In The Industry
In the Industry – Article Archive
The Scoop on Self-Funding
With so many U.S. employers making the move to self-funding, it’s become a popular topic for people to explore. We collect some of the headlines here on the Self-Funding Success website as a source of more information from a variety of places and perspectives. Check out these articles to get a look at how self-funding works and the impact its having.
Pinterest: Traditional insurance ‘was letting us down’
Pinterest has joined a growing rank of employers who are fed up with the healthcare system and doing away with traditional insurance models as a result. The social media platform switched from their traditional healthcare plan to a self-funded model…. Pinterest isn’t the only employer to seek out alternatives to the traditional healthcare system. Last year, Amazon…. READ MORE
SPBA Part of Collaborative Effort to Encourage Congress to Address Surprise Billing in Health Care
Following a recent hearing that covered the issue of surprise billing in health care, the Society of Professional Benefit Administrators (SPBA) was part of a collaborative effort in which 30-plus organizations urged the United States Congress to pass additional legislation as a protection to patients…. “As an advocate for our third party administrator members and their plan participants, SPBA understands the real-world burden and effects of surprise billing”…. READ MORE
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 of flexibility with a variety of arrangements and overall cost-savings…. 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 broke…. Bartlett came with some unique qualifications. She had just spent 13 years on the insurance industry side…. Most importantly, Bartlett understood something the state officials didn’t: the side deals, kickbacks and lucrative clauses that …. [help] explain why Americans pay the highest health care costs in the world — and why the tab continues to increase, year after year…. And so Bartlett pitched a bold strategy… 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 another $108,951. That sum – a so-called balance bill – was the difference between what the hospital and his insurer thought his care was worth…. 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 was Association Health Plans…. 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 from for-profit helicopter operator Air Methods. At the heart of the dispute is a gap between what insurance will pay for the flight and what Air Methods says it must charge to keep flying…. when health plans balk, patients get stuck with the tab…. 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 care landscape because they enable employers to share risk with a larger population…. 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 hopped on the RBP bandwagon in 2015. “I just want to pay fair market value for the services I get.” More companies are taking note of the RBP model, which has been around for years, but only recently has seen increased viability and appeal….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 loss goals. Current wellness programs … have expanded to focus on more than just the physical aspect…. 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 variety of settings. With…increased interest from both health care professionals and patients, it’s clear that telehealth will only continue to grow…. Here are five critical events and developments from the past year that have accelerated — and will continue to promote — the growth of telehealth programs…. READ MORE
Survey: Self-Funded Health Plans Grow in Popularity
As organizations begin to assess options for group health coverage in 2018, new data out this week could help provide some perspective. Employer premiums on health care plans rose higher this year than they have in the past five years…. Additionally, self-funded plans…are also becoming more prevalent…[and] are becoming increasingly desirable to employers…. READ MORE
The Rise of Reference-Based Pricing
Reference-based pricing (RBP) is a fast-growing alternative to the PPO systems self-funded employers have utilized for their group benefit plans over the past 30 years…. As the PPOs started to build larger networks and attempted to bring costs down, they met resistance from key providers…. there were no regulations on what hospitals could bill for services, so the PPO shell game of “discounting” went into effect…. RBP offers two remedies to this inflated, unfair system…. READ MORE
SPBA Releases Industry Update & 2018 Forecast for TPAs & Self-Funding
In preparing for the year ahead, the Society of Professional Benefit Administrators (SPBA) has released its State of the TPA Industry & Forecast for 2018. Fred Hunt, SPBA’s active past president, has been writing this report annually for the past 37 years…. As with years past, the 2018 Forecast shares a candid perspective on current issues affecting the health benefits landscape as well as projections for the future. READ MORE
More Smaller Companies Are Self-Insuring Health Benefits
Small and midsized companies are increasingly providing their own health coverage for employees instead of buying fully insured plans …. As the Affordable Care Act drives up premiums because of more requirements and taxes, self-insurance has become a more attractive option because it is often less expensive than purchasing fully insured plans…. But some policy analysts argue the companies that are self-insuring generally have healthy employees and that leaving the fully insured risk pool results in higher costs for fully insured companies with older, less healthy employees. READ MORE
Self-funding Health Plans is Hot, But Could Get Tougher to Do
Small employers are facing formidable hurdles as they consider self-funding health insurance plans. But self-funding still holds appeal…. Increasing regulation of self-funded health plans is complicating the efforts of some employers as they seek an alternative to plans offered under the Affordable Care Act, one analyst says. Most of the stiff regulation involves stop-loss, the reinsurance that protects employers from catastrophic losses. The regulatory hurdles still are not enough to deter many employers who see self-funding as the better option… READ MORE
Views: Why Employers Should be Thinking TPA
When it comes to healthcare plan administration, ASOs (administrative services only) say they offer a big discount to self-funded plans. If you look closer, however, you’ll see that they actually do come with a cost, both monetarily and in terms of lack of flexibility…. Here are five benefits of working with a TPA… READ MORE
SPBA Member and TPA Owner Testifies Before Department of Labor’s ERISA Advisory Council
