Drug Cost Information Bills

In late Fall, the President signed two bills that should make it easier for pharmacists to help customers find the lowest cost, appropriate medications. The “Know the Lowest Price Act of 2018” and “Patient Right to Know Drug Prices Act” bills are designed to crack down on “gag clauses” that prevent pharmacists from telling patients about more affordable options for prescription drugs. Having developed a “drug pricing blueprint” to promote greater price transparency, the President praised these bills as representing significant steps in that direction.

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Getting Creative Can Attract Talent

men shaking handsWith unemployment for college-educated people age 25 and above at just 2.2%, it’s been a long time since we’ve seen a jobs market this tight. To attract and retain workers in this environment, growing companies are offering more than just competitive health benefits, and this is especially true for smaller companies forced to compete with larger companies.

Executive search firms have shared examples of employers going above and beyond their health plan by offering additional compensation to cover a candidate’s projected out-of-pocket medical expenses going forward. Technology-related firms in competitive markets are adding wellness benefits like on-site clinics or pre-arranged access to nearby fitness centers. For early to mid-career employees, companies are expanding their family leave or flex-time policies to provide easier transitions for young parents returning to work.

Flexibility and More

Whether it be more paid time off or arranging your work day to meet outside demands on your time, flexibility is becoming increasingly important, especially when you’re dealing with millennials or X-ers. Equally important to young workers is the culture present at an organization and the opportunity to make a difference – to know that what they are doing is helping their community or the world at large.

From unique apprenticeship programs at manufacturing and industrial companies to help with retiring outstanding student debt, more employers are looking for creative ways to gain an edge that will appeal to qualified, prospective employees. In a really tight job market, it pays to be creative.

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How Is Your Health Plan Responding to Millennials?

You might be surprised to hear that millennials represent one third of the American workforce, but Pew Research Center confirms it. If your health benefit plan hasn’t adapted to the needs and lifestyles of these young people, you’re missing an opportunity to boost retention, build loyalty and enhance wellness.

For starters, it’s important to realize that 45% of young adults age 18 to 29 do not have a primary care doctor. They do, however, have a smartphone and you can bet they use it to access the internet constantly. With online sources like WebMD offering so much healthcare information, it’s no wonder that millennials are likely to self-diagnose and even treat one another at home before seeing a doctor. If young people can find much of the healthcare information they need in the palm of their hand, you can bet they expect to find benefits and enrollment information easily accessible as well.

They Want Information Now
Just like so many of us who have come to expect an immediate response to everything, millennials who do need a doctor expect the visit to happen quickly and easily. According to PNC Healthcare, this explains why 34% of millennials prefer to use a retail clinic rather than waiting several days to see a primary care physician in their office – a rate twice as high as baby boomers. It would also seem to point to an increased use of telemedicine.

Cost Matters to Millennials
Millennials face more than their fair share of financial pressures and take their finances seriously. Surveys show they are more willing to request a cost estimate prior to choosing a treatment option than baby boomers or seniors ever were. This not only makes cost transparency tools important, but it’s a very positive trend that should contribute to lower claim costs going forward.

Whether it be treatment options, provider access or cost of care, the demand for health and benefit plan information will only increase as more and more millennials enter the workforce. In order to respond to change, self-funded employer groups will need the resources of an independent TPA that can combine the right plan design with more personalized, interactive communications and more innovative ways for younger employees to access the more personalized care they will need going forward.

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How Can Your Health Plan Be More Personal?

health-planInvestment bank Morgan Stanley recently hired a Chief Medical Officer. General Motors made the Detroit-based Henry Ford Health System the only in-network option for 24,000 salaried employees in southeast Michigan. And, Apple joined many other large employers in using on-site clinics to provide more personalized care. These tactics are being used to address a combination of risk factors contributing to costly chronic conditions like diabetes, heart disease and obesity.

Filling Voids in Wellness Programs
We all know how hard it is to change lifestyle habits. While traditional wellness programs can offer great tools and improved access, more and more employers are realizing that to boost engagement and keep it from fading over time, you must tailor a program to the needs of each individual.

