Bundled Payments for “Baby Bundles”

Another major insurance carrier has cooperated with selected healthcare providers in two states to introduce a bundled payment program for maternity care. Like bundled payment programs used by Medicare and commercial carriers for total joint replacement, the bundled maternity program reimburses the care provider for an entire episode of care, including prenatal, delivery and postpartum services, with one overall fee. Insurers are encouraged with the positive outcomes, citing early access to care and open lines of communication as significant advantages of this approach.


Amazon com: Joins Trend of Sending Workers Away for Health Care


This article was published on October 15, 2019 on MarketScreener.com written by Melanie Evans.

Employers are increasingly going the distance to control health spending, paying to send workers across the country to get medical care and bypassing local health-care providers.

One of the latest is Amazon.com Inc., which will pay travel costs for workers diagnosed with cancer who choose to see doctors at City of Hope, a Los Angeles-area health system. More than 380,000 of the Seattle-based company’s employees and families across the U.S. are eligible for the travel benefit.

Travel programs are winning over employers despite added costs for airfare, hotels and gasoline. Proponents say companies can get competitive prices and employees get better care — such as avoiding unnecessary treatment — by shopping around the country instead of always relying on local providers. Employer health plans, which cover roughly 153 million people in the U.S., struggle to command competitive prices and quality controls in some markets as health-care providers have consolidated and gained leverage in negotiations.

“If you’re able to look nationally, you’re just going to have more choices,” for top doctors, said Lee Lewis, chief strategy officer of the Health Transformation Alliance, an employer group aimed at holding down health spending. Still, travel programs require more work to run, he said, and employees can be reluctant to be away from home when ill or undergoing a procedure.

City of Hope began to contract with employers last year with multiple programs, including one through a program jointly run by the Pacific Business Group on Health and consultants Health Design Plus. An employer with 30,000 U.S. workers began to cover cancer-care travel costs in March, according to PBGH, an employer group. Four other employers signed on to its travel programs this year, including two large regional employers in the Midwest and Southeast that in January started to cover travel for spine and joint-replacement surgeries, the group said.

About 10% of those eligible to travel to City of Hope for cancer care are expected to do so, according to Health Design Plus. City of Hope declined to say how many Amazon workers have traveled to see its doctors since April, when that program was launched.

By paying employees’ way to travel for medical care, Amazon hopes to increase workers’ choices and curb health spending by getting workers to top specialists and reducing the chance of the wrong diagnosis or treatment, said Dene Sparrman, the company’s director of global benefits.

Workers who travel to City of Hope meet with specialists who review local doctors’ records and might seek additional information, such as genetic testing, to make treatment recommendations.

“Instead of waiting for patients to get the wrong care first, then reaching out to the expert, this model is designed so that the patient has access to expertise as early as possible to help ensure the correct care is delivered first,” Ms. Sparrman said.

Amazon has stepped up its focus on employee health care. The company last year announced a venture with Berkshire Hathaway Inc. and JPMorgan Chase & Co. to reduce health costs. The venture, named Haven, wasn’t involved in the launch of Amazon’s new travel benefit, Haven and Amazon officials said.

Travel benefits are one of many strategies by employers seeking to tamp down growth in health-benefit spending, which Labor Department data show has increased faster than wages, though not recently.

Employers typically cover about 70% of premium costs for workers’ health insurance, annual Kaiser Family Foundation data show. Premiums have increased an average of 7% a year in the past two decades, reaching about $20,500 for a family.

Some employers still balk at sending employees long distance for care, said Dr. Jeff Dobro, health and benefits strategy and innovation leader for consulting firm Mercer. That is changing with more data to compare price and quality for hospitals and doctors, he said. “Let’s accept the fact that there are some hospital systems and some doctors that do get better outcomes than others,” Dr. Dobro added.

Other employers have run travel programs for years. Published results are limited but suggest the programs save money and reduce unnecessary care. Walmart Inc., Lowe’s Cos. and McKesson Corp. saved an estimated total of $19.4 million in 2017 as workers who traveled to see spine and joint surgeons avoided unnecessary care, Walmart reported in the Harvard Business Review in April.

Walmart workers diagnosed with breast, lung or colorectal cancer can travel to the Mayo Clinic for evaluation. Of those who traveled to Mayo for cancer care since 2015, about 10% received a new diagnosis, the Bentonville, Ark., retailer’s data show.

City of Hope said doctors have recommended a new diagnosis or treatment for 84% of complex cancer patients in one of its employer programs.

Amazon previously paid for travel only when no treatment was available within 100 miles for life-threatening conditions, such as advanced heart surgery. The new travel benefit can be used for any cancer diagnosis, regardless of local options. Those who choose to remain home can meet with City of Hope doctors by videoconference, when state regulations allow.


IRS Increases HSA Limits

Employees will be able to save some additional healthcare dollars in 2020 as the IRS will increase the limit on deductible contributions to an HSA by $50 for individuals and $100 for families. The limits will be $3,550 for individuals with self-only coverage and $7,100 for family coverage. The minimum deductible for a qualifying high deductible health plan will also increase, rising to $1,400 for single coverage and $2,800 for family coverage.

