The Altarum Center for Sustainable Health Spending reports a significant drop in health hiring, pricing and spending during the first five months of this year. On average, 22,000 jobs per month were added by hospitals and ambulatory care facilities, compared to 32,000 per month during the same period in 2016. While the healthcare sector continues to be the biggest contributor to overall U.S. job growth, Founding Director Dr. Charles Roehrig expects the 3-year run of greater than 5% growth in overall health spending to end, mostly due to uncertainty over efforts to repeal and replace ACA and a smaller increase in overall spending by consumers.
A recent article in The Self-Insurer magazine described a very simple, straightforward approach to combating the rising cost of healthcare. It featured an approach a law firm is using to encourage and incentivize employees to utilize more cost-efficient healthcare providers.
The firm provides its members with the data needed to compare costs for various procedures, then shares the savings that accrue to their self-funded health plan when a more cost-efficient provider is selected. In some cases, members have received checks for hundreds and even thousands of dollars. Everyone wins according to the CEO and in the process, members learn that shopping for healthcare can be the responsible and rewarding thing to do.
In a previous newsletter, we discussed bundling introduced by Medicare which focuses on orthopedic and cardiac procedures. Through the mandatory initiative for comprehensive care for joint replacements (CJR), which became policy in 2016, some 800 hospitals are participating in the program.
While some sources report the results of bundling as mixed, Medicare reports that joint replacement payments increased by approximately 5% nationally, but decreased 8% for BPCI participants. One large health system achieved a 20.8% episode decrease and another reported a significantly shorter prolonged length of stay – a sign of fewer complications resulting from surgery.
Providers, both acute and post-acute, shared in the savings and indications are that post-acute savings were achieved because their care was bundled, placing these providers at risk. Even though efforts to repeal and replace or modify the Affordable Care Act are on hold, more healthcare providers and payers can be expected to embrace bundling going forward.
The State of Benefits report from BenefitFocus shows that workers under the age of 26 are investing 20% more of their salary in HSAs than other generations. This is certainly due to the fact that nearly half have elected to enroll in high deductible health plans in 2017. While PPO plans remain very popular, especially among older adults, employee contributions to HSAs and FSAs are rising. A growing interest in savings among young people is another factor contributing to the increased popularity of HSAs.
The IRS and Department of Health and Human Services recently released new limits for contributions to HSAs and Health FSAs for 2017. Contributions by individuals to HSAs cannot exceed $3,400 in 2017, with the maximum family contribution remaining at $6,750, the same as 2016. Once again, a $1,000 catch-up contribution also applies.
Health FSA limits for 2017 have been increased by $50 from $2,550 per employee to $2,600. Health FSA transportation fringe benefits for parking, transit passes or vanpooling are remaining the same this year, with a limit of $255 for each.
The IRS began indexing affordability safe harbors to inflation last year. This year, minimum annual deductibles for High Deductible Health Plans (HDHPs) remain unchanged at $1,300 for individuals and $2,600 for families, with required out-of-pocket maximums remaining at a minimum of $6,550 for individuals and $13,100 for families.
The U.S. healthcare system is changing as many consumers are trying to be proactive, make financially smart and healthy choices and find more ways to get a better handle on costs. Taking charge of your health and saving money on medical expenses can truly begin with knowing how to talk to your doctors and medical providers. Here are tips to maximize communication:
- Write down the top problems you are experiencing to help your doctor focus on what to treat first.
- Bring a list of all current prescription medications as well as over-the-counter medications, vitamins or supplements and include dosage and how often you take them.
- Keep a handy record of recent test results, lab reports, surgeries and other relevant health information.
Costs should also be a part of every conversation and patients should be not be afraid to bring up the subject. While doctors are typically not afraid to discuss costs, they simply may not know exact costs or projected out-of-pocket expenses.
Another area of concern is the rising cost of prescription medications. If your doctor does not bring up a generic alternative, then you should. Here are ways to save on prescriptions:
- Skip chain drugstores and consider shopping at a warehouse store for lower prices.
