Saxon's Go365 Clinic: A Can't Miss Wellness Event

In this installment of CenterStage, we are spotlighting our upcoming event, as presented by our Wellness Director, Abby Graham!

Wellness Director

Saxon, along with Humana and HealthWorks, will host a wellness seminar about Humana’s wellness program on Wednesday, May 23. This exciting wellness clinic will aid employers in creating a more engaged workforce around wellness. Plus, there may be an awesome incentive involving a discount on insurance premiums, so keep reading!

Relationship Status - Going Strong

Humana is an insurance carrier represented by Saxon. Humana offers a personalized wellness and rewards program that we find to be exceptional for helping workplace environments create a great sense of community and health. HealthWorks is an outside vendor that works alongside Humana to provide wellness guidance and related services. HealthWorks will have a roundtable discussion explaining how they coordinate benefits with the Go365 program. With all three of us together at the event, employers will have the ability to have all their questions answered and have educational resources at their disposal.

Things to Look Forward to

“If you are someone in your company that is into wellness and is wanting to get others involved in a health initiative, then this event is for you! It will allow you to become an expert on Humana’s Go365 program and see why it is a fantastic incentive-based wellness program.” - Abby Graham

The event will feature several individual round tables, each one covering a different topic (see next page for topics). There will even be a 15% discount on premium insurance once you reach Gold Status in the program. The event is free to attend, and breakfast and lunch will be provided.

Sounds pretty great, right? If you are interested in saving money, increasing employee incentives, and creating a healthier workforce, be sure to sign up now to attend our Go365 seminar.

All questions and concerns regarding the event can be directed to Abby Graham at 513.334.0371 or send her an email via agraham@gosaxon.com. We can't wait to see you there!

Download this article here!


What to Know in the Immigration Debate Now: “Queen-of-the-Hill”?

What will be the fate of those who dream to come to America? Explore the immigration debate in this article from SHRM.


Immigration reform is filled with complexities.  Just to name a few are the politics, the body of law and policy and often the use of terms that only add confusion. During the 2007 immigration debate, I recall the term “clay pigeon” (a Senate floor procedure) confused even the experts.  Right now, the term that is turning heads is “Queen-of-the-Hill”. So why does it matter you ask? Well let me explain.

A bipartisan group in the House has called on leaders to consider a proposal for a "Queen-of-the-Hill" (most votes wins) immigration rule (H. Res. 774) and urge action to vote on a legislative solution for the Deferred Action for Childhood Arrivals (DACA) program. SHRM and CFGI are members of the coalition for the American Dream which issued a press statement in support of action.

A vote on this issue matters because earlier in the year votes in the Senate failed. Right now, 190 Democrats and 50 Republicans in the House (a majority of the House) support H. Res. 774 and a debate and vote on immigration DACA related proposals.  If Congress, could begin to move proposals forward there might be a chance (if even a small chance) to break the logjam on immigration reform.

Specifically, "Queen-of-the-Hill' is a House procedure that has not been used since 2015. The procedure would require separate votes and consideration of (four immigration) proposals on the House floor and members could vote in support of as many proposals as they want.  The proposal that receives the greatest number of votes would be adopted. If none of the proposals receive a majority-of-the-votes, then none of the proposals would be adopted.

The proposals that would get a vote under H. Res. 774 include:

  • The Securing America's Future Act (HR 4760), a bill that would allow DACA recipients to apply for three years of work authorization and deferred deportation that may be extended if they qualify. The bill also includes other provisions like mandatory E-Verify, historical limits to family sponsored green cards, a reallocation of visas to employment-based green cards and a new agricultural guest worker program.
  • The House DREAM Act (H.R. 3440), a bill that would allow DACA recipients and DACA eligible individuals to apply for work authorization and deferred deportation, legal permanent residence and a five- year path to citizenship if they qualify.
  • The USA Act (H.R. 4796), a bill that would allow for DACA recipients and DACA eligible individuals to apply for work authorization and deferred deportation and legal permanent residence if they qualify.
  • A yet to be unveiled bill from House Speaker Ryan (R-WI)

Whether there is any chance for success will be up to House leaders, as the House bipartisan group is asking leaders to support H. Res. 774.  However, the resolution may be far from successful. House Speaker Ryan (R-WI) has publicly stated he does not believe it makes sense to bring a bill through a process that only produces something that would get vetoed by the president. In this scenario, it is possible that any immigration bill that could pass the House might not make it through the Senate let alone find support from the president.

Given, the president’s resistance to many DACA related proposals, perhaps in the end, he will be the “King” of this “Queen-of-the-Hill” strategy.

This article was written by Rebecca Peters of SHRM Blog on April 23rd, 2018.


The Cadillac Creep Will Impact Your Econo-Health Plan

How will the Cadillac tax affect you in the near future? From SHRM, get the details in this article.


As an HR Professional in 2010, I recall thinking, as I struggled to wrap my mind around the myriad of complex provisions included in the ACA, that the Cadillac tax was probably one provision that I didn’t need to concern myself with. After all, it was years in the future and only applied to those other, richer plans, right? Time for a fast forward reality-check.

