overreach. Clarifying that regulators cannot redefine stop-loss insurance would prevent future administrations from limiting a popular health care option for workers and employers.

For a copy of the bill, click here.

For a fact sheet on the bill, click here.

WhyTPAvideoCTA

The End of the American Health Care Act (AHCA)

Instead of preparing for the changes that were expected from the American Health Care Act (AHCA), employers now need to continue or resume their efforts to maintain compliance with the ACA. As House Speaker Ryan said, “I don’t know what else to say other than Obamacare is the law of the land. It’ll remain law of the land until it’s replaced,” he said. “We’re going to be living with Obamacare for the foreseeable future.”

Determining where we go from here seems to be anyone’s guess, but after watching the industry ebb and flow for decades, our best advice is to stay calm and carry on as self-funded health plans continue to cover an estimated 75% of the U.S. workforce.

ACA The Law of the Land

Until the Republican majority decides to try again or Obamacare implodes, as President Donald Trump and others say is inevitable, individuals and employers with 50 or more full-time employees will have to live with the Affordable Care Act. Many who thought the American Health Care Act (AHCA) meant the certain loss of coverage made possible by the ACA can breathe easier. Providers and employer groups, many of which have adopted self-funding in order to better cope with the added regulations of Obamacare, can take comfort in the fact that drastic change has been avoided, at least for the foreseeable future.

EBSO will be monitoring the events on Capitol Hill and will continue to provide updates as things arise. As always, thank you for being a valued Client and/or Business Partner.

obamacare-drives-interest-in-selffunding

Digital Marketing Delivers Results for EBSO and Other TPAs

The article below is featured in Ernie Clevenger’s 2/6/17 MyHealthGuide Newsletter, News for the Self-Funded Community. MyHealthGuide Source: Barcelona Creative Group, 1/30/2017

While personal relationships have long been the foundation for Third Party Administrator business strategies, many TPAs are now discovering the proven benefits of  adding a strong digital marketing program such as those developed and supported by Barcelona Creative Group.

ebso-mobile-marketing-blogWith a business model based on creating and nurturing strong personal relationships, most TPAs have been somewhat hesitant about pursuing digital marketing strategies.

The influx of “millennials” now populating the TPA market as decision makers, employees and plan members has altered this dynamic. TPAs are discovering that this younger, 25-34-year-old audience prefers to utilize digital and social media channels for information on health plans and benefits coverage. They also prefer useful content over promotional ads and want to access their information via mobile devices – with content delivered in easily digestible chunks and formatted for viewing on smaller screens.

For years, Barcelona Creative Group (BCG) has been working with its TPA clients to incorporate advanced digital strategies into their existing marketing programs. Interactive websites, blogs, online videos, email marketing, mobile applications, paid search and social media postings on sites such as LinkedIn, Twitter and Facebook are generating increased  interest from this younger demographic. These digital strategies have also significantly enhanced TPA brand awareness and are delivering quantifiable results.

Establishing an Online Presence

“In 2016, every one of our TPA clients saw a major increase in mobile traffic to their websites of from 28 to 46 percent. To maintain this growth and expand our capabilities in this key area, we’ve added new team members who bring a wide range of digital and social media expertise to our creative endeavors,” said Juli Barcelona, president and COO of Barcelona Creative Group. “When combined with our 20+ years of experience serving the TPA industry, these added resources allow us to maximize our clients’ online presence and build awareness and interest in the services they provide.

“

Further, digital marketing can be less costly than more traditional advertising and captures valuable viewer data including contact information, business profiles and areas of interest. Outgoing digital media and social postings can also be targeted to reach a specific demographic, such as agents or brokers in a defined state or region.

According to Tom Barcelona, founder and CEO, program success is about more than just utilizing digital media. “It’s about building a cohesive brand with a common look, feel and message that runs throughout each web page, white paper, blog/social media post, sell sheet and proposal,” he states. “We work to ensure that all of these media are used in concert to position the TPA as an authority and make them easily recognizable, no matter the digital vehicle. No longer are big carriers the only online presence for health benefits information.

“

Brooks Goodison, president of Diversified Group in Marlborough, CT, had a specific goal in mind when working with BCG on their digital strategy. “We want to be widely known as self-funding experts and trusted benefit advisors,” he states. “The branding and digital marketing initiatives developed and implemented for us by Barcelona Creative Group have helped us  establish a strong and far more visible presence in the marketplace. In fact, brokers have told us that they’re seeing us everywhere.”

“We consistently get positive feedback from employers and brokers about our website and recently signed a stop loss carrier who was able to find us through an online search,” says Bruce Flunker, president of EBSO, Inc., a national TPA with sites across the U.S.

“The digital strategy we’ve developed with Barcelona Creative Group has enabled us to keep our widespread internal staff informed, while delivering qualified leads for our organization,” added Cindy Sheffield, CEO of EBSO, Inc.

