Is Direct Primary Care the Future?

A fee-based model that gives individuals unlimited access to a primary care physician without their insurance being billed is being heralded as the right prescription for healthcare. Most patient needs, such as consulting, tests, drugs and treatment are included, and no insurance billing is involved.

Sources estimate there are about 1,000 direct primary care practices in the continental United States. While most patients pay for the service out-of-pocket, more and more employers are choosing to offer this as a benefit and sharing in the cost.

TPAs and advisers supporting the trend caution that direct primary care is not a replacement for insurance, but rather a great supplement to an existing health plan. By removing the barrier of costly copays and deductibles, employees can forge a much closer relationship with their doctor, making them far less likely to choose a costly emergency room or urgent care clinic when the need for medical care arises. Direct primary care is an option that is growing and one we’d be happy to talk with you about at your convenience.

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Federal Judge Derails New Association Health Plans

As reported by The Phia Group on March 29, 2019, a federal judge in Washington, D.C. ruled that the new Department of Labor rules expanding the marketing of Association Health Plans (AHPs) violate existing law. TPAs, brokers and employers see this as a significant blow to AHPs, especially new self-funded AHPs that have been preparing to launch on April 1, 2019.

Federal Judge John Bates sided with several states that took issue with the DOL’s final rules several months ago, arguing that a broad availability of AHPs is not within the scope of ERISA, which defines an employer as having at least two or more employees. The final rules were going to allow small employers, including working business owners (employers of one), to join with others based on either common geography or industry affiliation to form an AHP. It appears that the Judge’s ruling means that both criteria, geography and industry affiliation, must be met and that qualifying employers must have a minimum of two employees.

Thus far, we are not aware of any response filed by the DOL. We will continue to monitor reactions to the ruling and other developments regarding Association Health Plans.

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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.

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Are Costs Really Beyond Anyone’s Control?

medical-moneyIn 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.

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How many times has your company changed its health plan in the last 5 years?

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.

While change came slowly at first, the pace quickened once everyone bought into the reality that the status quo was no longer acceptable.

As their TPA, we partnered with the employer to lead the way. Actively managing the plan and navigating care demonstrated to members that the days of simply pulling out an ID card and paying a co-pay were over.

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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.

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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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ACA Fee Moratorium and Self-Funding

acaWhen Congress delayed the Cadillac Tax until 2020, the same law placed a one-year moratorium on the annual fee the ACA imposes on health insurance carriers. While the fee does not have a direct impact on TPAs or self-funded plans, it does sometimes impact stop loss premiums.

Since this fee applied to insurance carriers and not the majority of self-funded plan costs claims, some small group plans that moved to level funding may experience a slight cost increase in 2017. When the tax returns in 2018, the revenue targets are expected to increase. If the tax increases from its previous levels of 3% to 4%, the potential savings available to self-funded and level-funded plans will increase as well.

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Digital Marketing Delivers Results for EBSO and Other TPAs

The article below is featured in Ernie Clevenger’s 2/6/17 MyHealthGuide Newsletter, News for the Self-Funded Community. MyHealthGuide Source: Barcelona Creative Group, 1/30/2017

While personal relationships have long been the foundation for Third Party Administrator business strategies, many TPAs are now discovering the proven benefits of  adding a strong digital marketing program such as those developed and supported by Barcelona Creative Group.

ebso-mobile-marketing-blogWith a business model based on creating and nurturing strong personal relationships, most TPAs have been somewhat hesitant about pursuing digital marketing strategies.

The influx of “millennials” now populating the TPA market as decision makers, employees and plan members has altered this dynamic. TPAs are discovering that this younger, 25-34-year-old audience prefers to utilize digital and social media channels for information on health plans and benefits coverage. They also prefer useful content over promotional ads and want to access their information via mobile devices – with content delivered in easily digestible chunks and formatted for viewing on smaller screens.

For years, Barcelona Creative Group (BCG) has been working with its TPA clients to incorporate advanced digital strategies into their existing marketing programs. Interactive websites, blogs, online videos, email marketing, mobile applications, paid search and social media postings on sites such as LinkedIn, Twitter and Facebook are generating increased  interest from this younger demographic. These digital strategies have also significantly enhanced TPA brand awareness and are delivering quantifiable results.