The Cadillac tax has been delayed in the past but is set to begin in 2022 on high-cost employer-sponsored health coverage. It will tax health coverage that exceeds $10,200 for individual coverage and $27,500 for family coverage at the rate of 40%. This includes contributions made by employers and employees toward health coverage premiums but not cost-sharing amounts such as deductibles, coinsurance or co-payments made when care is delivered.

But, employers, like mine, have certainly not been idle during the last eight years. We have continued to work to design health care plans that will attract and retain top talent while ensuring that coverage meets minimum value and affordability requirements mandated by the ACA. All the while, health care costs, particularly driven by prescription drug costs, continue to climb. Studies suggest that prescription drugs will continue to represent a larger portion of the overall health spending. I have seen this firsthand with the employer-sponsored plans I manage where prescription drug costs may represent over 30% of total health claims spent.

This leaves employers with some tough decisions to either reduce the benefits they offer to maintain a cost-effective plan that still meets minimum coverage and affordability standards or absorb additional costs.  And then, there’s the Cadillac creep. A monthly individual premium of $10,200 annually or $850 per month no longer seems far-fetched as I stare into a future where drug cost inflation rates outpace wage increases.

I’m a proud member of the Society for Human Resource Management (SHRM), which encourages Congress to fully repeal the excise tax. I support and join in SHRM’s advocacy efforts to defeat this tax because over 178 million Americans get their health care through employer-sponsored health plans. We can’t afford to let the Cadillac creep impact employers and employees.

This article was written by Crystal Frey of SHRM Blog on April 20th, 2018.


The Opioid Epidemic and Medicaid’s Role in Facilitating Access to Treatment

The Kaiser Family Foundation has released the key findings in Medicaid's role in the opioid epidemic. Get the facts, statistics, and visual charts here.

Key Findings

In 2016, 1.9 million nonelderly adults in the United States had an opioid addiction. Medicaid covers 4 in 10 nonelderly adults with opioid addiction. This brief examines Medicaid’s role in facilitating access to treatment for opioid addiction. Key findings include:

  • Among nonelderly adults with opioid addiction, those with Medicaid were twice as likely as those with private insurance or no insurance to have received treatment in 2016.
  • Medicaid facilitates access to treatment by covering numerous inpatient and outpatient treatment services, as well as medications prescribed as part of medication-assisted treatment.
  • States use Medicaid Section 1115 waivers and other program authorities to expand treatment options for enrollees with opioid addiction.

While additional states expanding Medicaid could increase coverage and access, support for new work and premium requirements could impose barriers to obtaining and maintaining Medicaid coverage that may compromise efforts to address the opioid crisis.


Introduction

The opioid epidemic continues to escalate, with 1.9 million nonelderly adults having an opioid addiction in 2016.1 Opioid addiction is often associated with comorbid physical and mental health conditions and high levels of health care services utilization.  These issues have worsened throughout the past decade as the opioid epidemic has escalated. In 2016, there were 42,249 opioid overdose deaths in the United States, more than quadruple the number in 2001, and the number of deaths from heroin and fentanyl have surpassed the number due to prescription opioids. The Trump administration has stated that addressing the opioid epidemic is a key priority.

Medicaid has historically filled critical gaps in responding to public health crises, such as the AIDS epidemic in the 1980s, the Flint water crisis, and numerous natural disasters since the program originated. As with these other public health crises, Medicaid helps to address the opioid epidemic by providing access to coverage and necessary health care. The program covers a disproportionate share of individuals with opioid addiction and facilitates access to numerous treatment services. Additionally, as of February 2018, 33 states have adopted the Medicaid expansion, with enhanced federal funding, to cover adults up to 138% of the federal poverty level ($16,753/year for an individual in 2018). All Medicaid expansion benefit packages must include behavioral health services, including mental health and substance use disorder services, which has increased access to care for many people with opioid addiction.

Based on data from the 2016 National Survey on Drug Use and Health, this brief describes nonelderly adults with opioid addiction, including their demographic characteristics and insurance statuses, and compares receipt of various treatment services among those with Medicaid to those with private insurance and those who are uninsured. It also describes Medicaid financing for opioid treatment and the ways in which Medicaid promotes access to treatment for enrollees with opioid addiction.

Characteristics of Nonelderly Adults with Opioid Addiction

Individuals with opioid addiction are predominantly white, male, and young. In 2016, nearly 3 in 4 (74%) nonelderly adults with opioid addiction were white (Figure 1).  Those with opioid addiction were also more likely to be male (58%), although the epidemic has touched an increasingly large share of women in recent years, including many pregnant women.2,3  Additionally, nearly half (48%) were between ages 18 and 34, and another one-third (32%) were between ages 35 and 49. This age distribution is comparable to those for other types of addiction, including addictions to both drugs and alcohol, which generally affect young adults more than they affect other age groups.4

Figure 1: Race, Gender, and Age of Nonelderly Adults with Opioid Addiction, 2016

The majority of nonelderly adults with opioid addiction are employed, but many have low incomes.  In 2016, nearly 6 in 10 (56%) were employed; however, there was wide variability with regard to the types of jobs and industries in which they work, their salaries, and the number of hours they worked each week (Figure 2). Of those who were employed, about 7 in 10 (72%) reported working at a full-time job during the previous week.5 One in ten were unemployed and an additional 13% were unable to work because of a disability, reflecting the complicated health needs of individuals with opioid addiction, many of whom may have developed an addiction to opioids after using opioids to treat their chronic pain.6 Adults with opioid addiction are also more likely than other adults to have many other health conditions, including hepatitis, HIV, and mental illness,7 all of which may hinder their ability to work.  As a result of these and other factors, more than half of nonelderly adults with opioid addiction had low incomes in 2016, and over a quarter (28%) lived below the poverty line (Figure 2).

