Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits

Employers can now use their own data to help fine-tune their employer-sponsored benefits packages. Continue reading to learn how this technology could be used to help fine-tune employee benefits offerings.


Last year’s World Series between the Houston Astros and the Los Angeles Dodgers came down to a seven-game battle based not only on talent, athleticism and coaching but also on data. Just as Sports Illustrated suggested back in 2014 via predictive data, the Astros were the victors.

The publication of Moneyball: The Art of Winning an Unfair Game spurred not only Major League Baseball teams to deploy predictive analytics, but also businesses to take a harder look at what their data means. It's no longer part of the hype cycle: Statista forecasts (paywall) that the predictive analytics market worldwide will reach $6.2 billion in 2018 and $10.95 billion in 2022.

I believe we are also at a transformational point in improving corporate employee benefits and our employees’ lives by embracing predictive analytics. HR is swimming in rich data. Instead of guesstimating needs across multiple generations of employees, employers can turn to their own data to fine-tune what they are offering as benefits solutions. Companies spend 25-40% of an employee’s salary on benefits. It simply makes strategic and financial sense to get it right.

Bring Employee Benefits Out Of The Dark Ages

Hiring and retaining great talent is at the very soul of almost every company’s strategy. Not surprisingly, more companies have turned to predictive analytics to give them a leg up in recruitment. However, HR benefits have lagged behind. As John Greenwood reported to Corporate Adviser, “More than half of reward and employee benefits professionals see predictive analytics as a game-changer, but 90 percent are still using spreadsheets to manage data, research from the Reward & Employee Benefits Association shows.”

One reason for benefits lagging behind recruitment in adopting predictive analytics is that the way companies choose new benefits varies greatly from business to business. Given that the majority of HR departments keep data in disparate spreadsheets, even if some HR departments conduct employee surveys or historical cost analyses, they often do not integrate the data about their workforce. If a new benefit offering is chosen based on a needs analysis, only some know the “why” behind a request from the workforce. Knowing how many employees are logging into a benefits platform is helpful; market standard benefit utilization reports provide this level of information. Yet they do not give insight into the underlying reason for an employee to utilize a benefit. The user of deeper analytics is required to look deeper into employees' behavior.

We have found firsthand that many HR departments do not have a full understanding of how their employees are utilizing their benefits across the entire offering suite. A one-size-fits-all or a one-off strategy no longer is effective. Companies must understand not only their employees’ needs but also the underlying data related to these needs to provide a valuable benefits offering.

Put Your Existing Data To Use

For the past five years, I have watched our clients glean valuable insights into what the real underlying issues are for their employees and what must be done to address these pressing needs. I also have been watching companies realize that what they thought were the core problems at hand sometimes were not.

For example, one of our national high-tech clients, with over 50,000 benefit-eligible employees, believed that a high number of their employees had children struggling with autism. This belief was initially based on input from some of their employees. After approximately 16 months, the client reviewed the masked utilization data from their benefit platform. The data illustrated that the overwhelming majority of employee families (tenfold) in fact faced challenges associated with youth anxiety, a concern that had never been expressed to HR previously. Once they reviewed what employees were doing within our platform, their results mirrored the National Institute of Mental Health’s report that approximately 31.9% of U.S. children ages 13-18 struggle with anxiety disorders.

Their own data helped them understand much more specifically where their employees’ stress lay, and their HR department was able to focus communications around it.

Getting Started

Mining and viewing use data across all benefits is ideal. This enables an employer to determine if the benefit suite is serving employees effectively. We have found that as quickly as year over year, users' behaviors shift. If a company solely chooses a benefit based on what they saw as most heavily utilized the previous year, they are not being strategic.

For that reason, HR should utilize past and current data to better predict future patterns of need for a truly strategic approach to benefit choice. With this insight, they can make better choices and serve their workforce more effectively.

Given the limitations across many employee benefit vendors today, to start initially:

1. Embrace KPIs. Agree upon them internally, and measure benefit vendors on them.

2. Work with your current vendors to determine what data they provide to support your internal analysis. Ensure you have access to all the data you need, and if not, consider a vendor change.

3. Hold possible new vendors to similar data standards, and create a transparent relationship from the start.

4. Collect current and historical data. Existing vendors can provide this history, so make sure to collect at least 2-3 years of information.

These analytics need to go deeper than basic demographics to show patterns of activity. In order to understand the benefit needs of your workforce, you'll want to analyze trends across multiple data sets: medical, pharmacy, worker's compensation, biometric screenings, utilization patterns, FMLA requests and demographic trends. From there, you can start to pinpoint what your employees need -- and the “whys” behind the needs -- in order to make a measurable impact.

While predictive analytics is still in the nascent phase in the benefits and vendor worlds, the easiest and most proactive thing any employer can do is to focus on other insights vendors can provide related to the workforce and benefit use beyond simple utilization. In doing so, you will be able to support your employees both in their work lives and their personal lives by providing them with the benefits they need to be at their best.

