October 2017 Volume 19 Issue 10
Providing Current Information on

Health Insurance Industry Issues and Legislation

Vermont Embarks On Another Big Healthcare Experiment
Vermont's single payer healthcare model failed because it was breaking the bank.
Undaunted, the state is launching a plan based on rewarding physicians and
facilities financially when patients are healthy, not just when they are sick. The goal
is to have 70% of insured state residents on the model by 2022 and limit growth in
healthcare spending to 3.5% a year.
Insurers Seek to Link Drug Prices to Outcomes
Costly new specialty drugs are threatening the sustainability of the healthcare
system in the US. It's estimated that emerging treatments could cost the
government nearly $50 billion in the next decade. Insurers are now seeking to link
payment for specialty medicines to control their cost. Some biopharma companies
have signed performance-based pricing contracts in other countries. Will they do
the same in the US?
Little Buys Fueling Healthcare Monopolies
Large doctor practices, many owned by hospitals, now exceed federal guidelines
for market concentration in more than 20% of market studied in the US. In 2015,
hospitals owned 26% of physician practices employing 38% of all physicians; nearly
double the levels just 3 years earlier. Bigger and fewer physician practices are driving
up prices for patients, employers and tax payers.
Reference Based Pricing It's Not for Everyone
If a group is not willing to have its enrollees deal with balance billing, even in
cases where the provider has agreed to accept the group's Medicare multiple
rate as payment in full, then RBP is not for them. However, if the group is willing
to educate its members how to deal with these situations and to provide
support when they occur, RBP makes sense for most groups who want to control
their healthcare spend both short and long-term. If RBP makes sense for your
clients, HHC Group is here to work with you to create the right customized
model, write a rock solid plan and then provide the support your client and its
plan enrollees may need.
THREE STAR PREFERRED PROVIDER PROGRAM ADDITIONS
IGG America, Inc.
Chicago, IL, 60693

Florida Keys Radiology Associates
Marathon Shores, FL 33052

Verralab JA
Louisville, KY 40209

Baptist Medical Center
Jacksonville, FL 32207

MSC Inc. DBA Lymphacare
Montgomeryville, PA

The Therapy Tree LLC
Lake Villa, IL 60046