February 2018 Volume 20 Issue 2
Providing Current Information on

Health Insurance Industry Issues and Legislation

Why We Spend So Much for Healthcare
In 2016, the United States spent $ 3.3 trillion or 17.9% of gross domestic product
(GDP) on healthcare. That's almost twice the percent of GDP of other industrialized
countries. Expenditures for healthcare in the US are growing 66% faster than the
economy as a whole. Prices are a primary driver of the increases, but not the only
cause. Multiple other factors are also driving up America's healthcare spending.
The Many Shapes of Reference-Based Pricing (RBP)
No two groups are the same; nor are their needs. Some RBP companies offer only
one RBP model. HHC Group offers multiple options, so each group can choose the
one that is right for them. Some choose to pay just their qualifying dialysis claims
based on a multiple of the Medicare rate. Some want to use RBP to pay their outof-
networks claims, while others find that paying all their claims or only hospital
or only professional claims using RBP best enables them to achieve their goals.
Whatever they choose, HHC Group makes sure it gets done and done right.
Health Plan Associations A Self-Insurance Opportunity
Under the Affordable Care Act small employers in the small group health insurance
market have faced rapidly rising costs. In part, that's because plans must include
essential benefits and community rating. A proposed regulation from the
Department of Labor would make it easier for small employers and even individuals
to join Association Health Plans.
Bundled Payments Win. Win. Win. But Not So Easy
Bundled Payments, fixed price payments based on episodes of care, can reduce
payor costs, are increasing provider profits and improving patient care. ORC
International projects the use of bundling will grow from 11% to 17% of all
healthcare payments over the next five years. The trick will be figuring out the
methodologies for calculating the right amount to charge. That is turning out to
be not so easy.
Three Star Preferred Provider Program Additions
Pathology Associates of Valdosta
Valdosta, GA 31602

Jackson General Hospital
Ripley, WVA 25271

Align Networks, Inc.
Atlanta, GA 30348

IA Methodist Medical Center
Des Moines, IA 50309

Dr. Joseph McCormack PHD
Jefferson City, MO 65101

Palm Garden Dialysis Center
Brooklyn, NY 11218

Ora Orthopedics PC
Bettendorf, IA 52722

Timothy Campbell
Pittsburgh, PA 15219