SOURCE: Goldberg, A. (2 October 2018) "Predictive Analytics Will Be The Silent Game-Changer In Employee Benefits" (Web Blog Post). Retrieved from: https://www.forbes.com/sites/forbestechcouncil/2018/10/02/predictive-analytics-will-be-the-silent-game-changer-in-employee-benefits/#26648166e182


Healthcare waste is costing billions — and employers aren’t doing anything about it

Providing your employees with healthcare insurance is expensive. A large chunk of healthcare costs is being wasted by the healthcare industry, according to a new survey. Read on to learn more.


Providing the workforce with healthcare coverage is expensive, but a new survey of 126 employers suggests a large chunk of that cost is being wasted by the healthcare industry on treatments patients don’t need.

The healthcare industry wastes $750 billion per year on unnecessary tests and treatments, according to a survey from the National Alliance of Healthcare Purchaser Coalitions and Benfield, a market research, strategy and communications consulting firm. Some 60% of employers don’t take steps to manage their healthcare plan’s wasteful spending, despite the fact that the same percentage of employers view it as a problem, the survey says.

“While waste has long been identified as a key concern and cost contributor, employers are operating blind and need to look at a more disciplined approach to address top drivers that influence waste,” says Michael Thompson, National Alliance president and CEO.

Employers are under the impression that prescription drugs are the culprit behind the spending waste, and they are, just not as much as other services. Around 54% of health spending waste is caused by unnecessary medical imaging tests, such as MRIs and X-rays, the survey says. Specialty drugs, unnecessary lab tests and specialists referrals are also major money pits.

However, the survey data isn’t suggesting these procedures and treatments shouldn’t be covered by employer health plans. The tests and treatments are potentially life-saving, they’re just used more than they should be. Sometimes previous test results can help with a current diagnosis, but medical staff don’t always check patient files before ordering new tests.

Most employers don’t monitor unnecessary healthcare spending. The 34% of employers who do rely entirely on their healthcare vendors to do it for them, trusting that it’s being taken care of.

“The idea of reducing waste in the healthcare system can be overwhelming,” says Laura Rudder Huff, senior consultant for Benfield. “While employers ask themselves: ‘Where to start?’ this is an issue where even small steps matter. Employers can begin by collecting data to identify where the inefficiencies are in their workforce and community and use assets such as vendors and organizations like coalitions to realize market improvements.”

The survey also recommends employers enlist the services of Choosing Wisely, an organization that counsels patients and employers on healthcare plans and medical treatments.

SOURCE: Webster, K. (7 November 2018) "Healthcare waste is costing billions — and employers aren’t doing anything about it" (Web Blog Post). Retrieved from https://www.benefitnews.com/news/healthcare-waste-is-costing-billions-and-employers-arent-doing-anything-about-it


How to Optimize Open Enrollment for Workers

From the rising cost of prescription medications to the ever-changing status of the ACA, benefit administrators are faced with many challenges when it comes to healthcare programs. Read this blog post to learn more.


Administrators of employer-sponsored healthcare programs face myriad challenges these days, from the rising cost of medications to the fluctuating status of the Affordable Care Act and state healthcare exchanges. As we head into the 2019 open enrollment season, it’s clear that these issues will continue to impact every type and rank of employee in the coming year.

To that end, I’ve outlined several key trends in open enrollment that frazzled HR leaders should explore before enrollment season begins. If it’s too late to make changes to your program this year, use these key points as a basis for measuring and evaluating current programs so you can begin planning for a more engaging, transparent and streamlined process next year.

You don’t have to take it all on yourself.

Employers are realizing that as great as some decision support and health advocacy tools may be, attempts to make employees better healthcare consumers have been only marginally effective.  High-performing (aka narrow) networks may be a viable solution as they enable better rates negotiated with the carriers and providers while reducing waste, errors and unnecessary costs. It’s the steerage option, but plan designs can provide incentives for employees to elect these plans and networks. In turn, the HPNs can provide:

  • more concierge-like service;
  • better coordinated care between providers for high-cost claimants—where much of runaway costs reside; and
  • support to ensure compliance with treatment protocols—for chronic conditions such as diabetes, CAD, COPD, etc.

In turn, these plans have the potential for shaving points off healthcare cost trend.

But it’s vital that communication strategies help reduce fears of reduced network choices (avoiding bad memories of restrictive HMO networks) while increasing confidence in the ability of the HPNs to drive results that actually enhance care while also reducing costs.

The best strategy is to provide easy-to-understand examples and scenarios that represent typical situations based on your company’s demographics and employee personas.

Use all the channels you have.

Education and engagement need to be done through a variety of channels to address the specific needs and preferences of demographic groups. Employees need to compare their options based on anticipated needs to look at both premiums (per paycheck costs) and out-of-pocket costs (deductible, copays, coinsurance), as well as employer-provided HSA contributions and incentives. The premium doesn’t tell the whole story—some people over-insure themselves by paying a higher premium for coverage that they may not use because they fear a higher deductible and out-of-pocket maximum.

Cost-comparison tools, interactive personalized assessment tools, microsites that are mobile-optimized with clear, consistent messaging, and extremely brief interactive videos make the message relevant to each individual.

Remember too that your company portal is both a useful tool in ensuring a personalized message to the employee, and a way for you to collect aggregated data about your employees’ interests, needs, action or inaction, and the user experience.

Don’t try to hit all the bases.