Figure 2: Employment Status and Income of Nonelderly Adults with Opioid Addiction, 2016

Medicaid covers a disproportionate share of nonelderly adults with opioid addiction, and an even greater share of those with low incomes. In 2016, nearly 4 in 10 (38%) were covered by Medicaid and a similar share (37%) had private insurance. Approximately 1 in 6 (17%) was uninsured (Figure 3). Low-income nonelderly adults with opioid addiction are typically less likely than adults with higher incomes to have jobs that offer health insurance.8 In 2016, over half (55%) were covered by Medicaid, while only 13% had private insurance. Nearly 1 in 4 (24%) were uninsured (Figure 3), although if they lived in states that expanded Medicaid, they would likely be eligible for coverage.

Figure 3: Insurance Status of Nonelderly Adults with Opioid Addiction, 2016

Utilization of Opioid Addiction Treatment Services

Overall receipt of treatment for opioid addiction is low. In 2016, fewer than 3 in 10 (29%) adults with opioid addiction received any treatment for their addiction (Figure 4).9 Opioid addiction treatment can be delivered in an inpatient or outpatient setting and can be provided in numerous types of facilities, including hospitals, drug or alcohol rehabilitation facilities (for either inpatient or outpatient services), mental health centers, or private doctors’ offices. Depending on the severity of their addictions, some patients begin in an inpatient facility and then later transition to an outpatient setting, while others require only outpatient treatment. Overall, in 2016, 16% of nonelderly adults with opioid addiction received inpatient treatment, while 25% received outpatient treatment.

Figure 4: Past-Year Opioid Addiction Treatment Among Nonelderly Adults with Opioid Addiction by Insurance Status, 2016

Among nonelderly adults with opioid addiction, those with Medicaid are significantly more likely than those with private insurance or those who are uninsured to receive treatment. In 2016, those with Medicaid were twice as likely as those with private insurance or no insurance to receive any treatment for their addiction (43% vs. 21% and 23%). Nearly a quarter of adults with opioid addiction who had Medicaid coverage received inpatient care, while nearly 4 in 10 received outpatient care. In contrast, just over 1 in 10 (13%) of those with private insurance received any inpatient treatment and only 17% received any outpatient treatment. Those who were uninsured received treatment at rates similar to those with private insurance. These differences in utilization highlight the significant role Medicaid plays in increasing access to treatment.

Figure 5: Past-Year Outpatient Addiction Treatment Among Nonelderly Adults with Opioid Addiction by Insurance Status, 2016

Adults with opioid addiction who were covered by Medicaid were significantly more likely to have received treatment at an outpatient rehabilitation center or at an outpatient mental health center than those with private insurance or those who were uninsured (Figure 5). In 2016, adults with opioid addiction covered by Medicaid were three times more likely to have received treatment at these facilities than privately insured or uninsured adults. At the same time, utilization of services at private physician’s offices did not differ significantly across the three groups. Higher rates of utilization of outpatient treatment services by those with Medicaid may reflect the greater push for outpatient community-based behavioral health treatment in recent decades.10

Medicaid’s Role in Covering Opioid Addiction Treatment Services

State Medicaid programs cover numerous addiction treatment services that fit into several state plan categories, including outpatient treatment, inpatient treatment, prescription drugs, and rehabilitation. The standard of care for opioid addiction is medication-assisted treatment (MAT), which combines one of three medications (methadone, buprenorphine, or naltrexone) with counseling and other support services. All state Medicaid programs cover at least one medication used as part of MAT,11 and most cover all three of these medications. State Medicaid programs also cover many counseling and other support services, delivered either as part of MAT or separately. Most of these services are delivered at state option and include detoxification, intensive outpatient treatment, psychotherapy, peer support, supported employment, partial hospitalization, and inpatient treatment.12

Several policy changes have allowed states to obtain waivers to allow Medicaid funding of substance use treatment services at institutions for mental disease (IMDs). Federal law has historically prohibited Medicaid payments for services provided to adults age 21-64 in IMDs as a way to preserve state financing of these services. However, in April 2016, CMS issued final Medicaid managed care regulations that allow federal matching funds for managed care capitation payments for services in an IMD for up to 15 days in a month in lieu of services covered under the state plan and at the enrollee’s option.13 Additionally, in July 2015, the Centers for Medicare & Medicaid Services (CMS) released guidance stating that states could request federal funding for substance use disorder services delivered to nonelderly adults in IMDs through Section 1115 demonstration waivers. On November 1, 2017, CMS issued revised guidance that continues to allow states to seek Section 1115 waivers to pay for services provided in IMDs, including substance use disorder services. A number of states have sought waivers of the IMD exclusion specifically to expand treatment options for substance use disorder services. As of March 2018, CMS has approved waiver requests in 10 states to provide substance use disorder services in an IMD, and 10 states have waiver applications pending with CMS.14