In some cases, plain words supported by facts carry the greatest impact. This was the case with the recent testimony provided by SPBA past Board of Directors member, Mary Smith, of Insurance Management Administrators, before the U.S. Department of Labor’s ERISA Advisory Council. Smith proved the point that… READ MORE
Non-Traditional Health Benefits are the Focus of New Piece in Self-Funding Series
SFS News Release: Non-Traditional Health Benefits are the Focus of New Piece in Self-Funding Series – Continuing to expand its collection of educational resources, the Self-Funding Success website has published another piece related to the benefits of self-funding. This latest resource explores the more non-traditional health benefits being implemented today and how they are saving plans money and making access to care more convenient… READ FULL RELEASE
Fiduciary Burden of the Quarter: Strictly Abiding by the Terms of the Plan Document
ERISA is very clear that the Plan Administrator is required to administer benefits strictly in accordance with the terms of the applicable plan document. Plan Administrators, though, are often faced with difficult situations – situations where paying a claim that might otherwise be excluded under the plan document would avoid considerable headache, appease a member of the C-suite, or more accurately reflect what the drafter of the plan document intended… READ MORE
Ready or Not, Leaders Prepare for a Value-Based Future
The future of the healthcare industry may be uncertain when it comes to Congressional action, or the lack thereof. But one concept that has been widely embraced for the past few years is the commitment of healthcare leaders to a value-based model for care and reimbursement. READ MORE
Cognitive Health Systems Provide Custom Analysis for Employees
With the healthcare price tag rising to $10,000 or more a year per person, employers and healthcare providers looking to lower costs and help employees manage their health are turning to big data and analytics to better handle surging costs…. cognitive health systems … integrate patient-level data from health records and other sources to create a better picture … at the individual, group and population level in order to improve patient outcomes. READ MORE
Newly Published Pieces Summarize How Self-Funded Benefit Plans Are Regulated
SFS News Release: Newly Published Pieces Summarize How Self-Funded Benefit Plans Are Regulated – Designed to be an informational tool for consumers who are exploring how self-funded health benefits work, the Self-Funding Success website has recently published two new resources… READ FULL RELEASE
Innovator’s Wellness App Aims to Improve Employee Nutrition
SFS Tech Tactics: occasional articles focused on technology’s expanding role in cost-savings and improved health in customized self-funded health plans – Jason Langheier, a physician, knew that poor diet was a major problem in the U.S. But he also knew employers could be — and should be — be part of the solution…. That’s why he created Zipongo in 2011…. the app … [is] currently in use at more than 150 companies, including Google and IBM…. and offers food benefits management services as a new employee benefit, similar to pharmacy benefit management. READ MORE
House Passes Bill to Limit State Regulators’ Powers over Self-Insurance
U.S. Congress has voted for a bill that provides protection for small and medium sized firms that choose to self-insure. The Lower House passed the Self-Insurance Protection Act … which sets legal limits to regulators’ jurisdiction over self-insurance health plans by setting unequivocal parameters to define medical stop loss policies and how they are different from traditional health insurance. READ MORE
FAQ Resource Published to Answer Common Questions about Self-Funding
SFS News Release: FAQ Resource Published to Answer Common Questions about Self-Funding – Adding to its collection of educational resources for consumers, the Self-Funding Success website recently developed an FAQ reference. This piece addresses questions on the basics of self-funded health plans, as well as many others related to costs, planning and implementation. READ FULL RELEASE
A Change for Small Biz Could Cost Some Employers their Custom Health Plans
Faced with rising premiums in the group health insurance market, the Park Slope Food Coop opted five years ago to create a custom plan for its 74 full-time employees and their family members and pay for the costs directly. “I’m convinced we would have had to raise prices if we weren’t self-insured,” said Joseph Holtz, general manager, who estimates self-insurance saves the co-op $300,000 to $500,000 a year. The co-op is one of several hundred New York employers that will be forced to stop self-insuring next year, thanks to a change in the state’s definition of a small business. READ MORE
MediBid Enhances its Free Market Medical Pricing for Self-Funded Employers
MediBid, the first online tool empowering patients to seek bids for low priced, high quality medical care, now shares the prices of winning bids to every doctor, hospital, and facility that makes a bid…. “Although there are many vendors in the transparency space, most of them report on PPO allowables, or Medicare rates…. We are the first entity to report on direct pricing.” ….[and] allow providers to compete for patients…. READ MORE
New Resources Developed to Educate Consumers About Self-Funded Health Plans
SFS News Release: New Resources Developed to Educate Consumers About Self-Funded Health Plans — The Self-Funding Success website recently added several new resources to its Self-Funding 101 section in its ongoing effort to educate consumers. These pieces focus on a variety of elements that contribute to the positive results many employers are experiencing with self-funded health plans – workplace wellness, prescription cost management and price transparency. READ FULL RELEASE
GPA Saves Clients A Record-Breaking $1 Billion
Dallas, TX — By consistently providing high quality, cost-effective services to its clients, Group Pension Administration Inc. (GPA) has achieved a record-breaking $1 billion in client savings…. audits on bills from hospitals, emergency rooms, and dialysis centers culminated in GPA reaching its impressive milestone…. READ MORE
Guardian Study Reveals Majority of Employers Overwhelmed With Increased Complexity of Managing Benefits
Here’s a recent study that indirectly affirms the need for high-quality, full-service TPAs for employers to best manage their employee benefits, maximize cost savings and ensure compliance… The Guardian Life Insurance Company of America recently released Benefits Balancing Act, the third set of findings from the Fourth Annual Guardian Workplace Benefits StudySM. The research highlights the increasing challenges employers face in managing benefits costs, improving administrative efficiency, and maintaining plan compliance, all while trying to improve workforce health and productivity…. READ MORE
Are Medical Captives the Answer to Data Transparency?