Trying to communicate too much information at one time tends to obscure the key message. Focus only on providing information needed to make effective enrollment decisions and use other points during the year to educate about broader topics like wellness.

A common failure is going paperless and forgetting that you really need to drive employees to resources to get them to pay attention. There may be very robust online content and resources but a very low rate of use of that valuable information. Remember that spouses at home often may be making the majority of the healthcare decisions for a family or, at the very least, for themselves. So going too far with the paperless approach can miss getting the message—and the needed information—to those key stakeholders.

Don’t fear transparency.

It’s intriguing to me that some employers are wary about communicating their level of cost-sharing with employees and how it benchmarks against peer companies. Employees often assume they are paying a far larger share than they are. There are other ways of being transparent about cost-sharing beyond the employer-employee split. For instance, we created an infographic for a client to explain the concept of self-insurance and are using it in an ongoing educational series with fact sheets and videos, getting across the idea that the decisions each of us make about our health and informed healthcare purchasing affect the costs in our individual as well as collective pockets.

The bottom line is that helping employees get smart about how they use healthcare and choose insurance options will save your company money. That’s not as callous as it sounds. If employers can’t find more and better ways to control healthcare and benefits costs, they’ll simply have to shift more of the burden to employees. Healthcare access is onerous enough. No one wants to make it harder or deprive workers of needed care. Healthy, satisfied, financially stable workers are better for business, productivity and the overall economy. Commit to exploring these key trends and making meaningful improvements to open enrollment in 2019 and beyond.

SOURCE: Brooks, B. (16 October 2018) "How to Optimize Open Enrollment for Workers" (Web Blog Post). Retrieved from http://hrexecutive.com/how-to-optimize-open-enrollment-for-workers/


5 things small business owners should know about this year's open enrollment

For small business owners, the benefits they offer are crucial to the way they attract and retain employees. Read this blog post for five things small business owners should know for 2019 open enrollment.


As a small business owner, offering competitive employee benefits is a crucial way to attract and retain strong talent. Whether you currently provide them and are planning next year’s renewal, or you are thinking of offering them for the first time, here are five things you should consider before your employees enter the open enrollment period for next year on November 1st:

1. Small businesses don’t have to wait until open enrollment to offer benefits to their employees

While your employees won’t be able to enroll in health insurance plans until November comes along, small business owners don’t have to wait at all to secure health insurance for their employees. The sooner you act, the better, to guarantee that you and your employees are protected. According to recent studies, healthier employees are happier employees, and as a result, will contribute to a more productive workplace. And a more positive and constructive work environment is better for you, your employees, and your business as a whole.

2. Health literacy is important

Whether you’ve provided health insurance to your employees before, or you’re looking into doing so for the first time, it is always worthwhile to prioritize health insurance literacy. There is a host of terminology and acronyms, not to mention rules and regulations that can be overwhelming to wrap your head around.

Thankfully, the internet is full of relevant information, ranging from articles to explainer videos, that should have you up to speed in no time. Having a good understanding of insurance concepts such as essential health benefits, employer contributions, out-of-pocket maximums, coinsurance, provider networks, co-pays, premiums, and deductibles is a necessary step to being better equipped to view and compare health plan options side-by-side. A thorough familiarization with health insurance practices and terms will allow you to make the most knowledgeable decisions for your employees and your business.

3. Offering health insurance increases employee retention

Employees want to feel like their health is a priority, and are more likely to join a company and stay for longer if their health care needs are being met. A current survey shows that 56 percent of Americans whose employers were sponsoring their health care considered whether or not they were happy with their benefits to be a significant factor in choosing to stay with a particular job. The Employee Benefit Research Institute released a survey in 2016 which showed a powerful connection between decent workplace health benefits and overall employee happiness and team spirit—59 percent percent of employees who were pleased with their benefits were also pleased with their jobs. And only 8 percent of employees who were dissatisfied with their benefits were satisfied with their jobs.

4. Alleviate health insurance costs

High insurance costs can be an obstacle for small business owners. A new survey suggests that 53 percent of American small business owners stress over the costs of providing health care to their employees. The 2017 eHealth report reveals that nearly 80 percent of small businesses owners are concerned about health insurance costs, and 62 percent would consider a 15 percent increase in premiums to make small group health insurance impossible to afford. However, there are resources in place to help reduce these costs, so they aren’t too much of a barrier. One helpful way to cut down on health insurance costs is to take advantage of potential tax breaks available to small business owners. All of the financial contributions that employers make to their employees’ premiums are tax-deductible, and employees’ financial contributions are made pre-tax, which will successfully decrease a small business’ payroll taxes.

Additionally, if your small business consists of fewer than 25 employees, you may be eligible for tax credits if the average yearly income for your employees is below $53,000. It is also beneficial to note that for small business owners, the biggest driver on insurance cost will be the type of plan chosen in addition to the average age of your employees. Your employees’ health is not a relevant factor.

5. Utilize digital resources

You don’t have to be an insurance industry expert to shop for medical plans. There are resources and tools available that make buying medical plans as easy as purchasing a plane ticket or buying a pair of shoes online – Simple, transparent. Insurance is a very complex industry that can easily be simplified with the use of the advanced technology and design of online marketplaces. These platforms are great tools for small business owners to compare prices and benefits of different plans side-by-side. Be confident while shopping for insurance because all of the information is laid out on the table. Technological solutions such as digital marketplaces serve as useful tools to modernize the insurance shopping process and ensure that you and your team are covered without going over your budget.

