May 2019 Volume 21 Issue 5
Providing Current Information on

Health Insurance Industry Issues and Legislation

Best-in-Class Employers Take a Different Approach to Benefits Management
Best-in-class employers manage their employee benefits programs differently that
other companies. They make employee healthcare one of their highest priorities.
They use a variety of tactics to lower pharmaceutical costs and incentivize their
employees to take an active role in programs to establish and maintain good
health habits. They create and implement solutions ranging from limiting the
number of medical plan options they offer to self-insuring to switching to RBP
model plans.
N.C. RBP Plan in Trouble
The North Carolina treasurer's strategy to use a Reference Based Pricing (RBP)
model to save the state employee health program may be in trouble. Unless
changes are made to the current program the state will run out of money to fund
it in 5 years. Converting to a RBP based payment model would solve the problem,
potentially saving North Carolina taxpayers and workers hundreds of millions of
dollars. Still, state legislators are moving to block implementation of the switch
to RBP. House Bill 184 would prevent the state health plan from converting to RBP
until at least 2021. The bill has passed the House and is now being reviewed by the
Rules and Operations committee in the Senate.
RBP It's not for Everybody
RBP may not be right for North Carolina's employees and it may not be right for
certain other types of groups. A good RBP company will help you make that critical
determination. When RBP does make sense, the question becomes which RBP
company delivers the best value and best meets your needs. Factors to consider
include their 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.
Hospital Prices Keep Rising Who is to Blame?
The cost of an average in-patient hospital stay increased by 36% from 2008 to 2017
and is continuing to rise faster than the rate of inflation. Why do hospital prices keep
climbing and what can be done to rein them in? The hospitals blame the insurance and
pharmaceutical companies. The insurers blame the hospitals. Physicians feel managing
costs is management's responsibility. The pharmaceutical industry and group
purchasing organizations say they are blameless and that the hospitals are increasing
prices to increase profits.
You Better Shop Around
The healthcare industry is truly unique. Prices for services vary wildly between
markets and within markets. People rarely know what they are going to pay ahead
of time. Take a basic metabolic blood panel. In the Miami metropolitan area the price
ranges from $149 to $725 depending on where the test is done and who is paying;
the cost in Baltimore $22 to $37. According to the Healthcare Cost Institute, the cost
of a C-section in the top 20 metropolitan areas ranges from $7.5K in Louisville
to $24.2K in San Francisco.
Three Star Preferred Provider Program Additions
Premier Surgery Center of Pittsburgh, LLC
Wexford, PA 15090

Saint Clare Surgery Center
Stow, OH 44224

Summa emergency Associates
Uniontown, OH 44685

N. E. O. Urology Associates, In.
Boardman, OH 44512

Sullivan County Internal Medicine
Shelburn, IN 47879

Liones Labs LLC
Coral Springs, FL 33065

University of Maryland Medicail
Boston, MA 02241

CV Medical Services, LLC
Beachwood, OH 44122

Western Reserve Eye Associates
Streetsboro, OH 44241

Wilmington Medical Supply
Willington, NC 28405

Johnson Chiropractic
Warsaw, IN 46580

Scott LaFein
Redding, CA 96001