Medical captive insurance is helping level the playing field for mid-market employers who, along with their brokers and advisers, pledge a more aggressive stance on cost containment….uses a pooling approach to self-fund employers with as few as 25 employees – a strategy that as many as 98% of larger employers have used for years. The cost savings of its stop-loss group captive is 20% on average, which he says is a double-digit advantage over traditional fixed cost health insurance. Under the medical captive model, which helps mitigate self-funding’s volatility challenge…READ MORE
Why Self-Funded Healthcare is a Great Option for 2017
Small- and mid-sized companies using traditional major medical plans are at a competitive disadvantage: either they are paying more in loaded costs than competitors that use smarter healthcare options, or they are finding it more difficult to hire employees because their competitors offer better plans….With the new year and a new healthcare landscape, HR executives and benefits directors are now reconsidering their options… To balance the scales and create a competitive advantage, more companies are turning to healthcare plans based on a self-funding model…READ MORE
Lack of Price Transparency Leading Employers to Self-Insure
One employer chose to invest in self-insuring his own company due to a general lack of price transparency seen with payers’ health plans…. the notion of a company self-insuring its employees and dealing with medical claims on its own terms is slowly becoming a more popular option…READ MORE
Effective TPAs Contribute to Self-Funding Success
One of the most important success factors in self-funding is the service provided by the third party administrator (TPA)…READ MORE
Self-Insurance is Surging: More Transparency, Lower Costs – and More Risk
Self-insurance for medical benefits is sometimes seen as a step into the unknown. After all, companies are taking on more risk, and the potential for catastrophic medical costs can intimidate some business owners. But many experts say that the potential cost savings outweigh the risk… READ MORE
Companies Move Toward Self-Insurance as Healthcare Rates Increase
The rising cost of healthcare – and the pressures associated with pushing more of the cost onto employees – is causing a shift to self-insurance among employers… READ MORE
TPA Contains Average Medical Plan Cost Increase to Just 2.05% for its Employer-Clients
A third party administrator (TPA) with multiple locations in the U.S., Cypress Benefit Administrators has released its annual cost data trends report comparing the average cost increase of its health plans to others throughout the nation… READ MORE
How Organizations Can Benefit from Self-Funding Employee Health Plans
How to fund health benefits is a major decision for any organization. There are two options — get fully insured through a health insurance carrier or fund it themselves. Until recently, self-funding was only considered for large organizations due to the potential risk involved, but that’s changing… READ MORE
8 Ways to Make the Most of a Self-Funded Health Plan
For companies that self-fund, unbundling your health plan benefits offers some distinct advantages including competitive rates, more flexibility, and greater transparency… READ MORE
Self-Funded Health Plans Can Save Money, Up Risks
Business consulting company Spooner Inc. found itself facing the same challenge its clients and many other employers across the country are grappling with: rapidly rising health plan costs… READ MORE
The ABCs of Self-Funding Your Health Plan
More employers are moving to self-funding. Here’s what you need to know to make the switch… READ MORE
2 Ways to Maximize Value in a Self-Funded Medical Plan
Much has been written about self-funding strategies for employers. Typically, these articles focus on fundamental elements such as understanding and selecting the best contract type, using tiered provider networks, developing and monitoring a well-thought-out and perpetual wellness strategy, as well as the unique flexibility in plan design that is inherent in this approach. That’s smart, and it’s exactly where you should start. However, it’s possible – and prudent – to go much deeper… READ MORE
Selfie Health Insurance is All the Rage
It is not often that the words elegance and health plan end up in the same sentence, but Steve Gransbury says self-insurance can bring them together—and not just in a sentence… READ MORE
How to Proactively Manage Self-Funded Employer Health Plans
As more patients join self-funded plans, hospitals face new challenges regarding billing and collection… READ MORE