SOURCE: Poblete, S. (15 October 2018) "5 things small business owners should know about this year's open enrollment" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/10/15/5-things-small-business-owners-should-know-about-t/


5 ways benefits educators can ease the open enrollment process

Are you prepared for open enrollment? HR professionals are responsible for effectively communicating plan options and changes to employees so they make informed decisions regarding their coverage and healthcare. Continue reading to learn more.


Open enrollment season is on its way, which means that HR’s already full plate just got a bit fuller. In addition to developing competitive health plans that attract and retain top talent – talent of all ages and with varying needs – HR pros are also responsible for effectively communicating plan options to employees to ensure that individuals make informed, cost-conscious decisions about their coverage and care.

See also: Here’s how HR pros can breeze through open enrollment

As the healthcare landscape becomes more complex, so do employee questions around their health care benefits. Many healthcare consumers today don’t feel comfortable navigating the health care system – which is why most roll over the same plan year after year. While HR teams want to manage the influx of employee questions around their benefits options, they struggle to provide the necessary guidance given their current bandwidth. Covering health plans in a large townhall meeting won’t provide the personalized information that employees need to make educated decisions. To deliver a more personal, empowering experience, organizations can look to benefits educators to supplement strapped HR teams.

Benefits educators can help individuals better understand the plan options available to them and select the package that offers the coverage they need at the price that best fits their budget. To ensure that benefits educators are aligned with the organization’s strategy, HR teams should arrange for educators well in advance of open enrollment so they are equipped to best explain the employer’s benefits plan options. Once up to speed, benefits educators can hold one-on-one conversations with employees to:

1. Define healthcare terms that employees don’t understand. With low healthcare literacy rampant across the U.S., disturbingly few employees are comfortable defining basic health terms such as “deductible,” “copay” or “coinsurance.” benefits educators cannot only explain these important terms but also help employees understand their significance in their coverage selection process.

2. Compare different plans to suit each employee’s needs. Benefits educators will work to understand the specific needs of each employee they meet. By taking the time to sit and get to know each employee, the benefits educator can recommend options that provide the coverage that best meets the needs of the employee and his or her family.

See also: Avoid these 12 Common Open Enrollment Mistakes

Third-party, independent benefits educators can be particularly valuable for employees who do not feel comfortable posing personal questions to their coworkers. By meeting one-on-one with an outsider who understands both benefits in general and company options in particular, employees are often more inclined to raise specific health or personal details that should guide their benefits selection. In fact, 45 percent of employees say they would prefer to speak to a benefits expert when choosing their coverage.

3. Equip employees with the information they need to choose their coverage. Left to their own devices, 83 percent of employees spend less than an hour reviewing their plan options before open enrollment – a lack of preparation that does not bode well for educated benefits selection. benefits educators can focus on the details that matter – saving the employee time and effort.

4. Explain voluntary benefits. Despite the increasing popularity of voluntary benefits, many employees are still confused about what they are, how they work and why they might be helpful. In reality, certain voluntary benefits can help control health costs and bridge the gap between medical coverage and out-of-pocket costs – added expenses that concern 61 percent of employees. In today’s multigenerational workforce – where employees have very different priorities when it comes to their health and financial wellness – benefits educators can dispel some of the mystery and suggest options that might meet individual needs.

5. Empower employees to make the most of their benefits year-round. Benefits educators can lay the groundwork for more educated health care consumers by directing employees to resources where they can find more information about their coverage and how their plans work after the open enrollment ends.

See also: 5 tips to make this the best open enrollment ever

More informed employees not only make smarter choices about their coverage and care but also better appreciate their employers – which has the potential to help with retention and business productivity. Ultimately, organizations see a win-win-win: happier employees who save on care, happier HR teams who save on time and happier executives, who see a significant return on their health care investments.

SOURCE: Murdock, G (21 September 2018) "5 ways benefits educators can ease the open enrollment process" (Web Blog Post). Retrieved from https://www.benefitspro.com/2018/09/21/5-ways-benefits-educators-can-ease-the-open-enroll/


Medicare: Why an Advisor Makes All the Difference

Often those approaching Medicare eligibility are overwhelmed by the quantity of information available – and understandably so. As a form of insurance, Medicare is fundamentally different from other group/employer, individual, or family plans in that it is centered around the individual, yet any decisions made could potentially affect family members. In order to understand the costs, benefits, plans, and overall structure of Medicare, professional advice is strongly recommended when weighing options. That’s why, in this installation of CenterStage, Rob Glover, our Senior Solutions Advisor at Saxon, provided the following insightful information. Generally speaking, Medicare plans are explored during a significant lifestyle change. Having an insurance sales agent to facilitate retirement planning can help in adjusting Medicare options.