About Barcelona Creative Group

Barcelona Creative Group has been supporting some of the most successful members of the TPA community for over 25 years by unleashing the power of creativity to build brand awareness and deliver proven results. Barcelona Creative Group – Driven by the belief that creative is not a department, that all media is social and that passion never punches a clock.

ebso-self-funding-works

Avoid Potential Penalties with EBSO’s Legal Guidance & Support

ebso-aca-comliance3-blogManaging an employee health benefit plan is not easy given the numerous reporting and compliance challenges that exist today. With the landscape of Health Care Reform constantly changing, there can always be “gray areas” and potential penalties looming.

EBSO offers Legal Guidance & Support Services as part of their Compliance Management Solutions. These services and tools give support for the complexities of ACA compliance, employment law (ADA, FMLA, etc.), ERISA, GINA, HIPPA and other benefit regulations. Services can vary based on group size and include, but are not limited to, free legal advice and online training for employees. All of which are designed to help organizations save time and money.

As a full-service third party administrator (TPA), EBSO offers all the ACA compliance resources necessary in today’s regulatory environment – from a comprehensive range of Health Care Compliance Management Solutions for our self-insured medical administration clients to a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered.

With all these options, it’s time you trust EBSO to be your compliance expert! To learn more and view a full list of Standard Compliance Services we offer, visit our website at: http://www.ebsobenefits.com/compliance-management.html.

Trusting Your ACA Compliance Management to EBSO is a Sure Thing

ebso-aca-comliance-blogThese days, managing an employee health benefit plan is NOT just that – companies face numerous reporting and compliance challenges that are continuously changing, which, in turn, has changed the game. And, the Affordable Care Act (ACA) has only upped the ante.

At EBSO, we have a full-time Compliance Department helping our clients with these challenges, guiding them through the rapidly changing ACA requirements and avoiding costly penalties. Our Standard ACA Compliance Services include your basic plan General Notice Requirements as well as mandated ACA reporting techniques and fees. From the Children’s Health Insurance Program (CHIP) Reauthorizations Act of 2009 to Patient-Centered Outcomes Research Institute Fee (PCORI) calculation, our health care reform compliance services help ensure that self-funded employer groups stay ahead of the game.

As a full-service third party administrator (TPA), EBSO offers all the ACA compliance resources necessary in today’s regulatory environment – from a comprehensive range of Health Care Compliance Management Solutions for our self-insured medical administration clients to a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered.

With all these options, trusting EBSO to be your expert is a safe bet! To learn more and view a full list of Standard Compliance Services we offer, visit our website at: http://www.ebsobenefits.com/compliance-management.html.

EBSO Offers ACA Reporting Services For All Health Plans

ebso-aca-blogThere are numerous reporting and compliance challenges that can make managing a health benefit plan quite perplexing. As a full-service third party administrator (TPA), EBSO provides a comprehensive range of Compliance Management Solutions for self-funded health plans they administer, such as:

  • Standard Compliance Services
  • ACA Reporting Services
  • Legal Guidance & Support Services

EBSO Excels in ACA Reporting
Since many employers are not fully prepared for the complex ACA data gathering and reporting requirements that exist today, EBSO also offers a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered. These services include options such as:

  • Reporting 6055 – self-insured (NON-ALE)
  • Reporting 6056 ALE not self-insured
  • Reporting 6055 & 6056 – ALE who are also self-insured
  • Populate 1094 and 1095 forms

EBSO offers all of the compliance resources necessary in today’s regulatory environment. With all these options, it’s time you trust EBSO as your ACA expert! To learn more, visit our website at: http://www.ebsobenefits.com/compliance-management.html

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

EBSO’s Mobile App Is Here!

ebso-mobile-imageMobile devices are the fastest growing medium for accessing healthcare data. With EBSO Mobile, your employees can now access a plethora of services 24/7 – right from their phone. EBSO Mobile puts our most popular online features right at their fingertips:

  • Look Up Claims
  • View Member ID Cards
  • View Benefits and Coverage Information
  • And More!

EBSO Mobile Is Safe & Secure

You must always sign in with your Username and Password to access the features in the app. Without that information, no one can reach your personal data, keeping it safe.

Please Note: You must sign in to access the app’s features. Only plan members whose employers use EBSO Online are allowed to Login and use the app. Once you have downloaded the app, simply use the same login information you have for EBSO Online.

Getting started is easy – simply click here to find the EBSO Mobile app for Apple or Android devices.

EBSO Mobile is just another example of how EBSO provides Benefit Solutions for Every Client, Every Situation, Every Day!

Will Mobile Enrollment Become the Standard?

mobileThe days when employers worried about workers who lacked a home computer with internet access have come and gone. Today, more employers are concerned with how to enable their workers to make benefit elections on their smart phone or mobile device.

It’s not surprising when you realize the speed at which the mobile revolution is taking hold. When you hear that 13 million new iPhones are sold on the first weekend they are released, it’s not hard to believe that 70% of working age adults possess a smart phone or tablet with internet access. As these devices become more and more powerful and displays become larger and easier to read, you have to believe that it won’t be long before email and printed handouts are replaced by mobile enrollment.

ebso-self-funding-works