- Go local to your neighborhood pharmacist and ask them to beat a competitor’s price.
- Know that some chain and big-box stores offer common generics at low prices for people who pay out-of-pocket and not with their insurance.
- Ask your pharmacist if any discounts, programs, cards or coupons could make your price lower.
- For long-term drugs, consider buying a three-month supply so you pay one co-pay rather than three.
Remember that walk-in clinics are suitable for common procedures like flu shots, sports physicals and minor injuries and they are always more cost efficient than emergency rooms. Staying healthy is still the optimal way to save money on healthcare, so take time for your own health. Know your blood pressure, pulse, cholesterol and family medical history and always make efforts to control weight.
Whether it comes as a shock or not, it’s a simple truth that the majority of employees don’t fully understand their health benefits. And, even if the benefit managers fully understand, sometimes they don’t have the tools to administer the kind of change needed to actually reduce healthcare costs.
Alithias is a platform that allows EBSO to give providers, employers and patients everything they need to take control of and better understand healthcare benefits. Sure, there are plenty of “transparency tools” out there that promise to make healthcare easier to understand and more affordable while also helping to engage employees. But, the people behind Alithias know that transparency tools have a utilization rate of less than 5%. That’s why Alithias is different – it offers features that truly help people “get it” and get the benefits assistance they need.
Compare Actual Prices
Something the average patient does not realize is that more than 30% of healthcare costs are “shoppable”. Alithias’ technology lets patients begin a search by first choosing a common medical procedure within a certain radius of their zip code. The search results then list options of available physicians or groups along with their location, average price for that chosen procedure and quality ratings. And, as if that weren’t simple enough, the patient will also see a detailed description of the procedure and the option to start a live chat with someone who’s ready to give them online support if they need it.
We believe that offering a personal relationship or live help might just be the only approach to ensure plan members seek appropriate care. Because, let’s face it, when people don’t understand their healthcare sometimes their only solution is to avoid it all together, especially when the fear of the unknown cost kicks in. Alithias uses assigned individuals, called Care Navigators, that are there to answer questions that patients don’t know the answers to and teach them what they need to know about healthcare, while also helping them find the best costs or the best doctors. With this kind of help, employees become more educated and involved in their own healthcare, ultimately making smarter decisions and saving on costs. In fact, the average savings for plan members using a Care Navigator is greater than $1,000 per procedure!
These are just two of the beneficial features Alithias can offer. If you’re struggling to give your employer groups and employees the benefits help they need, it’s time you talked to EBSO about Alithias.
The article below is from benefitsPro.com, written by Michael Levin on April 18, 2017.
Now that the American Health Care Act has failed to advance, small businesses, and the brokers who serve them, are looking for ways to manage health care costs within the status quo of the Affordable Care Act (ACA).
As it did with individuals, the ACA community rating methodology benefited some while burdening others. The community rating methodology spreads the costs associated with the differing risk of group (or individual) profiles over the entire risk pool. In the case of small groups, older and/or sicker groups benefited from lower rates while younger and/or healthier groups pay more. Those small groups for which this “peanut-buttered” risk solution has resulted in increases to their health insurance may want to look at level-funded plans, an alternative to fully-insured plans.
But what if the group has a really bad year? In a bad year, the stop-loss kicks in to protect the employer. Again, the entire concept of the level-funded plan is that the employer never has to pay more than the level monthly amount. But as an underwritten plan, it is reasonable to expect an increase — perhaps even an untenable increase — in the level-funded plan. Here is where it really gets interesting. Today, in such a situation, the group can simply revert back to a community-rated ACA plan. Here, small groups have an advantage that large groups do not: they can revert back to a non-underwritten plan; one that is likely to be to their financial benefit.
So, for small groups, the question is why not explore a level-funded plan? With savings of up to 30 percent, protection against extraordinary costs, and the ability to fall back on an ACA plan, there is very little reason not to do so.
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.
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.