Category Archives: Health Care

April 16, 2012

Lowest Cost Projection since 2001

By Paula L Wilson, RHU, REBC

Employers with health insurance costs weighing heavily on their backs should enjoy a small sigh of relief as Buck Consultants released their recent survey results of 129 insurers and administrators.   The results?  For the first time since 2001 they estimate the cost increase for health plans to be less than 10%……..only 9.9% for 2012.

The survey goes on to explain the reduction in the rate of increase is primarily due to a correction in margins insurers had previously built in for health reform as well as a reduction in elective procedures by the insured public.   During a time of such prolonged economic slowdown, people are just putting off what they consider to be elective.

Last year the trend was 11.2%.

Even at 10%, the result is a huge new nut to crack on top of already enormous numbers.  It  isn’t quite what employers were looking for in upcoming benefit budgeting.   They still long for that time when rates remained relatively flat.

It is my opinion that employers and benefit professionals should continue to push everyone to take advantage of the preventive services now available on all non-grandfathered plans.   Getting the right preventive care and continuing the expansion of Wellness Programs is vital in order to avoid the explosion of costs to follow if new disease is left undiagnosed or untreated due to cost concerns.  Employers and their Benefit Advisors cannot to overlook the proactive role they must continue promote.

If you are interested in learning more about Health Care Reform, Wellness Programs or preparing for the upcoming mandates, please contact Paula Wilson at 951-694-1009.

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April 13, 2012

Employer’s Getting ready for more PPACA

By Paula L Wilson, RHU, REBC

Employers getting overwhelmed with timelines and deadlines shortly after PPACA was passed are now confused with the slowdown on the action.   Why?  Because timelines change as the administration realizes they keep putting the cart before the horse and extend and amend deadlines.   And so it is with the ominous Summary of Benefit and Coverages requirement.   You know, the one that says people can’t possibly comprehend the benefits as outlined in the current Summary Plan Description, yet need twice the information carved into a 4 page cornucopia of information they still won’t read.   Originally slated for March 2012, employers who were paying attention to these threats of non-compliance are worried about fines and fees…..are they behind the curve?

Well, we are currently receiving  phone calls and inquiries regarding these PPACA regulations  that were to go into effect on 3-23-2012.    Specifically employers are asking us for directions on the required Summary Benefits of Coverage that, if not distributed, can result in $1,000 penalties per failure.  Please note the following:

ON SUMMARY BENEFITS OF COVERAGE 

  • Refresher:  PPACA (Obama Care) requires that ALL employers distribute a very specific 4-Page Summary of Benefits (not to be confused with the current Summary Plan Description).
  • The original deadline for implementation of this requirement has been delayed, in general, to the first renewal after September 23, 2012.   AKA:  All effective or renewal dates beginning 10-1-12.
  • The Insurer is responsible for creating this Summary for each plan offered.   It applies to your health benefits only.  (HSA and HRA information may be included.)
  • It is the responsibility of the employer to make sure this is distributed to all of the employees and their dependents.   It can be in paper or electronic form.   (Caution:  Electronic form must abide by current ERISA rules.  In short, if your employees don’t log on to a computer daily to receive employer communications, that system will not pass. )
  • These rules apply to COBRA beneficiaries as well.  This is where you COBRA administrator will become very important. We are confident that every COBRA administrator we have installed will provide excellent support in this area.
  • A penalty of $1,000 per failure applies to the Employer.
  • This applies to our Self-Funded clients as well.  We will negotiate with the reinsurance carriers for that SBC.
  • There are very specific rules regarding continued distribution of this 4-page SBC as new employees are hired, benefits are change mid-year and upon request of any beneficiary.

ON PREMIUM REBATES

As you know, insurers must rebate excess premiums when they exceed the new MLR (minimum loss ratio) rules.  We have just received details on how employers distribute rebates to employees.   We are reviewing these regulations now regarding the taxability of these to the employees as well as other details.   Since the first rebates are not expected until August 2012, we will be sure to present you with guidance long before they occur.  We believe the taxability will depend on the method of deduction in the first place.   (After tax vs. Pre-Tax via Section 125 Cafeteria POP Plan)

NOTE:  California employers currently receiving rebates from Blue Shield should not confuse these current voluntary rebates with the upcoming MLR rebates.

Ongoing Support during PPACA Implementation

Please be assured that we continue to be very current on all of the implementation details of PPACA and will continue to monitor and assist our employer clients as if PPACA will survive the pending SCOTUS decision.  Our library of details is very complete and we will get information to you on a timely basis.

We appreciate all referrals to your employer group friends and associates that may benefit from our services.   Frankly, I rarely run into insurance “agencies” that know or care much about this challenge.  We continue to be very hands on in order to assure that OUR clients receive the most timely and proper advice as the full implementation of this law approaches.  Planning over the next year is critical.   We are just 19 months away from the full implementation.  HHS is rolling out more and more detail every week.  The sooner we can build relationships with new clients, the better we will be able to guide them through the upcoming tsunami of regulations coming at them.  Please feel free to forward this to your associates.

Paula L. Wilson, RHU, REBC      PAULA@PAULAWILSON.COM     951-694-1009

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March 2, 2012

Free steak for everyone!