Research shows that the number of HSAs increased by 13% over the past year, topping 25 million accounts with an anticipated increase to 30 million by 2020. Another important statistic revealed that the average employer contribution to HSAs rose from just over $600 in 2017 to $839 in 2018 – an increase of some 39%. Supporters are encouraging legislators to make HSAs even more consumer friendly by allowing adults over 65 to continue using an HSA to save for healthcare costs in retirement. We will continue to report on these efforts going forward.


Can Chronic Disease Management Really Work?


With the Centers for Disease Control and Prevention projecting that 83 million people will soon have three or more chronic diseases, the number of employers working to manage chronic conditions like diabetes, high blood pressure and coronary artery disease is staggering.

Not only do the average medical costs for a diabetic exceed $16,000 per year, but the loss of productivity is estimated to add an additional $1,700. How can your health plan cope?

Begin with Good Information
Reviewing claims data, diagnostic tests and prescription drug data is a critical starting point. Once plan members with chronic illnesses are identified, care managers, nurse navigators or health coaches can talk with them to learn about their lifestyle, ask about medications, nutrition, their family situation and other factors that may be impacting their condition.

Chronic disease management is not a one-step process. It involves partnering with a member’s physician and other professionals to understand the patient’s needs and develop a personalized care plan. This level of personal involvement will not only help the member receive the care they need but also help them better understand how to use their health plan to their benefit.

Experience shows that 80% of a company’s healthcare spend is often attributed to 20% of plan members. Chronic illness is likely the reason, making disease management a critical part of high-quality healthcare plans.


Walmart offers to pay for employees’ health care degrees


Photo Source: BenefitsPro.com

This article was published on September 27, 2019 on BenefitsPro.com written by Jack Craver.

The retail giant hopes the offer will yield a stock of qualified professionals to staff its rapidly growing network of health care providers.

In part of an effort to expand its health care business, Walmart is expanding its offering of nearly free college courses, focusing on health and wellness.

The company’s 1.5 million employees can now apply for nine different higher education programs through six universities.

Employees can receive training as pharmacy technicians or opticians through Penn Foster, an online college, or they can pursue bachelors degrees in business, health care administration and IT specialties through the University of Florida, the University of Southern New Hampshire, Purdue University Global, Bellevue University and Wilmington University.

Walmart is also pondering adding behavioral health specialties to the mix next year.

Workers who qualify for the program only pay $1 a day in tuition, or $365 a year. The company launched the program in May 2018, but initially it only offered degrees in supply chain management or business and only those without college degrees were eligible.

The retail giant hopes the offer will yield a stock of qualified professionals to staff its rapidly growing network of health care providers, which includes 5,000 pharmacies, 3,000 vision centers and 400 hearing centers.

“These offerings will arm associates to fill critical health-care roles across Walmart and Sam’s Club,” Walmart chief medical officer, Thomas Van Gilder, said in a call with reporters. “It’s filling a critical need in a growing field.”

Similar to its online rival Amazon, Walmart is seeking to disrupt the health care industry by offering low-cost and low-barrier services.

Next month, the company will begin offering Sam’s Club members in Pennsylvania, Michigan and North Carolina bundled health care services for a monthly fee. Individuals who pay $50 a month will qualify for unlimited $1 per-consultation telehealth services, big discounts on a variety of wellness services, such as chiropractic and massage therapy, and free access to 20 generic prescription drugs.


Protecting Member’s Health Data


The sensitive nature of information shared with payers and providers makes health plan members prime targets for identify theft. While no legislation is currently moving through Congress, a number of senators are taking steps to learn more about recent breaches of healthcare data involving collection agencies and diagnostics firms.

While some employers are taking very costly measures to protect their business and their employees, there are a few steps employers can implement at little or no cost:

  • Encourage everyone to use strong passwords and change them often.
  • Consider adding an Identify Theft protection service to your benefits package. Lifelock and Identity Guard are two common options.
  • Offer educational sessions or webinars to build awareness to the cyber threats that exist today.

On-going education is critically important because the constant use of technology has made too many of us numb to the serious nature of cyber threats. As prevention measures have evolved over time, so have the ways hackers and cyber criminals go about attacking organizations and individuals.


More Large Employers Offer On-Site Clinics

Some mega-employers manage clinics on their own while others outsource to clinic vendors or healthcare systems. Many provide clinics within their own facilities, but some offer near-site locations and even share a near-site clinic with other companies. Regardless of which model is preferred, more organizations with 5,000 or more employees are deciding that on-site or near-site clinics can make primary care more convenient and affordable for everyone.

Some of these clinics offer pharmacy services and many have expanded to offer services such as physical therapy, telehealth and even behavioral health. One benefit that clinic operators often emphasize is that by making primary care convenient to employees, and in many cases their family members, fewer employees will neglect primary care because of cost or the inability to take time off to see a doctor.