The Employee Benefit Research Institute (EBRI) reports that while the number of mid-sized businesses self-funding their health benefits actually declined slightly during 2015 and 2016, the percentage of smaller employer groups, those with less than 100 employees, increased from 14.2% to 17.4%.
According to preliminary government data, U.S. deaths involving fentanyl and other synthetic opioids fueled a 21% jump in annual drug overdose deaths during 2017. The increase from 9,945 opioid deaths in 2016 to 20,145 during 2017 reflected the sharpest one-year increase since the U.S. began experiencing a widespread opioid addiction. CDC data shows that deaths involving heroin and prescription painkillers such as oxycodone, are also increasing.
The 1993 federal Family and Medical Leave Act (FMLA) provides up to 12 weeks of unpaid leave for qualifying employees. While workers at some companies are able to cover a portion of their pay during their leave, the vast majority do so by using their employers’ short-term disability insurance.
While federal budget proposals discussed earlier this year included funding for six weeks of paid leave for new mothers and fathers, and a proposal in the House has endorsed “workflex” options, newly passed Tax Reform legislation did not address the issue. With first-daughter Ivanka Trump promoting paid family leave throughout the 2016 campaign, and mid-term elections approaching, we are sure to hear more about this later in the year.
In at least one big city, a major carrier is providing 100% coverage to public employees for MRIs, CT Scans and other imaging services only when free-standing, non-hospital based facilities are used. What do you know? Independent TPAs have been helping self-funded health plans do things like this for years.
Too many people have long considered rising health care costs to be a condition we simply must live with. Fact is there are alternatives, most of which can only be implemented when the plan’s best interests are first and foremost.
Detailed Reporting Needed
In contrast to a fully insured plan or self-funding with a carrier-owned ASO, using an independent TPA enables the plan to make informed decisions based on detailed reporting – reporting that the plan owns.
There is no secret to controlling plan costs. It requires discipline and the tools to monitor individual parts of the plan, such as prescription drugs, imaging, chronic disease management and more. Analyzing expenditures such as these can yield huge savings over the course of a year, but only when your administrator is free of carrier or provider affiliations. Having checks and balances in place can make all the difference.
Members would be well advised to keep an eye out for a new wrinkle in provider billing – facility fees, resembling resort fees often tacked on to daily room charges at upscale hotels. These fees, being charged by some hospital-owned clinics in addition to the charge for physician services, are said to be the result of hospitals acquiring more and more physician practices. They are also one more reason to look closely at provider billing.
Financial wellness, standing desks and other wellness strategies are high on the list of benefits trending upward in 2018. According to the Society for Human Resource Management, a growing number of organizations are offering programs to help employees improve their financial well-being. Some companies are providing debt counseling and help with repayment of student loans. Standing desks are becoming very popular, with a growing number of companies offering them to employees as a new wellness benefit.
EBSO Benefits, an independently owned Third Party Administrator, helps employer groups self-fund their health benefits, thereby giving their clients an opportunity to reduce administrative costs, increase plan flexibility and expand the services they offer to their employees.
More importantly, EBSO is leading the way in a new phase of employee healthcare by helping employer groups take control of their healthcare plan. And taking control means more than self-funding. It means really managing the plan, doing some heavy lifting and shaking things up when what was commonplace is no longer working.
One example EBSO is proud to reference is that of a Midwest-based food processor that has not only stabilized costs for its 700+ employee group but seen the cost of its self-funded health plan drop by approximately 8 percent over the past 4 years. There’s no magic involved – taking ownership of the plan and managing it each and every day has made the difference. New steps have also been taken over time, like adding on-site clinics and contracting directly with high value providers for certain procedures.
As shown, navigating care in a self-funded environment can achieve high quality, affordable healthcare over time. Employees value the many resources available to them, such as an online benefits portal, mobile apps and day-to-day support. They also learn to share in the responsibility.
If moving from carrier to carrier isn’t working out well for your company, it’s time you discovered the freedom, flexibility and control that self-funding with an independent TPA can offer. Contact EBSO and learn more today.
The 2017 Employer Health Benefits Survey by the Kaiser Family Foundation shows an increase in the cost of family coverage from $18,142 in 2016 to $18,764 in 2017. While the 3.4% increase is seen as relatively modest compared to previous years, it was also noted that employees paid close to a third of the annual family premium – approximately $5,700.
The Society of Actuaries reports that nearly one in five Americans in their early 70s are still working. A big reason cited is that the age at which people can claim full Social Security benefits is currently 66. With actuarial tables showing that a 65-year old male can expect to live an additional 20 years, working longer has become a necessity, since retirement may very well last far longer than previously anticipated.
According to new guidelines being published by the American Heart Association (AHA) and the American College of Cardiology (ACC), high blood pressure is now defined as readings of 130 mm Hg and higher for systolic blood pressure or 80 and higher for the diastolic measurement. As the first update to the U.S. guidelines for blood pressure detection and treatment since 2003, these new measurements are intended to encourage earlier detection, prevention and management of high blood pressure.
While estimates are that high blood pressure diagnoses will rise by 14%, the hope is that the vast majority will be counseled about lifestyle changes rather than receiving prescribed medication. Often referred to as the “silent killer” because there are no symptoms, high blood pressure accounts for the second largest number of preventable heart disease and stroke deaths, second only to smoking.