Getting People to Use Telemedicine

ebso-mobile24/7 physician access by phone or video has the potential to do great things for health plans and consumers. Getting a doctor’s help without waiting in a medical office is a great convenience, especially if you’re traveling or your primary care physician is unavailable. The challenge, however, is that telemedicine does not sell itself – it needs to be communicated over and over again if we want members to remember they have this great, easy-to-use benefit instead of driving to an urgent care center. Technology is great, but it won’t activate itself. People are creatures of habit and it takes a good deal of effort to change behavior. Low tech tactics like email reminders, flyers or refrigerator magnets may just be what the doctor ordered when trying to drive home the benefits of telemedicine.

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Reference Based Pricing Gaining

ebso-rpbWhile plenty of folks talk about reference based pricing as though it’s a fad that has come and gone, we’re finding more interest from employers all the time. This may be because many like to brand it as another form of disruption, but regardless of how you brand it, reference based pricing is becoming a more important part of our value proposition all the time. It’s becoming more widespread because it enables a self-funded plan to limit costs to an extent that few other measures, if any, can match. This is primarily because by negotiating in advance with hospitals to accept a schedule of fixed payments for certain healthcare services, carrier-sponsored provider networks can be bypassed.

The fact is that while reference based pricing may be considered disruptive by many hospitals, it works. It is a transparent approach that can save a lot of money for self-funded health plans and their members. And finding ways to help self-funded employer plans provide high quality, high value healthcare to their members is our most important job.

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Women More Vulnerable to Stress

woman holding headA study of nearly 700 individuals with coronary artery disease has revealed that hearts in men and women react differently to a temporary reduction in blood flow to heart muscles, a common symptom caused by stress. While some men may experience an increase in blood pressure and heart rate, making their heart work harder, about 1 in 5 women experienced constriction in their smaller blood vessels, which can cause more serious heart complications. American Heart Association representatives recommend physical exercise as a way to manage mental stress. Exercise will make blood vessels dilate, counteracting the constriction seen by some of the women who participated in the study. Regular exercise, like a daily walk or run, can go a long way in helping us cope with mental stress.

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The Changing Definition of Wellness

wellness-programAfter decades of preaching to workers about the importance of staying fit and physically healthy, the term worksite wellness is beginning to mean much more to employers and employees alike. Leading companies are expanding their workplace wellness initiatives to address mental health and financial security – key components of their employee’s overall well-being that go way beyond physical health.

The National Business Group on Health shows that a majority of employers are addressing emotional and mental health as well as financial security as part of their overall well-being strategy. Other initiatives, such as support for community involvement and social interaction, are pointing to a growing trend of focusing on the entire person and not just physical health or fitness. Research is showing that addressing physical health is only one way to improve the workplace experience and reduce employee turnover.

More Choice Means Greater Satisfaction

While traditional wellness programs have been more “one size fits all” and lacking in personal appeal, some employers are encouraging employees to do the things they like to do by giving employees a flat dollar amount to spend on a gym or pool membership, personal trainer or other self-defined activity they find rewarding. Volunteering to help with community causes or enrolling in educational classes are not out of the realm of possibilities, since these activities can do a lot to help an employee gain a healthier perspective on work and life.

When choices are made by individuals and not for them, better decisions often result. As people share their experiences with others, the impact on a company’s culture can be extremely positive. Better well-being becomes an important priority for everyone and not just those who like spending time on treadmills or yoga mats. From the employer’s perspective, objectives can expand beyond healthcare cost savings and increased productivity. As an example, offering health coaching is a great way to focus on the needs of individuals rather than the group as a whole. It can help companies address emotional and mental needs as well as physical needs.

If worksite wellness is a priority for your organization, this might be a good time to review the goals of your program and then to make sure the activities you are offering are in line with those objectives. There is a lot more to be gained from worksite wellness than lower medical claim costs and redefining wellness may be just what your organization needs.

