For Healthcare Data Security, 2018 Was a Bad Year

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Did your organization’s healthcare data security protections hold during 2018? Most employees have no idea how to answer that question. Unless they work in IT or handle financial transactions, data security might not be a top priority – or at least, it might not seem like a top priority. One breach is all it takes to realize how wrong that thinking is. Any company that handles healthcare information is obligated to safeguard it, even if the company’s only healthcare records are related to employee insurance. Hospitals and other health-care providers aren’t the only entities that are affected by accidental and malicious breaches.  Continue Reading >

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Does Reference Based Pricing Make Sense for Your Organization?

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The lack of transparency around medical pricing puts self-insured employers and their employees at a disadvantage. Without the bargaining power that major insurers have, self-insured employers can’t be certain that they’re getting the best possible prices for the services that their plan members need. Enter reference based pricing. It’s a pricing strategy that more and more self-funded employers are using to control costs. Traditionally, hospitals and health care providers set inflated prices for services and insurers negotiate lower rates for their members. A procedure that a hospital charges $10,000 for may only be billed at $5,000, depending on the patient’s insurance plan. Continue Reading >

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Where’s Our Check? Getting Stop Loss Claims Paid Quickly

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With stop loss coverage, claims costs depend on the services you need, as well as the actual costs of those services. This can be tricky to navigate, and reimbursement for claims can also be a pain to receive in a timely manner. But, what you may not know is that there's actually a lot on the back-end that goes into claim reimbursement. Continue Reading >

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A New Bill Could Raise the Stakes for Self-Funded Insurers

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Self-funded insurers may be negatively affected in a newly drafted bill titled “Protecting Patients from Surprise Medical Bills Act” back in September. Though its goal is to minimize unexpected medical bills and prevent medical bankruptcies, self-funded insurers and covered employees, might not garner any savings from this proposed legislation. Continue Reading >

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Improving Transparency About Health Care Costs

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The human's natural instincts for curiosity are not always about being nosy: other considerations, such as financial transparency, help to distinguish what is right and fair within the healthcare industry. Going into an operation with some sort of estimated rate for services and goods keeps patients from being exploited and overcharged. In this case, being nosy can benefit Americans greatly with their health costs. Continue Reading >

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Keeping Millennials on Your Self-Insured Health Plan

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If some news outlets are to be believed, Millennials only care about avocado toast and Netflix. But while this generation isn’t well respected by some older Americans, Millennials take health insurance seriously. Considering that they have lived through a period when health insurance has been a hotly contested issue, it shouldn’t be a surprise that Millennials are invested in their coverage. Continue Reading >

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Chronic Kidney Disease: A Major Hurdle for Self-Insured Employers

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Many Americans worry that they or their loved ones will suffer from cancer, stroke, heart disease or dementia. Kidney disease isn’t as high-profile a condition, and the average person probably doesn’t give it much thought. Self-insured employers don’t have that luxury. Chronic kidney disease is common, deadly and hugely expensive to treat. Continue Reading >

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Personalized Medicine: The Future Has Arrived

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What if a simple blood test could predict your future? It’s a very real possibility, thanks to personalized medicine, also called precision medicine. Under this model, each patient’s medical care is completely customized and tailored to his or her DNA makeup. Personalized medicine can’t predict a person’s medical future with 100% accuracy, but it can help doctors identify potential roadblocks in their patients’ futures and develop treatments to target those roadblocks. Continue Reading >

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In 2011, the top 5 most expensive medical conditions treated in US hospitals were: Septicemia, Osteoarthritis, Complication of device, implant or graft, Liveborn, and Acute myocardial infarction

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From 2010 to 2013, the number of claims that were individually $1 million or above rose by 1,000%

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In 2017 approximately 18% of the American public will purchase insurance through exchanges, radically transforming the health insurance landscape.

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In 2014, 98% of large firms (= 200 Workers) offer 1+ wellness programs to their employees.

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The most costly 1% of patients account for 20% of national health expenditures – accruing average annual expenses of nearly $90,000 per person.

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6% of firms offering fully-insured plans report they intend to self-insure because of Obamacare.

Reference: “2013 Employer Health Benefits Survey”. The Henry J. Kaiser Family Foundation.

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In 2014, PPO plans remained the most common plan type, enrolling 58% of covered workers.

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In 2012, 93% of businesses with 5,000+ employees and 80% of companies with 1,000-4,999 employees were self-funded

Massachusetts has the third-highest prevalence of self-funded insurance in the small-group market (Fewer than 50 employees).

Reference: “Self-Insured Health Plans: State Variation and Recent Trends by Firm Size”. Employee Benefit Research Institute, Nov 2012, Vol. 33, No. 11.

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In 2013, the average deductible was $2,906 for individuals selecting plans from marketplaces. This compares with average deductibles of $1,135 for an individual with employer coverage.

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In 2013, the average annual premiums for employer-sponsored health insurance are $5,884 for single coverage and $16,351 for family coverage, up 5% and 4% respectively from 2012.

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From 2010 – 2013, cancer followed by chronic/end stage renal disease and leukemia accounted for the top 3 costliest illnesses.

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