Many states have also applied for other Medicaid Section 1115 behavioral health waivers focused on treating individuals with addiction, including opioid addiction. CMS has approved community-based benefit expansions proposed in Section 1115 waivers, which enable states to provide additional services to individuals with addiction, such as supportive housing, supported employment (such as job coaching), and peer recovery coaching. Additionally, CMS has approved waivers that allow states to expand Medicaid eligibility to cover additional populations with behavioral health needs, to provide home and community-based services, and to implement certain delivery system reforms, such as physical and behavioral health integration and alternative payment models.

Because of the large number of Medicaid enrollees with opioid addiction and the breadth of treatment services that Medicaid covers, Medicaid finances a substantial proportion of addiction treatment. In 2014, Medicaid financed 21% of all addiction treatment, which was more than the share covered by all private insurers combined (18%). Nine percent of all spending on addiction treatment came from out-of-pocket payments (Figure 6).15

Figure 6: Proportion of Total Spending on Addiction Treatment Services in 2014, by Payer

Looking Ahead

Medicaid plays a major role in facilitating access to inpatient and outpatient treatment services for individuals with opioid addiction. Nonelderly adults with Medicaid were more likely than those without insurance to receive various types of opioid addiction treatment and had better access to treatment than those with private insurance. Furthermore, despite the IMD payment exclusion, individuals with Medicaid were more likely than privately insured individuals to receive inpatient treatment.

As the opioid epidemic continues to worsen, particularly as fentanyl has become more pervasive,16 states are increasingly looking to Medicaid to expand treatment options to stem the crisis. In addition to covering MAT medications and numerous other treatment services, states are seeking waivers to allow payment for opioid treatment services provided in IMDs, to expand coverage of community-based benefits to support treatment and recovery, and better integrate behavioral health services, including substance use disorder services, with physical health services.

Non-expansion states can improve access to treatment by expanding Medicaid, which would enable them to cover many people with opioid addiction who are currently uninsured. At the same time, using 1115 waivers to impose new requirements in Medicaid, including work requirements and premiums, could compromise efforts to address the opioid epidemic. Although some states exempt people in addiction treatment from work requirements and other states count treatment as work hours, other states do not have such exemptions. Additional reporting requirements coupled with new premium requirements may also make it more difficult for eligible individuals to enroll in Medicaid and for those currently enrolled to keep their coverage. Utilization of treatment by adults with an opioid addiction is already low; imposing new barriers to obtaining and maintaining Medicaid could further impede those battling opioid addiction from getting the care they need.

This article was brought to you from the Kaiser Family Foundation on April 11,2018.


Taking Action to Prevent the Harmful Impact of Short-Term Plans

This article explores the recently established rule on short-term limited duration plans - as proposed by HHS - which would not comply with consumer protections afforded under ACA.

The U.S. Department of Health and Human Services (HHS) has proposed a new rule, open for comment until April 23, 2018, that is dangerous to consumers and to health care marketplaces. This rule would expand the sale of “short-term limited duration plans” that do not have to comply with the consumer protections afforded under the Affordable Care Act (ACA) and often leave consumers uncovered for major medical expenses.

The short-term plan rule will harm consumers and health care markets

The proposed rule would alter the definition of short-term plans as a backdoor way of creating a new class of plans that do not have to comply with the ACA, extending the duration of short-term plans from policies that last for 3 months to policies that can last just short of one year. Under this rule, insurers may also be allowed to renew a short-term plan for an enrollee after that period is up.

Companies selling these plans can make large profits at consumers’ expense, and the plans do not have to cover pre-existing conditions, provide essential health benefits, include adequate provider networks, or comply with a host of other key protections, as we describe in Seven Reasons the Trump Administration's Short-Term Health Plans Are Harmful to Families. Moreover, if many young and healthy people are drawn into these plans, the plans will undermine the market for real coverage, driving up prices in the ACA-compliant marketplace.

Now is the time to take action to prevent short-term plans from harming consumers and insurance markets throughout the country. Here we outline how advocates, consumers, and states can take action to address this harmful rule.

Stakeholders can urge HHS to stop the spread of harmful short-term plans

It’s important that HHS hears from stakeholders all over the country about how short-term plans will leave those who enroll in them without adequate protection from the costs of care, and how those who seek to stay in the market for comprehensive coverage will experience spikes in premiums and jeopardized access to coverage if short-term plans are allowed to expand.