A Two-Way Relationship

Insurance agents are able to conform Medicare options around desired preferences and requirements. Each beneficiary is unique and therefore deserves a plan that delivers a standard of quality that is suited to varying budgets and ways of life. Agents can act as personal advisors and offer close collaboration when sifting through insurance plans. After becoming aware of defined healthcare coverage needs, Medicare advisors can narrow the search and find a solution that will safeguard both the individual and his or her family from looming financial damages.

It’s best to have a licensed agent with years of experience in Medicare. While textual knowledge is certainly important, learned wisdom is paramount in avoiding pitfalls throughout the process. Agents with real experience in the field are the best guides in navigating the processes, policies, and terminology of Medicare. Also, there are benefits in maintaining a relationship with them, since they are well-versed in the details of plans germane to the area. They are likely more familiar with supplier and provider networks and, using this knowledge, can provide guidance on which Medicare plan to choose.

The beneficiary-advisor relationship doesn’t end after the sale. In fact, they are often an advocate for many years after, offering consultations that address subsequent concerns with coverage. Medicare advisors can help review healthcare needs on a yearly basis to ensure the plan is lining up with changing criteria.

Services Worth Using

Independent advisors can offer many options across a multitude of carriers. Some agents are able to compare dozens of providers by contracting many different insurance companies. This method of contracting also aids in eliminating biases during plan research and comparison. The independent advisor can assist in making an informed decision on a Medicare insurance plan that is in line with the individual needs of the beneficiary. There aren’t any fees associated with merely utilizing an advisor. To elaborate, the rates linked to insurance plans already cover advisors’ commissions and thus render the decision on whether or not to employ one free from frugal urges. Therefore, there’s no reason not to seek the advice of a discerning sales agent to make the enrollment process easier. Licensed sales agents in the Medicare field take part in numerous hours of continued education and training annually. They are knowledgeable to pertinent information that could shape the decision-making process in addition to their understanding of a client’s defined parameters. Nevertheless, beneficiaries can only change insurance once within a year and can wind up “stuck” in a chosen plan unless the said beneficiary is eligible for a Special Enrollment Period. Regardless of position in the retirement process, time becomes increasingly more important. Utilizing an informed advisor will lead to time saved on plan comparison and research as they can help pinpoint a solution that fits the circumstances rather than waste time through trial and error. Licensed advisors are able to grant a one-stop shopping experience. Through innovative technology, they can access any and all relevant information at any time. Some create webinars regarding important issues, answer frequently asked questions, and elicit 24/7 assistance. Within some websites, beneficiaries can enroll in Medicare Advantage plans, request proposals, and research and compare options.

If you would like to learn more, contact Rob Glover at 513.703.7720 or rglover@gosaxon.com.


Seeing beyond size in vision care networks

How do you measure the quality of your vision care network? When it comes to the world of vision care, size isn't the only factor to consider when deciding which network best fits the needs of your employees. Read on to learn more.


Most people believe that “size matters” in regards to provider networks, but in the world of vision care, there are other important factors to consider when deciding which network matches the needs of employees. Network members usually see their vision provider for routine services just once per year. When an employer changes vision administrators, employee in-network utilization is more than 90% regardless of the new network size. Why? Employees are not concerned about changing providers to access in-network benefits. Plus, the new vision provider network will always provide access to multiple providers wherever the employee lives and works.

But what about the quality of the vision care network? To properly assess this measurement of competing networks, employers and benefits advisors need to ask several different questions.

Determine the network’s quality
The quality of the network is vital. Start asking these questions: How are vision care providers credentialed? Do they follow the National Committee for Quality Assurance (NCQA) guidelines developed to improve healthcare quality? Are there provider audit programs provided on an ongoing basis? Is the vision care provider re-credentialed and how often? How frequently are reviews conducted of the Office of Inspector General and Medicare and Medicaid disbarment lists?

Establish the network’s effectiveness
Once you know you have a quality network, now you must ask how effective the network is. How diverse is the network? Are there ample ophthalmologists, optometrists and optical retailers we can access? Are some private practitioners? You want to make sure that a solid provider mix is available to give employees options when choosing a vision care provider.

It’s critical to know what languages are spoken within the employee population as well as the providers who care for them. If you have a large population who speak a certain language you want to make sure your network gives them access to people who can truly understand them and with whom they feel comfortable.

Finally, look at the hours of operations. With schedules being busier now than ever before, people need flexibility when it comes to visiting hours. Do they offer evening hours? Weekend hours? This is particularly important for single parents who work during the week and need the flexibility to visit an eye care professional with his or her child after work.

Having a diverse, quality vision care provider network with convenient access helps keep employees happy, healthy and in-network.

Other factors to consider
One of the other factors to be cognizant of is network ownership. Today, many managed vision care companies are involved in not only providing coverage for vision care but also in delivering it. This means the vision benefits company you’re considering may own optical laboratories, frame companies or retail locations, which can pose conflicts of interest between you, your employees and the managed vision care company. Their need to produce profits can lead to undo pressure on your employees to purchase expensive and potentially unnecessary lens types, materials and options. Coupled with direct to consumer advertising and the expansion of brands, eyeglasses have become even more expensive.

This leads to another factor for consideration. Does the potential vision benefit administrator provide meaningful information to help your employees make informed decisions about what they really need, when it comes to the myriad of options available for frames, lenses and lens options?

