Responding to Growing Demand for Transparency

Experts agree that a lack of true price transparency has contributed significantly to the inefficiency in healthcare. Several websites compare the costs for certain procedures at varying hospitals, but it’s still very difficult, if not impossible, to make an informed choice when preparing for a non-emergency procedure. As a result, most people still go to doctors participating in a covered network and follow physician referrals when a specialist is required. In most cases, these choices are made without any knowledge of the cost.

Powerful Mobile Technology

Today, leading TPAs are providing self-funded health plan members with a variety of very powerful mobile transparency tools. One new mobile app enables members to identify fair pricing for more than 200 common procedures, including surgeries, imaging and diagnostic testing. By linking a rewards program, the app awards financial incentives when high quality, competitively priced providers are selected over those with lesser ratings.

Another software maker that describes a third of healthcare procedures as “shoppable”, has introduced a mobile app that enables plan members to search for physicians by procedure, location and price. This tool even goes beyond facts and figures to provide detailed descriptions of the procedure being searched. When members need further assistance, care navigators are available to provide online support via a live chat option.

Expert Administration Still Matters

While a totally open pricing system may never be possible in a business as complex as healthcare, TPAs are making self-funded health plans more transparent all the time. Strategies such as Reference Based Pricing and Concierge Health Advocacy are having a tremendous impact on cost and employee engagement. And while insurance carriers typically withhold claims data from fully insured groups, TPAs are experts at helping their clients put valuable claims data to work to identify cost drivers and manage chronic conditions in ways that help the plan avoid catastrophic claims in the future.

As the transition from volume to value-based healthcare continues, more responsibility will land in the hands of plan members. Smart employers know that a well-designed health plan can foster positive change and lower costs only if members understand their benefits. As long as self-funded plans, highly personal service and creative ideas are allowed to flourish, the number of engaged consumers capable of making economically wise healthcare decisions will continue to grow.

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The End of the American Health Care Act (AHCA)

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.

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Level Funding Lets Your Plan Retain The Savings

levelfundingAfter integrating a new health plan strategy and reducing overall claim costs, you discover that the company managing your health plan has kept half of your savings!

While it’s always encouraging to achieve a savings, especially when it’s so difficult to trim health care costs to any significant extent, it’s pretty disappointing to see half of the windfall disappear.

EBSO offers a Level Funded alternative that truly gives qualifying employer groups the best of all worlds. Monthly costs are established in advance, much like a premium for a fully insured plan. In contrast to a fully insured plan, however, your plan retains up to 100% of the savings when claims are lower than anticipated levels. Best of all, ongoing claims data is provided to keep you aware of how your healthcare dollars are being spent.

Avoid Surprises

Employers love the Level Funding approach because overall plan costs are predictable. Monthly costs are established in advance and consist of two parts; one part including fixed costs such as stop loss insurance premiums and administrative fees – the other part including an estimate of claims expenses. If claim costs are greater than anticipated during any one month, stop loss insurance covers the excess expense, limiting risk and capping the employer’s overall financial exposure.

Other benefits of Level Funding include plan design flexibility, access to claims data and ACA compliance. Since a Level Funded plan is a hybrid plan, your organization will not be subject to the Health Insurance Tax (HIT), associated with the Affordable Care Act (ACA).

Enjoy Greater Flexibility

Because a Level Funded plan is a partially self-funded plan, you gain the flexibility needed to tailor plan designs that meet your organization’s benefit objectives and the needs of your employees. As monthly reports identify factors impacting claim costs, plan designs can be modified and strategies such as employee education, wellness and preventive care can be implemented.

Look Before You Leap

While Level Funding is certainly an option to consider, all Third Party Administrators and all administrative agreements are not alike. The administrative services agreement should identify not only the services to be provided but also how any savings that may result from lower claim costs will be allocated. EBSO has built a long-standing reputation for cost transparency among clients and brokers.

Whether you choose EBSO for Level Funding or another self-funded option, you’ll work with an experienced partner known throughout the industry for helping employer groups manage the risks and future costs of employee health care.