The short-term plan rule will also burden states and insurance companies that are interested in making comprehensive coverage affordable. Particularly if the rule allows the proliferation of short-term plans that last for up to 12 months to take effect after insurers have already planned their premium pricing for 2019, these plans will cause chaos for comprehensive insurance providers and states alike in maintaining a stable insurance market. These expanded short-term plans should not be put on the market at all, but at the very least HHS should delay implementation of the final rule to give states and insurers more time to plan for it to take effect.

Advocates, consumers, state officials, health care providers, and other stakeholders can all make a difference by commenting to HHS about these problems. Stakeholders can also make a difference by urging state policymakers and officials to comment on the rule as well. Comments should urge HHS to stop or at the very least delay implementation of the rule on short-term plans. Comments should be submitted here by 5 PM on Monday, April 23rd.

States can take direct action to protect against short-term plans

States can take direct action to protect consumers and insurance markets from the harm of short-term limited duration plans. States have broad authority to regulate short-term plans and can adopt new laws or issue new regulations or guidance that exceeds the standards in the proposed rule. Given other upcoming changes in 2019 that will also pose risks for the market, including the repeal of the individual mandate penalty, taking swift action is particularly important.

These strategies can provide protections for consumers and help limit market instability caused by the expansion of short-term plans.

States can prohibit short-term plans altogether. Massachusetts, New Jersey, and New York currently prohibit short-term plans, and California is pursuing a prohibition via SB910 (Hernandez).

States can require that short-term plans comply with all protections that health plans sold on the comprehensive individual market meet. For example, a few states prohibit short-term plans from refusing to sell to a consumer based on their health status— those plans cannot “underwrite,” or take people’s health status into consideration when people seek to buy them. States could protect consumers from the harm of short-term plans by applying the same requirements to them as apply to comprehensive insurance. These include requirements for external review, essential health benefits and state benefit mandates, network adequacy, medical loss ratios, and pre-existing condition protections, including a requirement that plans do not charge people rates based on their health status. States can also ensure companies that offer short-term plans have to pay any existing state-based assessments, such as insurer taxes. States could also consider assessing short-term plan insurers and using those funds for a reinsurance program for plans that meet ACA standards.

  • States can restrict the duration of short-term plans. For example, states can pass laws prohibiting short-term plans from lasting for longer than 3 months. This will ensure that these plans are used as they were intended- to fill short gaps in coverage- and not as a long-term solution to substitute for real coverage. Some states already limit the period for which a short-term plan can be sold to less than the nearly 12 months allowed in the proposed federal rule. For a good index of such state laws, see State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting Risk to the Individual Market from the Georgetown Center on Health Insurance Reform.
  • States can prohibit short-term plans from renewing consumers’ policies beyond their allowed duration: To ensure that short-term plans are not treated as a replacement for comprehensive insurance, states can prohibit plans from renewing their contract with a consumer once the duration of the short-term plan is over. For example, a state could prohibit insurers from selling a short-term policy to anyone who has enrolled in one during the last 12 months.
  • States can require strong disclosure and marketing rules to ensure short-term plans are transparent about their shortfalls. States can require short-term plans to include prominent disclosures in marketing materials (including websites), application forms, and other forms to warn people about what the plans do not cover and how they may expose consumers to high out-of-pocket costs. For example, Colorado requires short-term plans to provide such a disclosure to warn people about the lack of coverage for pre-existing conditions in short-term plans. Additionally, states can require short-term plans to supply simple, clear, and comparable information about what benefits they do and do not cover, and corresponding cost-sharing requirements. Comprehensive plans must comply with requirements to produce a summary of benefits and coverage, and states could apply such requirements to short-term plans as well.

There are additional protections that states may want to consider to protect people from the harms of short-term plans. For additional discussion of how states can take action, see State Options to Protect Consumers and Stabilize the Market: Responding to President Trump’s Executive Order on Short-Term Health Plans by the Georgetown Center on Health Insurance reform.

State legislators and insurance departments can lead the efforts to enact these important protections. And, they along with any health care ombudsman programs or other organizations that assist health insurance consumers in the state may know of complaints and problems regarding short-term plans that can inform what protections the state should enact. State attorneys general, Better Business Bureaus, or other consumer protection agencies may also be aware of problems and can be helpful allies in efforts to prevent short-term plans from harming consumers and insurance markets alike.

Additionally, the National Association of Insurance Commissioners (NAIC) is currently updating its model law for states on Accident and Sickness Insurance Minimum Standards (Model #170) and its companion regulation, the Model Regulation to Implement the Accident and Sickness Insurance Minimum Standards Model Act (Model #171). NAIC consumer representatives including Families USA are advocating to make these models as robust possible in their protection of consumers and the market from the damage of short-term plans. (See the March 2018 report by the NAIC consumer representatives and former Montana regulator Christina Goe, Non-ACA-Compliant Plans and the Risk of Market Segmentation.)

This article was brought to you by Families USA by Claire McAndrew on April 2018.


Resisting Popular Healthcare Trends and Getting Creative

In this article, experts explore the idea that companies need to use the many tools at their disposal, as opposed to relying specifically on one popular trend.

A recent study found that substantial wellness incentives and high-deductible health plans are not the quick fix to improving health care costs they were originally thought to be.