Network matching
Start by remembering two things when matching networks. First, if you’ve changed vision carriers in the past, you selected a network that was not identical to your previous one. Vision networks never match each other. Some have higher proportions of independent providers and lower percentages of large retailer chains. Second, the infrequency with which the vision benefit is available to be used mitigates the impact of changing providers. People don’t have the same attachment to their eye care professional as they do with their physician.

Beyond quality and effectiveness is the important factor of access. The vision industry has grown to a point where there are often many more providers than would ever be necessary to provide convenient access for your membership. The reality is that two networks may be equally sized in an area and yet there may be little overlap, making the selection of the best network with the lowest overall cost a better strategic direction than simply selecting the one with the highest provider match.

The vision industry has long demonstrated that employees are willing to select new providers, especially when costs are more competitive, and services are more convenient.

SOURCE: Moroff, C (22 August 2018) "Seeing beyond size in vision care networks" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/opinion/seeing-beyond-size-in-vision-care-networks?feed=00000152-a2fb-d118-ab57-b3ff6e310000


Top 10 health conditions costing employers the most

Conditions that impact plan costs can be problematic. Here is a look into the top 10 health conditions hitting the hardest on employers wallets.


As healthcare costs continue to rise, more employers are looking at ways to target those costs. One step they are taking is looking at what health conditions are hitting their pocketbooks the hardest.

“About half of employers use disease management programs to help manage the costs of these very expensive chronic conditions,” says Julie Stich, associate vice president of content at the International Foundation of Employee Benefits Plans. “In addition, about three in five employers use health screenings and health risk assessments to help employees identify and monitor these conditions so that they can be managed more effectively. Early identification helps the employer and the employee.”

What conditions are costly for employers to cover? In IFEPB’s Workplace Wellness Trends 2017 Survey, more than 500 employers were asked to select the top three conditions impacting plan costs. The following 10 topped the list.

10. High-risk pregnancy

Although high-risk pregnancies have seen a dip of 1% since 2015, they still bottom out the list in 2017; 5.6% of employers report these costs are a leading cost concern for health plans.

9. Smoking

Smoking has remained a consistent concern of employers over the last several years; 8.6% of employers report smoking has significant impact on health plans.

8. High cholesterol

While high cholesterol still has a major impact on health costs- 11.6% say it's a top cause of raising healthcare costs- that number is significantly lower from where it was in 2015 (19.3%).

7. Depression/ mental illness

For 13.9% of employers, mental health has a big influence on healthcare costs. This is down from 22.8% in 2015.

6. Hypertension/ high blood pressure

This is the first condition in IFEBP's report to have dropped a ranking in the last two years. In 2015, hypertension/ high blood pressure ranked 5th with 28.9% of employers reporting it is a high cost condition. In 2017, the condition dropped to 6th with 27.6% of employers noting high costs associated with the disease.

5. Heart disease

This year's study found that 28.4% of employers reported high costs associated with heart disease. In 2015, heart disease was the second highest cost driver with 37.1% of employers citing high costs from the disease.

4. Arthritis/back/musculoskeletal

Nearly three in 10 employers (28.9%) say these conditions are drivers of their health plan costs, compared to 34.5% in 2015.

3. Obesity

Obesity is still a top concern for employers, but slightly less so than it was two years ago. In 2017, 29% of employers found obesity to be a burden on health plans. In 2015, 32.45 cited obesity as a major cost driver.

2. Cancer (all kinds)

Cancer has become more expensive for employers. Now, 35.4% of employers report cancer increasing the costs of health plans, compared to 32% in 2015.

1. Diabetes

The king of raising health costs, diabetes has topped the list both in 2015 and 2017. In the most recent report, 44.3% of employers say diabetes is among the conditions impacting plan costs.

SOURCE:
Otto. N (18 June 2018) "Top 10 health conditions costing employers the most" [Web Blog Post]. Retrieved from https://www.employeebenefitadviser.com/slideshow/top-10-health-conditions-costing-employers-the-most


Are You And Your Primary Care Doc Ready To Talk About Your DNA?

Knowing your genes could save your life, especially if a genetic mutation is hereditary. See why incorporating DNA testing is a crucial part of your primary care.


If you have a genetic mutation that increases your risk for a treatable medical condition, would you want to know? For many people the answer is yes. But such information is not commonly part of routine primary care.

For patients at Geisinger Health System, that could soon change. Starting in the next month or so, the Pennsylvania-based system will offer DNA sequencing to 1,000 patients, with the goal to eventually extend the offer to all 3 million Geisinger patients.

The test will look for mutations in at least 77 genes that are associated with dozens of medical conditions ranging from heart disease to cancer, as well as variability in how people respond to pharmaceuticals based on heredity.

“We’re giving more precision to the very important decisions that people need to make,” said Dr. David Feinberg, Geisinger’s president and CEO. In the same way that primary care providers currently suggest checking someone’s cholesterol, “we would have that discussion with patients,” he said. “‘It looks like we haven’t done your genome. Why don’t we do that?’”

Some physicians and health policy analysts question whether such genetic information is necessary to provide good primary care — or feasible for many primary care physicians.