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It’s Never Too Early for Sunscreen

sunscreenThe American Cancer Society reminds us that more skin cancers are diagnosed each year in the U.S. than all other cancers combined. Most are caused by too much exposure to ultraviolet (UV) rays, most of which come from exposure to the sun. One thing to remember is that you don’t have to be spending a day at the pool to be at serious risk. Simply staying in the shade will make a huge difference. If you do want to catch some rays, slip on a shirt, wear a hat and apply sunscreen with a SPF value of 30 or more. UV blocking sunglasses will help protect the delicate skin around your eyes and help you avoid certain eye diseases as well.

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Jury deems Centura Health $230K surgical bill ‘unreasonable,’ awards $766

This article was published on June 21, 2018 on BenefitsPro, written by Greg Land. Photo Source: BenefitsPro.

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A Colorado jury declared a hospital’s billing unreasonable, turning aside its lawsuit demanding almost $230,000 from a patient whose insurer already covered the cost of her surgery.

The patient had already paid her deductible and her insurer had paid the hospital about $75,000, which an audit deemed the “reasonable value of the goods and services” she had been provided, her lawyer said.

Lead attorney Ted Lavender of FisherBroyles’ Atlanta branch, who represented the former patient with office partner Kris Alderman and Denver partner Frank Porada, said testimony in the case revealed just how murky hospital billing can be and how some patients are targeted for whopping bills to make up for those who pay substantially less for the same services.

“The hospital experts explained how the rates get set, and it ultimately devolved into this idea that paying patients have to pay more to make up for nonpaying patients, the uninsured, those on Medicare and Medicaid, who don’t pay full price,” Lavender said.

In his client’s case, records showed that surgical spinal implants cost the hospital about $31,000.

“They turned around and charged $197,640 for those items on the hospital bill,” said Lavender. “That is a 624 percent markup.”

The hospital is represented by Traci Van Pelt, Michael McConnell and David Belsheim of Denver’s McConnell Fleischner Houghtaling.

Van Pelt said they will file posttrial motions and appeal the verdict.

The case involved back surgery performed on Lisa French in 2014 at St. Anthony North Health Campus, north of Denver. Hospital filings said French’s surgery was to relieve back pain and was “considered elective.”

French’s employer had a self-funded ERISA insurance plan, and she was told prior to surgery that she would owe $1,336, of which she immediately paid $1,000.

French’s contract included phrasing that she “understand[s] that I am financially responsible to to the hospital or my physicians for charges not covered or paid pursuant to this authorization.”

St. Anthony’s billed her insurance plan $303,888 after the surgery and for two presurgical consultations based on its “chargemaster” billing schedule, an industrywide practice whereby providers list all the prices they charge.

As Lavender explained, French’s employer’s insurance plan contracts with a health care consulting firm, ELAP Services, which audits claim costs and negotiates with providers for self-funded insurers. On its website, ELAP says it “assists in plan design and jointly establishes limits for payment of medical claims that correlate to the providers’ actual cost of services.”

ELAP audited the fees St. Anthony’s charged French and determined that her actual charges came out to about $70,000, Lavender said. Between her co-pays and the insurance plan, St. Anthony’s was paid $74,597.

St. Anthony’s parent company, Centura Health Corp., sued French in state District Court in Adams County, Colorado, seeking an additional $229,112 in 2017.

ELAP provides legal representation to clients facing suit pursuant to its services, and Lavender, Alderman and FisherBroyles Denver partner Frank Porada were assigned French’s defense.

According to defense filings, Fishers contract with St. Anthony’s contained no stated price and was thus ambiguous.

The hospital was already paid the reasonable value for the services, according to a defense account. The chargemaster rates are “grossly excessive and defendant had no choice but to sign the Hospital Service Agreement, making them unconscionable” and thus unenforceable, the defense said.

During a six-day trial in Brighton, Colorado, before Judge Jaclyn Brown of Colorado’s 17th Judicial District, Lavender said the entire dispute was over the prices and methodologies medical providers use.

“We had one expert, and they had three,” said Lavender. “They spent $100,000 on experts.”

“The reality is that there’s nobody to say how much they’re charging is reasonable,” Lavender said.