Employers pinned their hopes on high-deductible health plans, but HDHPs only represent 30 percent of medical plans offered by employers, according to the “2018 Medical Trends and Observations Report” released in early March by DirectPath and research and advisory company Gartner.

“Increasingly, employers are realizing that true, long-term cost management will come from a combination of tools and that they need to enlist employees in the effort in a meaningful way,” said Kim Buckey, vice president of client services at employee engagement firm DirectPath.

Employers have explored different options starting with managed care plans and health maintenance organizations the past several decades, moving toward consumer directed health plans years later and considering wellness programs and private exchanges after that, according to Buckey. These solutions could provide short-term relief but not singlehandedly solve the problem, she said.

The logic behind HDHPs was that if employees had skin in the game, they’d be more conscientious about looking for lower-cost options in medical care and become smarter health care consumers, Buckey said. But what this idea did not address the larger issue: employees’ lack of health literacy and little understanding of health insurance comprehension.

“Employees historically just hadn’t had the knowledge or the tools to truly become educated consumers,” she said.

The report, based on an analysis of 900 employee benefit health plans, also found that fewer companies are offering wellness incentives. Some 31 percent of employers offer them today, according to the 2018 report. This number is considerably lower than the 2017 report, which found that 58 percent of employers offered incentives, and the 2016 report, which found that 50 percent did.

“That was surprising because using incentives to drive employee behavior was a big component of most companies’ strategies across the past couple years,” said Brian Kropp, HR practice leader at Gartner. “What companies are finding in a lot of cases is that the incentives were most likely used by healthiest people whose health care costs were already quite low.”

For many companies, incentives have been cutting health care costs for employees who were already spending less rather than making prices more reasonable for people with higher expenses, he said.

This is not the ideal result since the idea behind incentives was, for example, to convince unhealthy people to get an annual physical. This would supposedly help them find health problems before they became serious and more expensive to treat.

“The idea that incentives as currently structured at most companies are becoming of less interest because they’re not as effective as we thought,” Kropp said.

The decline in incentive use may also have to do with concerns about the future legality of these plans, according to the report. A federal judge ruled in December 2017 that the EEOC’s incentive rules — which deem a wellness program voluntary if the incentive or penalty was no more than 30 percent of the cost of the health plan — will only continue until the end of 2018.

Other reports have found different data on wellness incentives. Jessica Grossmeier, vice president of research for the think tank Health Enhancement Research Organization, shared that a Mercer report in 2016 found that two-thirds of employers were using incentives to encourage employee to participate in wellness programs and that 29 percent provided incentives for achieving, maintaining or showing progress toward specific health status targets.

Whether employers will maintain their commitment to using financial wellness incentives will depend on the individual employer and what happens with the EEOC incentive rule. For the time being, employers can take the conservative approach and offer no incentives, take the middle-ground approach and offer modest incentives, or take the aggressive approach and offer up to 30 percent incentives as usual, according to law firm K&L Gates.

Privacy is another concern with wellness programs, Buckey said. Despite generous incentives, some employees may hesitate to participate in these programs because of privacy concerns. Some wellness programs provide employers with aggregate data about the current health status and health risks of their employee population. “With financial and health data breaches increasingly in the news, I think we will see a leveling off or even a lack of interest in participating in programs whether data — even in aggregate — is collected about an employee’s health,” Buckey said.

While strategies such as relying on wellness programs to lower health care costs or using HDHPs to make employees smarter health care consumers have not become the ultimate fix, there are some ways employers can get more creative with their strategy, according to Buckey. She suggested several ways for employers to take a multi-pronged approach to health care cost management.

Employers can offer transparency services, which allow employees to compare pricing for the same service near their home, when they are planning an elective high-cost service like diagnostic tests or surgeries. Employers can also provide better enrollment support in open enrollment so that employees choose the right plan and more carefully manage pharmacy costs by adding measures like mandatary generics or step therapy.

Buckey also mentioned that some of her company’s clients provide patient-advocacy services.

“[It] helps employees identify billing errors and resolve disputes with providers and insurance companies,” she said. “This frees up the employees to focus on their work, rather than financial and medical concerns.”

It’s important for companies to get creative with their health care benefits more than ever before, Kropp said. In the past, employees knew that the health insurance they received at one company was comparable to what they’d receive at many other companies. What the insurance was exactly didn’t matter because most employees felt the plans were more or less the same, he said.

Now companies are starting to realize that better health care plans are a significant differentiator for attracting talent in a competitive labor market, he added. As information for employees and candidates became more transparent and accessible, it became easier as a candidate to understand what health plan offerings looked like at other companies.

“It is a relatively new phenomenon of companies becoming much more vocal about their benefits offerings as a way to compete in a tight labor market,” Kropp said.

This article is from Workforce written by Andie Burjek on April 10, 2018.


Half of Americans think the ACA marketplace is collapsing

Most Americans are happy with the insurance they buy on the individual market, yet those same people think the markets are collapsing before their eyes.

A poll by the Kaiser Family Foundation  (Kaiser Health News is an editorially independent program of the foundation), released Tuesday, found that 61 percent of people enrolled in marketplace plans are satisfied with their insurance choices and that a majority say they are not paying more this year compared with last year’s premium costs.

