Healthcare Consumers About to Have Their Day

ebso-giantsFrom Amazon, Berkshire Hathaway and JP Morgan to Walmart and Humana – disruption is all around us. The future of our healthcare system is unfolding right before our eyes and regardless of how this giant chess match turns out, health plan participants just may be the biggest winners.

The Retail Effect
While many healthcare plans have done well under Obamacare, they need to review what many retailers have experienced since Amazon began building its Prime subscriber base of 100 million plus. When you consider the scope of Walmart, their potential for retail clinics is virtually unlimited. Whether by Amazon, Walmart or others, home delivery of prescriptions could make things very difficult for brick and mortar pharmacies. No matter what area you examine, these mega-partnerships have the potential to impact access to care in ways that most traditional healthcare providers have never imagined. And, if recent retail history means anything, healthcare consumers are sure to benefit.

Self-Funding Will Rule
Most working Americans are already covered by self-funded health plans, and we would expect the new Amazon, Berkshire Hathaway, JP Morgan family to offer at least one self-funded option. Studies show that self-funded plans offer employers far more flexibility than fully insured counterparts and Berkshire Hathaway’s Specialty Services unit certainly has the resources to provide the required stop loss insurance.

A Transparency Opportunity
With a little creativity, the transaction processing infrastructure of JP Morgan could make real-time claims processing a reality for fellow plan members. Real-time payments may encourage providers to discount more. Add telehealth and enable physicians to view electronic medical records and patients may know what to expect from their visit and what they will pay before they make the appointment. The bottom line is that as the level of information sharing increases, cost transparency and the potential for savings will grow.

As a TPA dedicated to controlling costs for self-funded health plans and members, we know these deals will keep more people out of the hospital and increase competition for outpatient care. Technology will move forward, actionable data will be more accessible and consumers will have their day as costs become more transparent and delivery more user-friendly.

controlling-costs

How clients can help curb healthcare costs during open enrollment

This article was published on August 29, 2018 on Employee Benefit Adviser, written by Rebecca Madsen.

Technology continues to reshape how employers select and offer healthcare benefits to employees, putting access to information at our fingertips and creating a more seamless and interactive healthcare experience. At the same time, these advances may help employees become savvier users of healthcare, helping simplify and personalize their journey toward health and, in the process, help curb costs for employers.

The revolution can be important to remember during open enrollment, which occurs during the fall, when millions of Americans select or switch their health benefits for 2019. With that in mind, here are five tips employers should be aware of during open enrollment and year-round.

enrollment brochure

Make sense of big data. Big data is a buzz word, but the applications are only meaningful if employers can make sense of that information. To help with that, employers are gaining access to online resources to help enable them to more easily analyze and make sense of health data, taking into account aggregate medical and prescription claims, demographics, and clinical and well-being information. This can provide an analytics-driven roadmap to help employers implement tailored clinical management and employee engagement programs, which may help improve health outcomes, mitigate expenses and help employees take charge of their health.

Help people understand their options. More than three-quarters (77%) of employees say they are prepared for open enrollment, yet most people struggle to understand basic health insurance terms, according to a recent UnitedHealthcare survey. In fact, only 6% of survey respondents could successfully define all four basic health insurance concepts: plan premium, deductible, co-insurance and out-of-pocket maximum. To support employees during open enrollment, employers can adopt online platforms designed to personalize and simplify the experience to help people select a health plan based on their personal health and financial preferences, while encouraging them to select a primary care physician and enroll in programs such as smoking cessation or weight loss.

Encourage your people to move more. An estimated 35% of employers now integrate wearable devices into their well-being programs, helping employees more accurately understand their daily activity levels. As these programs become more common, there may be opportunities for cost savings for companies and their workforce. For instance, some wearable device wellness programs may enable people to earn more than $1,000 per year by meeting certain daily walking goals, while employers can achieve premium renewal discounts based on the aggregate walking results of their employees.

Offer incentives to employees who comparison shop for care. More than one-third (36%) of Americans say they have used the internet or mobile apps during the last year to comparison shop for healthcare, up from 14% in 2012, according to the UnitedHealthcare survey. To encourage employees to participate in this trend, some employers are offering financial incentives — such as $25 or $50 gift cards — to employees for using healthcare transparency resources. Healthcare quality and cost varies widely within a city or neighborhood, so encouraging the use of online and mobile transparency resources may yield savings for employers and employees.

Integrate medical and ancillary benefits. Open enrollment is also the time for people to select important ancillary benefits, such as vision and dental coverage. While some people may overlook these plans, offering this coverage as part of an employee’s menu of benefits options may maximize the effectiveness of a company’s healthcare dollars, provide families with added peace of mind and help build a culture of health. Combining medical and ancillary benefits under a single health plan may enable for the integrated analysis of a wide range of data that can facilitate proactive outreach and clinical support for employees, including for people with chronic conditions such as diabetes, or to help prevent the development of such conditions.

controlling-costs

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.

ebso-self-funding-works

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.

ebso-self-funding-works

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.

ebso-self-funding-works

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.

ebso-self-funding-works

 

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.

ebso-self-funding-works

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.

ebso-self-funding-works

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.

ovacome-tweet

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.

flu-jab

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:

NHS-Tweet

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.

controlling-costs

Blood Free Glucose Monitors

Thanks to a new system approved recently by the U.S. Food and Drug Administration, Medicare patients with diabetes are able to monitor their glucose levels without sticking their fingers. The first-of-its-kind system reads glucose levels through a sensor placed on the back of the upper arm. Sensors, which can be worn for 10 days, are priced at $36 while a handheld reader, placed over the sensor to obtain real-time readings, retails for about $70.

ebso-self-funding-works