The jury made that determination for French on June 11, answering “no” when asked whether her bills were reasonable. The panel agreed she had a contract with St. Anthony’s to pay “all charges of the hospital,” but that those charges were “the reasonable value of the goods and services provided,” not those set by the hospital’s chargemaster.

The jury awarded the hospital $766.74.

The hospital’s attorneys did a good job explaining how hospitals have to shoulder the burden for underpayments and nonpayment by other patients, Lavender said.

“They know they’re not going to collect from everybody,” he added. “But in the end, it just reveals how antiquated and nontransparent the system is, because nobody understands the bill.”

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IRS Penalties Are Being Issued

The Internal Revenue Service is finally issuing penalty letters to employers who failed to provide health coverage, in compliance with the employer shared responsibility provisions of the ACA, for the 2015 tax year. Some letters may describe a no coverage excise tax while others may assess an excise tax for failure to provide “adequate or affordable” coverage. The notices are catching many employers off guard because issuance of these letters was delayed several times.

Those who receive a letter describing the specific violation, could be liable for penalties ranging from $2,080 to $3,480 per affected employee, depending on the violation and the plan year involved. Regulatory experts recommend that employers refer to the data submitted on forms 1094-C and 1095-C and respond to the IRS on time, even if they don’t believe the tax is owed.

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Robotic Coronary Intervention

doctor-holding-heartResponding to an anticipated shortage of cardiologists and other specialists, Mayo Clinic is using a $3.3 million charitable grant to conduct a preclinical study enabling doctors working at a remote location to use telemedicine to place heart stents by guiding a robotic arm. The study, being done in collaboration with a robotic equipment manufacturer, is being referred to as “telestenting” because it takes telemedicine to a new level.

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Apple to Introduce Employee Health Clinics

healthEven though on-site clinics are not revolutionary, the announcement by Apple seems to have captured more attention because of the excitement generated by newsmakers Berkshire Hathaway, JP Morgan Chase and Amazon. Apple, currently working to add medical personnel, expects the clinics to be available at their Cupertino, California headquarters this Spring.

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4 Ways Social Media is Changing the Healthcare Industry

stethescope for healthcare

This article was published on May 30, 2018 on Businessmole, written by Sam Allcock.

Social media and healthcare may not seem like two things that should go hand in hand. Social media is all about sharing information whereas the health sector is mostly about privacy. So, how is social media changing the healthcare industry?

Like most industries, healthcare is moving to be more digital. The main reason being that the general population is becoming increasingly more ‘plugged in’, therefore to reach prospective clients, those in healthcare need to move with the times and get online.

Social media isn’t just an outlet to share pictures of food, funny videos or stories of your day, but it in fact is a powerful communication tool that is shaping the success of many businesses.

Here are just a few ways in which social media is changing healthcare:

Improving the physician-patient relationship

Social media has provided the opportunity to develop relationships between patients and physicians. Instead of only being able to communicate with a patient for the 10 minutes given for an appointment, doctors are now able to share valuable health information on their social media platforms. This helps physicians further improve the lifestyle choices of their patients, through reinforcement of health studies, research and messages on this media patients will be exposed to health information on a daily basis.

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Social media also helps to expand the reach of information: there will be patients that only visit their local GP or hospital very occasionally, meaning their exposure to important health information is limited. Through the sharing of these messages on social media, members of the public that would otherwise miss these important notices are exposed to them.

Similarly, it helps develop trust between patient and consultant. By allowing the physician to share up to date health research and stories on their accounts, patients can be confident that their physician is ahead in their education and patient care. Not only does this build confidence with existing patients but is excellent for ‘word of mouth’ referrals. People are likely to share what the doctors are putting on their feeds, this will then be seen by a new circle of people and is likely to influence their healthcare decisions.

The example below shows an oncologist sharing news about a new cancer treatment, this then has been retweeted by three separate accounts. This news is relevant to the industry that Dr. Greg Wilson is in, making him appear to be up to date with developments in his field but also, by sharing it on Twitter, he has made that information available to other accounts who then have shared this information to their own following, further spreading the news and his name.