Yet, more than half of the overall public — 53 percent — also think the Affordable Care Act’s marketplaces are “collapsing.”

Experts have warned that some policy actions supported by the Trump administration would undermine the market, including repealing the penalty for going without insurance and giving people the option to buy short-term plans. Such plans are often less expensive but cover fewer benefits. They are not automatically renewable, and insurers are able to charge people with medical conditions more — or exclude them altogether.

But only about one-fifth of people who obtain coverage on the individual market were even aware that the mandate penalty had been repealed as of 2019, according to the poll. It is still in effect this year.

Nine in 10 enrollees said they would still buy insurance without the penalty, and 34 percent said the mandate was a “major reason” they chose to buy insurance at all.

“They may have been prompted to buy the coverage in the first place because of the mandate,” said Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute. “But now that they’ve got it, they clearly value it.”

Most of the people who buy plans because they don’t get coverage through work or the government, 75 percent, said they bought insurance to protect against high medical bills, and 66 percent said peace of mind was a major reason.

In February, President Donald Trump eased some of the restrictions on short-term insurance plans, allowing them to cover people for 12 months instead of three.

Critics worried this alternative would draw people away from traditional insurance plans and weaken the individual market. According to the poll, though, only 12 percent of respondents buying on that market said they’d be interested in buying one of the short-term plans.

Georgetown’s Corlette cautioned that these numbers could change when people are faced with an actual choice next open enrollment season.

“If you look at how these things are marketed, your average consumer will not be able to tell that these products are any different from a traditional health plan,” she said.

Most people said they didn’t face a premium increase this year. Thirty-four percent said their premiums were “about the same” as last year and 23 percent said they actually went down.

That’s not surprising, said Joseph Antos, a resident scholar at the conservative American Enterprise Institute who follows the health industry. Many consumers saw their premium subsidies rise too.

Thirty-five percent of people said one of the major reasons they bought insurance was because government subsidies made it affordable.

The subsidies that people receive, Antos noted, went up to offset the premium increase in many cases, especially if consumers took the advice of experts and shopped around for coverage.

“They’re buying because they feel they need insurance and that their net premiums and deductibles add up to something they’re willing to buy,” Antos said.

The poll was conducted Feb. 15-20 and March 8-13 among 2,534 adults. The margin of sampling error is +/-2 percentage points for the full sample, +/-7 percentage points for all non-group enrollees and +/-9 percentage points for marketplace enrollees.

Source: Kaiser Health News senior correspondent Julie Appleby contributed to this report.
By Rachel Bluth, Kaiser Health News | April 03, 2018 at 10:06 AM | Originally published on BenefitsPro


Healthcare analytics market grows as providers take aim at cost-cutting

Electronic medical conceptData-enriched tools have cut the communication gap between caregivers and patients even as they provide a large amount of data that can be used to create personalized treatments. (Image: Shutterstock)

 

The need by hospitals and other health care providers to cut the cost of providing care is helping to drive up the global health care/analytics market, to reach an anticipated worth of $53.65 billion by 2025.

That’s according to a new report by Grand View Research, Inc., which says that hospitals are already using health care analytics to manage the number of workers working in a particular shift.

Citing the example of a hospital in Paris that uses health care analytics to predict the number of patients that may be hospitalized, the report points out that such data can be used to decide the number of staff members that will be needed for a particular shift, thus assisting in driving down the cost of labor in hospitals.

Data-enriched tools such as mHealth, eHealth, Electronic Health Records and mobile applications have cut the communication gap between caregivers and patients even as they provide a large amount of data that can be used to create personalized treatments. However, patients might hesitate to use such tools; that could weigh on the implementation of analytics.

But a combination of artificial and human intelligence data analytics, offering the opportunity to bring greater customization to medical approaches, is expected to expand demand for such tools over the next few years.

Among other findings in the report is the significant market share held by descriptive analytics in 2015 because of its applications in process optimization in organizations. In addition, the services category dominated the component segment in 2015, with outsourcing of big data services contributing to their growth in aiding the high volume of services rendered.

The hardware systems category came out the winner in the component segment, with the high cost of hardware contributing to its growth, while on-premise delivered analytic services dominated the delivery mode category in 2015, capturing a market share of approximately 54.0 percent.

North America has captured a significant share in the global market, the report finds, with advanced health care infrastructure in the region and growing per capita health care spending supporting greater consumption of these services.

Source:
By Marlene Satter 
| April 02, 2018 at 12:13 PM | Originally published on BenefitsPro


Medicare Advantage payments to see 3.4 percent increase next year

 
About 21.4 million people are enrolled in Medicare Advantage plans, while 37.7 million rely on standard Medicare. (Image: Shutterstock)

 

The U.S. agency that oversees Medicare said it will increase payments to privately run health plans for the elderly by an average of 3.4 percent next year, almost double the amount it had previously estimated.

That’ll be a boon for insurers such as UnitedHealth Group Inc. and Humana Inc. that have big businesses selling the private plans, known as Medicare Advantage. Including changes based on how sick or healthy people are, the total increase in payments to insurers is estimated to be about 6.5 percent, on average, the Centers for Medicare and Medicaid Services said in a statement Monday.