By Paula L Wilson, RHU, REBC

January 1, 2013.   Today President Obama signed a bill that will entitle all Americans to free steak.   The OMB estimates the cost at $100 Billion over the next ten years.

June 1, 2013.  Today the OMB revised the estimate on the steaks to $230 Billion.   Previous estimates didn’t assume that people who previously couldn’t afford steak, would give it a try.  President Romney decided to tackle this projected deficit because he had already learned the lesson while Governor.

November 1, 2013,   Today the OMB revised the estimate on the steaks to $310 Billion.   Previous revisions did not predict that people would like the steak and increase their consumption of the steak.

January 1, 2014.   Today the OMB revised the estimate on the steaks to $370 Billion.  Damn vegetarians couldn’t stay on the wagon.

January 1, 2016.  Today the House passed a bill that rations steaks only to people that have grown or still have ALL of their own teeth.  One steak per person will be allowed each six months.  A queue will form for people who feel they must have steak and would like to appeal.

Ex-professional butchers, who had changed occupations when the government mandated a 90% reduction in their salaries, will volunteer to sit on the committee to review these appeals.

Today’s Headline: March 2, 2012.   White House increases estimate of the cost of ObamaCare by 30% or $111 Billion.   Earlier projections may not have accounted properly for the number of people who would shift from private market to the government subsidized private market plans.

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February 28, 2012

Bending the Cost Curve: ACO’s – Maybe Ford was on to something

By Paula L Wilson, RHU, REBC

Maybe the American health care system of the past, where people were to be treated as individuals and doctors were allowed to consider each patients personal needs is inefficient.  It is certainly too inefficient to be allowed to go on, so say the academics trying to change a system they know nothing about.  Certainly all aspects of the American health care system are under attack, but the rubber hits the road when you turn into a number and your doctor won’t even be allowed to consider you anything more than a statistic that needs to be pushed to the next column.  Maybe Ford was on to something when he invented the assembly line.

John Goodman of the National Center for Policy Analysis, posted this blog at the NCPA website where a physician is describing what it is like to work within an ACO.  Accountable Care Organizations, the panacea of efficiency for Medicare patients under PPACA.

She states:

I am a Board-certified general internist. I worked for many years for…an Accountable Care Organization. It was factory work: we were interchangeable cogs in a vast machine.  The people who saw patients, especially “primary care providers” like me, were at the base of the pyramid and the bottom of the pecking order.

The future is clear. The management of the ACO — professional administrators, and physicians who see few if any patients — will schedule every moment of every primary provider’s day, critique every decision, continually scrutinize and evaluate every aspect of one’s practice. At my ACO, yes, we were on teams, but given no time to communicate with one another. We were forced to complete clunky electronic records we had no time to read. Despite years of training and experience, we had no input to the system that controlled our lives. We were not respected as professionals. It was demoralizing.

The health policy elite appears to have concluded that the crux of the problem is primary care practitioners, internists included, who are largely ignorant, lazy, and indifferent to their patients’ welfare, and oppose change of any kind. We do not know or care that a diabetic’s hemoglobin A1C should be below 7.

Therefore, we need tight supervision, complex systems of financial incentives and penalties, and frequent “feedback” about our deficiencies. We need electronic records to remind us that our female patients are due for mammograms that we should advise smokers to quit. And we must reach our goals efficiently, using the minimum number of those expensive tests, and managing large panels of patients.  (So we can’t spend much time with anyone.)

I highly advise everyone to set down the burger and fries, get to the gym and plan to be healthy until you drop.  It’s a wonder why we are starting to feel the effects of a primary care physician shortage.  Obamacare isn’t going to do anything to make medical practice any more attractive to our best and brightest.   The best and the brighest that would normally be attracted to Primary Care medicine don’t want to be part of an assembly line.  For that matter, neither do I.

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February 24, 2012

Bending the Cost Curve: Improving Medication Adherence

By Paula L Wilson, RHU, REBC

It may not seem obvious to most, but NOT taking your medication contributes to one of the largest reasons for increased national health care costs.  According to the a 2011 NEHI study, improving patient medication adherence could reduce wasteful spending by $290 Billion.  Of the 187 million Americans taking one or more prescriptions, it is estimated one-half do not take medications as prescribed.

Not taking medication costs over $100 billion in excess hospitalizations.   The most expensive offenders are diabetics and hypertension patients.  A non adherent diabetic spends more than twice as much one that properly manages their disease as instructed.  They also run a 30 percent chance of hospitalization each year compared to 13 percent by their adherent counterpart.

Poor adherence to medication occurs for many reasons.  High out of pockets costs, lack of care coordination and follow up as well as co-morbidities such as severe or persistent mental illness.   Often medications are not taken as prescribed simply due to lifestyle, culture and belief systems.

Solutions revolve around improving care coordination and enhancing patient engagement and education.  With the rapid increase and improvement in the area of HIT (Health Information Technology), managed care programs have really jumped on the bandwagon agressively by reaching out to high risk members to ensure medication adherence and education.   At a very minimum, we see all insurers offering assistance through programs for patients that want to participate responsibly toward better health.

In the end, each individual must become responsible for themself in this area of medication adherence.   We must spread the word that not doing so will continue to escalate the rise in health care costs.

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