The new clinical program builds on a research biobank and genome-sequencing initiative called MyCode that Geisinger started in 2007 to collect and analyze its patients’ DNA. That effort has enrolled more than 200,000 people.

Like MyCode, the new clinical program is based on whole “exome” sequencing, analyzing the roughly 1 percent of the genome that provides instructions for making proteins, where most known disease-causing mutations occur.

Using this analysis, clinicians might be able to tell Geisinger patients that they have a genetic variant associated with Lynch syndrome, for example, which leads to increased risk of colon and other cancers, or familial hypercholesterolemia, which can result in high cholesterol levels and heart disease at a young age. Some people might learn they have increased susceptibility to  malignant hyperthermia, a hereditary mutation that can be fatal since it causes a severe reaction to certain medications used during anesthesia.

Samples of a patient’s blood or spit are used to provide a DNA sample. After analysis, the results are sent to the patient’s primary care doctor.

Before speaking with the patient, the doctor takes a 30-minute online continuing education tutorial to review details about genetic testing and the disorder. Then the patient is informed and invited to meet with the primary care provider, along with a genetic counselor if desired. At that point, doctor and patient can discuss treatment and prevention options, including lifestyle changes like diet and exercise that can reduce the risk of disease.

About 3.5 percent of the people who’ve been tested through Geisinger’s research program had a genetic variant that could result in a medical problem for which clinicians can recommend steps to influence their health, Feinberg said. Only actionable mutations are communicated to patients. Geisinger won’t inform them if they have a variant of the APOE gene that increases their risk for Alzheimer’s disease, for example, because there’s no clinical treatment. (Geisinger is working toward developing a policy for how to handle these results if patients ask for them.)

Wendy Wilson, a Geisinger spokeswoman, said that what they’re doing is very different from direct-to-consumer services like 23andMe, which tests customers’ saliva to determine their genetic risk for several diseases and traits and makes the results available in an online report.

“Geisinger is prescribing DNA sequencing to patients and putting DNA results in electronic health records and actually creating an action plan to prevent that predisposition from occurring. We are preventing disease from happening,” she said.

Geisinger will absorb the estimated $300 to $500 cost of the sequencing test. Insurance companies typically don’t cover DNA sequencing and limit coverage for adult genetic tests for specific mutations, such as those related to the breast cancer susceptibility genes BRCA1 or BRCA2, unless the patient has a family history of the condition or other indications they’re at high risk.

“Most of the medical spending in America is done after people have gotten sick,” said Feinberg. “We think this will decrease spending on a lot of care.”

Some clinicians aren’t so sure. Dr. H. Gilbert Welch is a professor at the Dartmouth Institute for Health Policy and Clinical Practice who has authored books about overdiagnosis and overscreening, including “Less Medicine, More Health.”

He credited Geisinger with carefully targeting the genes in which it looks for actionable mutations instead of taking an all-encompassing approach. He acknowledged that for some conditions, like Lynch syndrome, people with genetic mutations would benefit from being followed closely. But he questioned the value of DNA sequencing to identify other conditions, such as some related to heart disease.

“What are we really going to do differently for those patients?” he asked. “We should all be concerned about heart disease. We should all exercise, we should eat real food.”

Welch said he was also concerned about the cascading effect of expensive and potentially harmful medical treatment when a genetic risk is identified.

“Doctors will feel the pressure to do something: start a medication, order a test, make a referral. You have to be careful. Bad things happen,” he said.

Other clinicians question primary care physicians’ comfort with and time for incorporating DNA sequencing into their practices.

A survey of nearly 500 primary care providers in the New York City area published in Health Affairs this month found that only a third of them had ordered a genetic test, given patients a genetic test result or referred one for genetic counseling in the past year.

Only a quarter of survey respondents said they felt prepared to work with patients who had genetic testing for common diseases or were at high risk for genetic conditions. Just 14 percent reported they were confident they could interpret genetic test results.

“Even though they had training, they felt unprepared to incorporate genomics into their practice,” said Dr. Carol Horowitz, a professor at the Icahn School of Medicine at Mount Sinai in New York, who co-authored the study.

Speaking as a busy primary care practitioner, she questioned the feasibility of adding genomic medicine to regular visits.

“Geisinger is a very well-resourced health system and they’ve made a decision to incorporate that into their practices,” she said. In Harlem, where Horowitz works as an internist, it could be a daunting challenge. “Our plates are already overflowing, and now you’re going to dump a lot more on our plate.”

SOURCE:
Andrews, M (12 June 2018). "Are You And Your Primary Care Doc Ready To Talk About Your DNA?" [Web Blog Post]. Retrieved from https://khn.org/news/are-you-and-your-primary-care-doc-ready-to-talk-about-your-dna/


Benefit change could raise costs for patients getting drug copay assistance

Health plans may change with time. Know what to expect and how to respond with these tips on how to avoid unexpected changes.


Since Kristen Catton started taking the drug Gilenya two years ago, she’s had only one minor relapse of her multiple sclerosis, following a bout of the flu.

She can walk comfortably, see clearly and work part time as a nurse case manager at a hospital near her home in Columbus, Ohio. This is a big step forward; two drugs she previously tried failed to control her physical symptoms or prevent repeated flare-ups.