This level of involvement, sometimes referred to as condition management, includes more personal involvement and communication. Providing guidance and support on nutrition, exercise, stress management and other concerns can help at-risk employees overcome the challenges that have kept them from enjoying their best life.

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Benefits Before Pay

benefitsThe American Institute of CPAs reports that its poll of 1,100 working adults revealed that by a 4 to 1 margin, workers would choose a job with benefits over an identical job that offered 30% more salary without benefits. Employed adults estimate that benefits represent about 40% of their total compensation. When asked which benefits are most valuable over the long run, 56% said a 401(k) match or health insurance while just over 30% said a pension.

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Restricting Provider Choice

medical-moneyWalmart is requiring employees to use certain hospitals for costly procedures, such as spine surgeries. Requirements like this are typically accompanied by an assurance that the plan will cover the full cost of the procedure, including travel, when applicable. In an effort to make sure plan members receive high quality, cost-efficient care and weed out unnecessary costly procedures, Ford struck a single-hospital deal earlier in 2018 and the State of North Carolina recently announced its intention to take similar cost-cutting measures for its 727,000 members.

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Tracking Sleep

stethescope for healthcareIn order to address a sleep shortage that is hurting productivity for U.S. businesses, the American Academy of Sleep Medicine has introduced an online wellness program to help employees track the quantity and quality of their sleep. Employees log their time online or upload data from a fitness tracker such as a Fitbit. With the CDC linking sleep to chronic illnesses such as Type 2 diabetes, heart disease and depression, researchers hope to help employees set a goal and improve the quality of their sleep.

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Apple Watch & Joint Replacement

ebso-mobileTechnology giant Apple reported recently that thousands of hip and knee replacement patients are using Apple Watches and a new health app, MyMobility from Zimmer Biomet, to share health data with their surgeons during treatment and recovery. The app is being used to provide physicians with data about the patient’s heart rate, number of steps taken and time spent standing continuously, rather than having to rely on traditional in-person visits.

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How Should Your Plan Address Medical Marijuana?

medical-marjuanaThere is a lot of misinformation surrounding medical cannabis, which can make it difficult to establish a plan document that accurately outlines its use. One particular obstacle is the lack of verified and sourced research regarding the medicinal use of cannabis, creating confusion around what the drug can and should be used for.

To address this confusion, benefit plans should limit coverage to areas where existing evidence supports the use. Create a benefit description that reflects approved applications determined by your state, while also limiting the care option to those members whose previous treatment options have failed. Experts agree that plan documents should clearly indicate that medical cannabis will not be authorized as a first line therapy.

Other parameters can be set, such as financial limitations within a certain time period, eligible products and dosages and even eligible suppliers. When addressing cost considerations, it’s important to know that medical cannabis should not be viewed as an alternative to prescription painkillers and opioids, but rather an add-on which does not eliminate those other costs.

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States Crack Down on Balance Billing

medical-moneyCurrently, only 21 states offer some protection against balance billing and most existing laws apply to emergency services required from out-of-network providers. Few, if any, address balance bills received for treatment by an out-of-network provider in an in-network hospital. In Pennsylvania, the Governor and General Assembly have introduced two bills aimed at taking consumers out of the middle of the reimbursement process. These bills have come after several other states have adopted more comprehensive laws that prohibit balance billing entirely.

Some measures addressed in Connecticut, New York, Maryland, Florida and New Jersey include:

  • Protections in emergency department and in-network hospital settings
  • Prohibiting providers from balance billing and requiring carriers to hold their members harmless
  • Adopting reimbursement rate standards and a payment dispute resolution process
  • Applying these laws to all types of managed care products, including HMOs and PPOs

The goal of the proposals is to keep covered persons out of the middle of carrier-provider payment disputes. In non-emergency procedures, healthcare facilities in New Jersey are required to disclose whether they are in-network and advise the covered person to ask if their physician is in or out-of-network. Individual healthcare professionals must inform the patient if they do not participate in the person’s plan network and provide a billing estimate and applicable CPT codes. With healthcare costs continuing to rise and a lack of federal regulations, we can expect more states to take measures to protect healthcare consumers. We will strive to keep our clients informed as changes develop.

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