Establishing an Online Presence

“In 2016, every one of our TPA clients saw a major increase in mobile traffic to their websites of from 28 to 46 percent. To maintain this growth and expand our capabilities in this key area, we’ve added new team members who bring a wide range of digital and social media expertise to our creative endeavors,” said Juli Barcelona, president and COO of Barcelona Creative Group. “When combined with our 20+ years of experience serving the TPA industry, these added resources allow us to maximize our clients’ online presence and build awareness and interest in the services they provide.

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Further, digital marketing can be less costly than more traditional advertising and captures valuable viewer data including contact information, business profiles and areas of interest. Outgoing digital media and social postings can also be targeted to reach a specific demographic, such as agents or brokers in a defined state or region.

According to Tom Barcelona, founder and CEO, program success is about more than just utilizing digital media. “It’s about building a cohesive brand with a common look, feel and message that runs throughout each web page, white paper, blog/social media post, sell sheet and proposal,” he states. “We work to ensure that all of these media are used in concert to position the TPA as an authority and make them easily recognizable, no matter the digital vehicle. No longer are big carriers the only online presence for health benefits information.

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Brooks Goodison, president of Diversified Group in Marlborough, CT, had a specific goal in mind when working with BCG on their digital strategy. “We want to be widely known as self-funding experts and trusted benefit advisors,” he states. “The branding and digital marketing initiatives developed and implemented for us by Barcelona Creative Group have helped us  establish a strong and far more visible presence in the marketplace. In fact, brokers have told us that they’re seeing us everywhere.”

“We consistently get positive feedback from employers and brokers about our website and recently signed a stop loss carrier who was able to find us through an online search,” says Bruce Flunker, president of EBSO, Inc., a national TPA with sites across the U.S.

“The digital strategy we’ve developed with Barcelona Creative Group has enabled us to keep our widespread internal staff informed, while delivering qualified leads for our organization,” added Cindy Sheffield, CEO of EBSO, Inc.

About Barcelona Creative Group

Barcelona Creative Group has been supporting some of the most successful members of the TPA community for over 25 years by unleashing the power of creativity to build brand awareness and deliver proven results. Barcelona Creative Group – Driven by the belief that creative is not a department, that all media is social and that passion never punches a clock.

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Avoid Potential Penalties with EBSO’s Legal Guidance & Support

ebso-aca-comliance3-blogManaging an employee health benefit plan is not easy given the numerous reporting and compliance challenges that exist today. With the landscape of Health Care Reform constantly changing, there can always be “gray areas” and potential penalties looming.

EBSO offers Legal Guidance & Support Services as part of their Compliance Management Solutions. These services and tools give support for the complexities of ACA compliance, employment law (ADA, FMLA, etc.), ERISA, GINA, HIPPA and other benefit regulations. Services can vary based on group size and include, but are not limited to, free legal advice and online training for employees. All of which are designed to help organizations save time and money.

As a full-service third party administrator (TPA), EBSO offers all the ACA compliance resources necessary in today’s regulatory environment – from a comprehensive range of Health Care Compliance Management Solutions for our self-insured medical administration clients to a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered.

With all these options, it’s time you trust EBSO to be your compliance expert! To learn more and view a full list of Standard Compliance Services we offer, visit our website at: http://www.ebsobenefits.com/compliance-management.html.

Trusting Your ACA Compliance Management to EBSO is a Sure Thing

ebso-aca-comliance-blogThese days, managing an employee health benefit plan is NOT just that – companies face numerous reporting and compliance challenges that are continuously changing, which, in turn, has changed the game. And, the Affordable Care Act (ACA) has only upped the ante.

At EBSO, we have a full-time Compliance Department helping our clients with these challenges, guiding them through the rapidly changing ACA requirements and avoiding costly penalties. Our Standard ACA Compliance Services include your basic plan General Notice Requirements as well as mandated ACA reporting techniques and fees. From the Children’s Health Insurance Program (CHIP) Reauthorizations Act of 2009 to Patient-Centered Outcomes Research Institute Fee (PCORI) calculation, our health care reform compliance services help ensure that self-funded employer groups stay ahead of the game.

As a full-service third party administrator (TPA), EBSO offers all the ACA compliance resources necessary in today’s regulatory environment – from a comprehensive range of Health Care Compliance Management Solutions for our self-insured medical administration clients to a freestanding suite of ACA Reporting Services available to any employer group, regardless of how the plan is funded or administered.

With all these options, trusting EBSO to be your expert is a safe bet! To learn more and view a full list of Standard Compliance Services we offer, visit our website at: http://www.ebsobenefits.com/compliance-management.html.