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Views: The Case for Self-Funded Health Benefit Plans and Reference-Based Pricing

Self-funding and reference-based pricing are hot topics with small businesses. They are so popular, in fact, that a recent survey shows an overall increase in their 2019 projection of small employer clients having a reference-based pricing health benefit plan design.... Self-funded health benefit plan designs that use reference-based pricing can allow for a great deal READ MORE>

A Proactive Approach to Plan Data Lowers Number of ER Visits

Having access to plan data is a unique advantage in self-funding that gives employers the ability to identify cost-driving trends and make the necessary adjustments to address them. Nova Healthcare Administrators, Inc., shares an example of how this diligent data monitoring led one client to recognize a trigger behind the overutilization of emergency room visits READ MORE>

A Tough Negotiator Proves Employers Can Bargain Down Health Care Prices

Marilyn Bartlett took a deep breath, drew herself up to her full 5 feet and a smidge, and told the assembled handful of Montana officials that she had a radical strategy to bail out the state's foundering benefit plan for its 30,000 employees and their families. The officials were listening. Their health plan was going READ MORE>

The Remedy for Surprise Medical Bills May Lie in Stitching Up Federal Law

Drew Calver, a high school history teacher and swim coach in Austin, Texas, had a heart attack at his home on April 2, 2017. A neighbor rushed him to the nearby emergency room … which was out-of-network on his school district health plan. …his health plan paid nearly $56,000 …. but the hospital charged Calver READ MORE>

News Release: SPBA Chair Kevin Schlotman Testifies at NAIC 2018 Summer Conference Meeting Regarding Self-Funding and Association Health Plans

Society of Professional Benefit Administrators (SPBA) Chair Kevin Schlotman, Benovation, testified on August 4, 2018, before the Health Insurance and Managed Care (B) Committee ERISA (B) Working Group at the National Association of Insurance Commissioners (NAIC) Summer Meeting held in Boston, Mass.  One of the main issues discussed by the NAIC at the summer meeting READ MORE>

Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind

Rising prices, billing disputes, and a quirk in federal law are creating a new health-care headache -- When three-year-old West Cox’s fever hit 107 degrees, doctors called a helicopter…. Flying would cut a 90-minute drive in half…. Three years later, his parents are still reckoning with the aftermath of his 76-mile flight: a bill for $45,930 READ MORE>

Shifting Models Could Advance Captives’ Role in Health Care

Rising health care costs, shifting care delivery models, escalating mergers and acquisitions activity and a potential new megaplayer are all complicating the health care landscape, but could also boost the use of captive insurers to cover health care risks, particularly group captives.... Stop-loss captives can be a valuable tool for employers navigating the evolving health READ MORE>

Reference-Based Pricing: 4 Steps to Successful Implementation

Is reference-based pricing the future of the health care industry? There are too many fluctuating variables currently in play to say for sure, but one thing is certain: it has a lot of appeal. “To me, being a financial guy, it made sense,” says Mark Gitter, chief financial officer for San Antonio-based GVTC Communications, which READ MORE>

8 Trends That Will Impact Worksite Wellness In 2018

The New Year will bring in some exciting corporate wellness trends for 2018.... If you’re wondering what’s next for the ever-evolving wellness industry, take a look below for some workplace wellness trends can you expect to see in 2018.... When corporate wellness programs first took off, the focus was primarily on smoking cessation or weight READ MORE>

Telemedicine on the Rise: Five Factors Driving Telehealth Growth in 2017 – and Beyond

Telehealth has been a growing point of emphasis in U.S. health care discourse, as health care providers look to leverage interconnectivity to treat patients from a distance and legislators seek new ways to improve care. In the past year, new state and federal regulations have cleared the way for telehealth programs to thrive in a READ MORE>