July 1 Deadline for Health Plans & Employers to List Prices |
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In This Issue
July 1 Deadline for Health Plans & Employers to List Prices
The Ideal Employer Health Plan is a Pyramid
Best Practices for Working Parents
In Memory of Dee Edington
The Healthcare Digital Dilemma
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July 1, was the deadline for health plans and self-insured employers to post online prices negotiated for healthcare for every physician, hospital, and surgery, item by item. This Kaiser Health News article outlines the requirements and ramifications of this federal law under the Affordable Care Act in 2019. It can impact how employers contract for healthcare in the future.
The biggest value of the July data release may be to shed light on how successful insurers have been at negotiating prices. It comes on the heels of research that found tremendous variation in what is paid for health care in the latest RAND hospital price transparency study. It demonstrated employers that offer job-based insurance plans paid, on average, 224% more than Medicare for the same services.
James Gelfand, president of The ERISA Industry Committee, a trade group of self-insured employers, noted in the article, "For the first time, an employer will be able to go to an insurance company and say, "You have not negotiated a good-enough deal, and we know that because we can see the same provider has negotiated a better deal with another company."
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The Ideal Employer Health Plan is a Pyramid |
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HBCH is working with employers, physician groups, hospitals and others to demonstrate the value of a Smart Network in the Houston market to significantly lower costs while improving health outcomes. This recent
A-Healthcare-Z video from Eric Bricker, MD describes a similar approach and references its proven and potential success.
1. Primary care is the foundation of a high performance employee health plan. There is virtual primary care and onsite clinics that provide care management, mental health services and health system navigation support. Primary care is paid directly by the employer and is not run through the insurance carrier.
2. Specialty care is the middle layer and is run through the third-party administrator or administrator services only carrier. The key is the plan design steers plan members to the highest quality specialists by offering them at a lower out-of-pocket cost, while the low quality specialists have a higher out-of-pocket cost.
3. Acute hospital care is at the top and direct contracting is used outside of the insurance carrier for orthopedic, cancer, cardiovascular care and other potentially high-cost or catastrophic claims.
This high performance employee health plan is then surrounded by a transparent, pass-through PBM.
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Best Practices for Working Parents |
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An excellent resource for employers is the Best Place for Working Parents organizational assessment, which identified 10 family friendly policies that are business friendly. The policies speak to benefits for families and their positive impact on business’ profitability.
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In Memory of Dee Edington |
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Dee Edington, the founder and former director of the University of Michigan Health Management Research Center, died on June 22, 2022 at age 84. His research and teachings on the relationship between healthy lifestyles, quality of life and the benefit to individuals and organizations, and the impact of health promotion and worksite wellness on healthcare costs, productivity and employee development were extensive and groundbreaking.
Many of the insights he described in his seminal book "Zero Trends: Health As An Economic Strategy" may seem obvious but have taken far too long to take hold. An excellent summary of his insights was prepared by Mike Critelli, former CEO of Pitney Bowes. Perhaps most important was Edington's mantra that a culture of health starts from the top and will result in a healthy and productive workforce that costs less to keep it that way.
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The Healthcare Digital Dilemma |
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Wednesday, September 21, 8:00 am - 11:00 am CST -
The Friedkin Group
1375 Enclave Pkwy, Houston, TX 77077
REASONS TO ATTEND
· Learn how digital technologies are transforming delivery
· Learn what to expect in terms of cost reduction and outcomes
· Learn how others support and enhance traditional in-person care
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