In a 2016 Forbes article, it was mentioned that “Social media will be THE place patients go to for information on doctors and hospitals and will be a major referral source for healthcare providers.”

Patients using social media to make a decision

In a similar way to people using social media reviews to choose a restaurant, more and more people are turning to social media before they make a decision about a healthcare provider. 41% of people say social media would affect their choice of a specific doctor, hospital or medical facility.

The image below shows three negative reviews of a GP surgery and outlines issues people have had with that particular facility. A new patient may look at these reviews and make the decision not to register with that particular doctors’ surgery.

People are able to research a healthcare provider before making a decision. By being able to read real life reviews they can ensure that they are making an informed choice when they choose a medical facility.

These reviews can also help to improve the quality of these services. If enough people are leaving feedback about any poor or unacceptable aspect of a business, changes are likely to be made to improve them.  Even if patients are not using social platforms to leave reviews, healthcare providers are able to distribute surveys or run polls via social media in order to obtain feedback on their services and then use this data to make changes to improve quality.

Raising Awareness

Social media is an effective platform to share information with the population and raise awareness about important subjects. Nothing is more important than health concerns. By creating shareable content healthcare providers are able to have their important subject spread wider, and faster, than if they used traditional media.

Social media can be used for targeted local campaigns. For example, every year the NHS call for vulnerable groups and those working within the healthcare sector to get their ‘flu jabs, you can usually see leaflets in the doctors surgeries and banners in local pharmacies. However, these marketing materials are easy to ignore when you are out and about. Social media targets the public when they are unlikely to be focusing on anything else.

South Tees Hospitals NHS Foundation Trust ran a campaign through October, 2016 called #Flutober. The campaign was aimed at the staff of these hospitals and involved a set of emotive pictures of vulnerable patients who would risk further harm by contracting ‘flu. This risk would be reduced by those working at the hospital getting the flu jab.

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As a result of the campaign 600 more staff, compared to the same period in the previous year, were vaccinated.

Due to a lack of funding and tight marketing budgets, marketers in this industry should ensure that healthcare call tracking software is applied to their campaigns as it will allow marketers to track which campaigns are bringing in the most leads and, as a result, they can determine which have been successful in raising awareness and which platforms have the most engagement. This can help marketers allocate budget effectively to achieve the greatest results with the budget provided.

Engaging with patients in real time

Social media has the benefit of being able to reach more people worldwide than most other media, according to numbers from Statista, the number of social media users worldwide is set to reach 2.62 billion in 2018. This reach is useful when there are global health crises as it provides a platform for sharing important information about epidemics. It also has the advantage of being a fastmoving media, there is no waiting for material to go to print or for footage to be edited, and it works in real-time.

An example of this in action was the Zika outbreak in Brazil in 2016. This virus is spread through mosquito bites and exposure to this virus while pregnant can produce life-altering birth defects. Due to the speed at which the disease was spreading in 2016, and being so close to the Rio Olympics, which were forecast to bring thousands of tourists to the country, it became a global issue. Using social media, healthcare providers, news outlets and charities were able to create content and spread important information about the virus, such as how to prevent it from spreading, how to avoid mosquito bites if you are traveling to the infected area, risks for vulnerable individuals such as pregnant women and symptoms to look out for.

The Centers for Disease Control and Prevention (CDC) won ’Social Media Campaign’ category of Ragan’s 2017 Health Care Marketing & PR Awards for their campaign during this health crisis. The campaign produced more than 6,800 messages to deliver information about prevention, updates on the outbreak and news of the CDC’s response. The videos were published 92 times across the CDC’s social media accounts and were viewed more than 680,000 times.

On a smaller, local level, GP surgeries and other medical facilities can update patients on waiting times, staff absences and closures in real-time through their social media pages, see the example below:

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Advice of this sort stops patients from making unnecessary trips only to discover they can’t see their preferred doctor or that the waiting time is over an hour; it also allows healthcare providers to keep patients informed even when they are out and about.

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