June 2019 Volume 21 Issue 6
Providing Current Information on

Health Insurance Industry Issues and Legislation

Are Carriers and PPO Networks Becoming Obsolete?
Brokers, consultants and account managers think so. They believe that carriers
and independent PPO networks are no longer saving claim dollars on covered
benefits outside of physician's office visits. In a recent survey 82% said they are
not. What will the new norm for self-funded payers be? Free market approaches
like reference-based pricing and direct contracting could be the answer.

Reference-Based Pricing Part of the Answer
More and more payers are moving away from carriers and independent PPOs
to self-funding and Reference-Based Pricing (RBP). The question is which
RBP company to choose. Which delivers the best value and best meets your
needs? Factors to consider include the ability to write or help write clear and
comprehensive plans, how they handle provider appeals and, very importantly,
how extensive, effective and member friendly their patient advocacy and member
education programs are. HHC Group's RBP program provides these and unmatched customer service, too.

Drugmakers Sued for Generic Drug Price Fixing
A lawsuit filed by over 40 attorneys general accuses drugmakers of widespread
collusion to reduce competition and fix the prices of generic drugs. The suit expands
on one originally filed in 2016. It alleges the impact of illegal arrangements among
the 19 named companies is highly-inflated prices for critical generic drugs causing
harmful and lasting damage to the US healthcare system. The suit names 19
companies and identifies specific drugs that experienced significant increases over a
short period of time.

Physician Compensation Continues to Soar
Increasing demand and an ever growing shortage of physicians are resulting in
skyrocketing compensation for newly hired providers. Between 2017 and 2018 the
medium guaranteed compensation rose most sharply for newly hired emergency
medicine physicians (+40.4%), cardiologists (+21.3%) and urologists (+20.0%). Total
compensation also increased significantly for both established providers and for non-
physician providers as well.

Three Star Preferred Provider Program Additions
High Level Speech Hearing
Harahan, LA 70123

Scott Laffin
Redding, CA 96001

Willis Surgical Center Philadelphia Station
Philadelphia, PA 19145

Michiana Counseling Group OOC
Elkhart, IN 46516

Coshocton County EMS
Coshocton, OH 43812

North Branford Family Chiropractic
North Branford, CT 06471

Lake City Chiropractic Center
Corinth, TX 76208

In Home Health LLC
Fremont, OH 43420

Universal Dermatology PLLC
Fairport, NY 1445

Sarah R. Leverett, PhD.
Spokane, WA 99201

Snap Diagnostics
Wheeling, IL 60090