Medicare Advantage is an important source of growth for health insurers as the U.S. population ages and more people opt for the private plans, rather than the traditional Medicare program. About 21.4 million people are enrolled in the private plans, while 37.7 million rely on standard Medicare.

Medicare Advantage has drawn plenty of interest from both startups and established firms. Walmart Inc. may be seeking a broader partnership with Humana Inc. in part to benefit from growing enrollment in the plans, Bloomberg reported late last week. CVS Health Corp. agreed to acquire Aetna Inc. late last year in a bet in part on providing better care for seniors.

Source: Tracer Z. (3 April 2018). "Medicare Advantage payments to see 3.4 percent increase next year" [Web Blog Post]. Retrieved from Benefits Pro.


10 perks that help attract and retain workers

Job seekers and employees today have more control over their careers than ever before. Leaving current positions for better opportunities, and being more selective when applying for a new job, are now commonplace.

With the war for talent in full effect, companies of all sizes have had to take a close look at their compensation and employee benefits to ensure that they meet, or preferably exceed, expectations.

While keeping up with the latest employee benefits trends is one great way to maximize benefit plans, employers should also explore additional employee and workplace perks to help with recruiting, retention and engagement.

1. Free snacks and coffee

coffee and donuts(Photos: Shutterstock)

 

An often-overlooked way to enhance the workplace is to provide employees with complimentary snacks and coffee. Not only does this help employees save a few dollars each day, but office snacks have shown to increase workplace production. And offering employees healthy alternatives can get people more energized and involved with a company’s overall wellness program.

2. Flexible work schedules

One of the biggest trends in the business world has been a shift away from the traditional 9 to 5 work day. While some positions require such a schedule, more and more companies are enabling employees to have more flexibility with their working hours. As a matter of fact, many businesses are including flexible working schedules in their job descriptions and on career sites to help attract younger job seekers. As work-life balance continues to become more important to employees, flexible working schedules can be valuable perk for employers to offer.

3. Working from home

While telecommuting is becoming more common, not all employees can exclusively work-from-home. However, enabling employees to work at home on occasion can be a great perk for keeping employees happy and engaged. Providing employees with the tools and resources necessary to work from home when needed can greatly assist with lowering turnover, and can also help reduce stress and improve the employee experience.

4. Employee assistance programs

A greater focus on employee wellness – both physical AND mental – is occurring in companies big and small. One way to help with this initiative is to have an employee assistance program (EAP). These programs provide counseling to employees for both professional and personal issues, and can include consultations with licensed clinicians for financial and legal services, grief counseling, and day-to-day support for full-time employees and anyone in their household.

5. Company events

You have probably seen or heard of Fortune-500 companies throwing elaborate and expensive events for their workforce. While small employers can’t do something to this level, having company-sponsored events throughout the year is a great way to boost employee morale and build a culture. These events also present an opportunity to boost employer branding and recruitment marketing efforts. Things like company picnics, holiday parties, and even individual team outings (such as a bowling night) help to boost company morale.

6. Employee referral programs

Hiring the best talent is a mission all companies have in common. But with recruiting more challenging than ever, it can be difficult to accomplish this goal. However, establishing an employee referral program (especially one that provides a cash or bonus reward) is a fantastic way to get your entire company involved with recruiting. These programs also help employees feel more invested in their organizations, especially if they can bring friends or professional colleagues to their organization.

7. Lunch and learns

Learning and development is important to employees. While investing in large-scale programs and bringing in industry experts on a routine basis may not be possible, each company has their own subject-matter-experts who can provide learning opportunities to their co-workers. A monthly lunch and learn session can be a great way to inform the entire company on new initiatives and projects, as well as boost employee engagement throughout the company.

8. Employee discounts

Another great additional perk that employees will enjoy are discounts on certain items or events. Discounts on items like clothing brands, tech, Broadway shows, sporting events, and many others can help employees save money while enjoying things that they enjoy. These types of perks are becoming increasingly popular, even for smaller employers and can be a great tool in recruiting. Not to mention the role they play with employee happiness, engagements, and ultimately retention.

9. Summer hours

We discussed earlier about the value of flexible work schedules. A fantastic addition to an already popular perk, giving employees summer working hours are a great way to boost happiness and morale. For example, many companies let employees leave the office early on Fridays to get a head start on their weekend plans. With work-life balance becoming more important, this simple perk can be a great for current and future employees alike!

10. Employee rewards and recognition

Boosting employee engagement and the overall employee experience are critical objectives for all companies today. An excellent way to help with these goals are to recognize and reward employees throughout the year. Whether it’s completing a difficult or important project, reaching certain milestones with the organization (such as years of service), or completing outside education, these can all be extremely valuable for the individual and the company. Additionally, providing rewards along with recognition can go a long way to building engaged culture and a great employer brand.

Source: Altiero M. (3 April 2018). "10 perks that help attract and retain workers" [Web Blog Post]. Retrieved from Benefits Pro.