This year, Catton, 48, got a shock. Her health insurance plan changed the way it handles the payments that the drugmaker Novartis makes to help cover her prescription’s cost. Her copayment is roughly $3,800 a month, but Novartis helps reduce that out-of-pocket expense with payments to the health plan. The prescription costs about $90,000 a year.

Those Novartis payments no longer counted toward her family plan’s $8,800 annual pharmacy deductible. That meant once she hit the drugmaker’s payment cap for the copay assistance in April, she would have to pay the entire copayment herself until her pharmacy deductible was met.

Catton is one of a growing number of consumers taking expensive drugs who are discovering they are no longer insulated by copay assistance programs that help cover their costs. Through such programs, consumers typically owe nothing or have modest monthly copayments for pricey drugs because many drug manufacturers pay a patient’s portion of the cost to the health plan, which chips away at the consumer’s deductible and out-of-pocket maximum limits until the health plan starts paying the whole tab.

Under new “copay accumulator” programs, that no longer happens.

In these programs, the monthly copayments drug companies make don’t count toward patients’ plan deductibles or out-of-pocket maximums. Once patients hit the annual limit on a drugmaker’s copay assistance program, they’re on the hook for their entire monthly copayment until they reach their plan deductible and spending limits.

Catton put the $3,800 May copayment on a credit card. She knows her insurer will start paying the entire tab once she hits the pharmacy deductible. But, she said, she can’t afford to pay nearly $9,000 a year out-of-pocket for the foreseeable future.

“I’m talking to my doctor to see if I can I take it every other day,” she said. “I guess I’m winging it until I can figure out what to do.”

Drug copay assistance programs have long been controversial.

Proponents say that in an age of increasingly high deductibles and coinsurance charges, such help is the only way some patients can afford crucial medications.

But opponents say the programs increase drug spending on expensive brand-name drugs by discouraging people from using more cost-effective alternatives.

Switching to a cheaper drug may not be an option, said Bari Talente, executive vice president for advocacy at the National Multiple Sclerosis Society.

“Generally the multiple sclerosis drugs are not substitutable,” she said. “Most have different mechanisms of action, different administration and different side effect profiles.” Generics, when they’re available, are pricey too, typically costing $60,000 or more annually, she said.

Most MS drug annual copay assistance limits, if they have them, are between $9,000 and $12,000, Talente said.

Employers argue that the drug copayment programs are an attempt to circumvent their efforts to manage health care costs. For example, employers may try to discourage the use of a specialty drug when there’s a lower-cost drug available by requiring higher patient cost sharing.

There’s also the issue of fairness.

“From an employer perspective, everyone under the plan has to be treated the same,” said Brian Marcotte, president and CEO of the National Business Group on Health (NBGH), which represents large employers.

If someone needs medical care such as surgery, for example, that person doesn’t get help covering his deductible, while the person with the expensive drug might, he said.

According to an NBGH survey of about 140 multistate employers with at least 5,000 workers, 17 percent reported they have a copay accumulator program in place this year, Marcotte said. Fifty-six percent reported they’re considering them for 2019 or 2020.

If there is no comparable drug available, drug copayment programs may have a role to play if they can be structured so that participating patients are paying some amount toward their deductible, Marcotte said. But, he said, assistance programs for drugs that are available from more than source, such as a brand drug that is also available as a generic, shouldn’t be allowed.

In 2016, 20 percent of prescriptions for brand-name drugs used a drug copay assistance coupon, according to an analysis by researchers at the USC Schaeffer Center for Health Policy and Economics. Among the top 200 drugs based on spending in 2014, the study found that 132 were brand-name drugs, and 90 of them offered copay coupons. Fifty-one percent of the drugs with copay coupons had no substitute at all or only another brand drug as a close therapeutic substitute, the analysis found.

Advocates for people with HIV and AIDS say copay accumulators are cropping up in their patients’ plans and beginning to cause patients trouble. Drugs to treat HIV typically don’t have generic alternatives.

The biggest impact for the community their organizations serve may be for PrEP, a daily pill that helps prevent HIV infection, said Carl Schmid, deputy executive director at the AIDS Institute, an advocacy group. A 30-day supply of PrEP (brand-name Truvada) can cost nearly $2,000. Drug manufacturer Gilead offers a copay assistance program that covers up to $3,600 annually in copay assistance, with no limit on how much is paid per month.

“They’re at risk for HIV, they know it and want to protect themselves,” Schmid said. “It’s a public health issue.”

Earlier this month, the AIDS Institute was among 60 HIV organizations that sent letters to state attorneys general and insurance commissioners across the country asking them to investigate this practice, which has emerged in employer and marketplace plans this year.

Compounding advocates’ concerns is the fact that these coverage changes are frequently not communicated clearly to patients, Schmid said. They are typically buried deep in the plan documents and don’t appear in the user-friendly summary of benefits and coverage that consumers receive from their health plan.

“How is a patient to know?” Schmid asks. They learn of the change only when they get a big bill midway through the year. “And then they’re stuck.”

SOURCE:
Andrews M (25 MAY 2018). [Web Blog Post]. Retrieved from address https://khn.org/news/benefit-change-could-raise-costs-for-patients-getting-drug-copay-assistance/